CARE HOME ADULTS 18-65
Palmwood Court Care Home 14/17 Palmwood Court, Highbury Vale Bulwell Nottingham NG6 9BZ Lead Inspector
Joanna Carrington Unannounced Inspection 8th December 2005 09:30 Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 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 Palmwood Court Care Home DS0000002238.V268848.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 Adults 18-65. 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. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Palmwood Court Care Home Address 14/17 Palmwood Court, Highbury Vale Bulwell Nottingham NG6 9BZ 0115 916 9334 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) myronneh@ncha.org.uk Nottingham Community Housing Association Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To allow one named service user of 67 years of age to reside at Palmwood Court 20th June 2005 Date of last inspection Brief Description of the Service: 14 / 17 Palmwood Court is a purpose built care home registered to provide personal support and accomodation for up to twelve adults with a mental health difficulty. There are three bungalows in total each accomodating four residents with one bungalow being all female and another being all male. There is another bungalow for the admin office and staffroom and a communal lounge for all residents and staff to come together. Each bungalow has its own kitchen and bathroom facilites as well as a private garden that residents are actively encouraged to maintain. The home is located in a quiet cul-de-sac in the residential area of Bulwell and is close to local amenities and bus routes into Nottingham City Centre. Palmwood Court Care Home DS0000002238.V268848.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 over four hours on the 8th December 2005. This was the home’s second statutory unannounced inspection for this inspection / financial year. The purpose of the inspection was to follow up any issues from the last inspection and to inspect remaining key standards that must be assessed at least once over a one-year period. Therefore, this report should be read in conjunction with the previous report. The main method of inspection was called ‘case tracking’ which meant selecting three tenants and tracking the care they receive through checking their records, discussion with staff and observation of care practices. All of the tenants available on the day of the inspection chose not to speak with the inspector. A partial tour of the premises was undertaken and staff records were also looked at. Altogether three members of staff were spoken with and the manager and deputy manager were available for discussion and feedback throughout the majority of the inspection. What the service does well:
The manager and staff spoken with continue being committed to their work and to the support they provide to the people that live at Palmwood Court. It is evident that ‘social inclusion’ is the underpinning ethos of the home and the rights of clients are respected and promoted. There are excellent links with the local community and staff were observed interacting with clients in a meaningful and respectful manner. Clients do not move to the home until their needs are assessed and there are good links with relevant professionals to ensure that the needs of residents are being appropriately met. Risk assessments are used well, to identify any necessary measures for promoting the safety and independence of clients. Staff understand their role and responsibilities in protecting clients from abuse and the Nottinghamshire Protection of Vulnerable Adults Policy and Procedures are appropriately adhered to. The views of clients are listened to, with regular client meetings as well as monthly visits from an advocacy group. Nottinghamshire Housing Association carry out an annual quality audit, which helps to ensure that the quality of care is of a good standard. Staff are well trained at the home, which enables staff to meet the collective and individual needs of clients. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 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. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective clients do not move to the home until their needs are assessed. EVIDENCE: For the clients that were case tracked all of have a copy of their Health and Community Care Assessment retained on their file. This assessment is essential for determining whether the home is appropriate to meeting their individual needs and then forms the basis for support plans. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Improving consultation with clients’ over their support plans is still required. Clients are supported to take risks as part of an independent lifestyle. EVIDENCE: At the last inspection it was noted that while current support plans are only held on computer then this restricts access to clients and also proves difficult in enabling consultation with individuals over the development and review of their support plans, which is a requirement in accordance with the Care Home Regulations. As yet, this requirement has not been met and is therefore outstanding. The Nottingham Community Housing Association (NCHA) policy for the SuRe System is that current care plans are printed off, which can then be signed by tenants, to evidence that consultation has taken place, and so that clients can have the choice to retain copies of their support plans themselves. The manager reported that in the new-year some work is being undertaken to ensure that the above system can be implemented. A fourth qualified nurse has been employed, who will also act as key-worker to clients. The aim is for clients to keep their support plans with their service user guides. It was evident from both discussion with staff and from the written risk assessments seen that clients are supported to take appropriate and managed risks in order to retain their independence and quality of life. There have recently been some problems with youths in the local community, which has
Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 10 resulted in the safety of tenants being put at serious risk. Appropriate measures have been put in place to promote the safety of all clients and all relevant parties such as the police, local neighbourhood have been involved. One client case tracked who is relatively new to the home requires support plans and risk assessments for managing his finances and with his cigarettes, (particularly when restrictions need imposing) as records seen indicate that he is not able to manage these independently, and is at risk of exploitation. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 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 17 Excellent links with the community continue and clients’ rights and responsibilities are respected and upheld. Without a detailed record of meals provided being kept then it is not possible to confirm whether residents are offered a healthy and varied diet. Improved facilities for the preparation of meals is required. EVIDENCE: ‘Social inclusion’ is promoted for all the clients living at Palmwood Court’ which means supporting tenants to access community amenities such as the library, restaurants and cinema and taking a proactive approach in educating the local community about mental health. The manager reported that some work is being undertaken with the local schools and the newsletter which tenants are involved in continues. Staff were observed interacting with clients in a meaningful and respectful manner and it was also evident from discussion with staff, and from the content of support plans and risk assessments that the rights of clients are acknowledged and respected at all times. Clients have unrestricted access to the home and can choose when they wish to spend time alone or be in the company of others.
Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 12 Palmwood Court is divided into three separate bungalows, all of which have their own facilities including lounge and kitchen. In one of the bungalows currently the kitchen facilities are totally inadequate. The Environmental Health Authority condemned the fridge / freezer so this is not in use and the oven and hob are also out of order. The main meal for all tenants is prepared centrally, but for tenants living in this bungalow no food can be safely stored there and there are no facilities to prepare snacks or be assisted to cook meals. The manager reported that it has been like this for over two months now, despite informing the appropriate department and requesting the installation of new equipment. Staff spoken with explained how the clients are consulted over the menu planning and their meal preferences. In the last couple of weeks there were at least seven days when there has been no record made of what meals have been provided and where there is an entry it does not state whether vegetables have been offered with that meal. When there is a buffet on then it needs to specify what buffet food was available, especially in case of food poisoning. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 and 20 No progress has been made with developing support plans for clients that require assistance with personal hygiene. Some further improvements to the administration and recording of medication is required. EVIDENCE: A requirement was set at the last inspection to add more information on support plans that identify a need with personal support / hygiene. Staff spoken with confirmed that in one bungalow, all of the clients need some level of assistance and all are supervised when bathing. Support plans are still required, to ensure individuals’ preferences are acknowledged and respected, that there is consistency with support and so that any changes in needs can be identified. On inspecting the Medication Administration Records in one bungalow it was observed on one day a number of gaps where medication administration should have been signed for. As soon as gaps on MAR records are seen then staff must check whether this dose has been administered and if not, follow necessary procedure. Given that there was unexplained gaps on MAR records at the last inspection it is recommended that the home’s procedure in case of a missed dose, or any other error is included with MAR records for staff to have immediate access to.
Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Clients’ views are listened to and acted on although there have been no complaints as such according to records under the Complaints Procedure. Staff are aware of their role and responsibilities in accordance with local adult protection procedures, which assures residents that they will be protected from abuse. EVIDENCE: There is an appropriate complaints procedure, which is displayed on notice boards and included in the Service User Guide. It is apparent from discussion with staff and from minutes of clients meetings that they are involved in the day to day running of the home and that the views of clients are listened to and acted on. However, there are no records of concerns or complaints under the Complaints Procedure, which when referring to this record suggests that no concerns or complaints are ever made. The recent assaults on clients by youths in the local neighbourhood have been followed up appropriately using the Protection of Vulnerable Adults Policy and Procedures. The Adult Protection Unit and the police have been notified and necessary action is currently being taken. Staff spoken with demonstrated an understanding of their role and responsibilities when protecting clients from abuse and the Policy File is available for all staff to access. Money that is held on behalf of clients is kept separately and held securely. Three clients monies were looked at and all appeared to be in order, with clear records of transactions, which tallied with receipts and totals. Clients sign when they receive their own money. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The home is kept clean and hygienic. EVIDENCE: It was evident from touring the premises that the home is kept clean and hygienic. There is a domestic member of staff during the week and staff spoken with feel that cleanliness is well maintained throughout the home. Clients are encouraged to take some responsibility for keeping their bungalow tidy and maintaining their independence. Laundry facilities can be used by clients and are suitable to meeting their needs. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 Staff files in future need to be made available for inspection, otherwise it cannot be ascertained whether recruitment practices protect clients. Clients’ needs are met by appropriately trained staff, but tenants will also benefit once supervision sessions are up and running for all staff. EVIDENCE: Staff files containing copies of references and Criminal Record Bureau disclosure are held centrally with the Nottinghamshire Healthcare Trust therefore at the time of the inspection it was not possible to access these files, which is necessary for checking that safe recruitment practices are being followed. If this information is not available at the home then there needs to be internal arrangements in place to ensure that these files can be made available for inspection. All staff spoken with confirmed that training opportunities are good, with a brochure of training provided by the Healthcare Trust they can then choose what courses they feel would be of benefit, for example, cultural awareness and death and bereavement. Training records also show that all staff attend annual mandatory training updates including Food Hygiene, Moving and Handling, First Aid and Fire Awareness. The home’s Project Strategy identifies the importance of regular supervision sessions for staff as a means for staff to reflect on their practice. Although staff spoken with feel that they are well supported, staff files looked at show that supervision sessions have not taken place at all in 2005.
Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 There are systems in place for monitoring and reviewing the quality of care which seeks the views of clients. EVIDENCE: The manager reported that service user surveys were recently sent out to all clients, with the support of staff but none were returned. It is evident, however, from looking at the minutes of clients’ meetings (held monthly) that the views of clients are taken seriously and where possible, underpin any changes to the service. Also every month an advocacy group called ‘Making Waves’ visit clients at the home, to discuss their support and any other issues affecting them. Nottingham Community Housing Association also does an annual quality audit, last one being in June 2005. Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 4 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Palmwood Court Care Home Score 2 X 2 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X X DS0000002238.V268848.R01.S.doc Version 5.0 Page 19 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 YA6 Regulation 15 Requirement Timescale for action 31/01/06 2. YA9YA6 15 3. YA17 16(2)(i) 4. YA17 16(2)(h) Ensure that clients are consulted on the development and review of their care plans and that there is a system in place that enables this consultaiton process and which can be evidenced. (This is an outstanding requirement from the previous inspection, initial timescale 31/08/05 not met) Develop support plans and 28/02/06 accompalnying risk assessments for the named resident for support with managing cigarettes and finances. Ensure that tenants are supplied 31/01/06 with nutritious, varied and balanced meals and that in accordance with Schedule 4 keep a record of food provided for service users in sufficient detail to enable any person inspecting the record to determine whether meals are as stated above. Replace fridge / freezer and oven 31/01/06 / hob in named bungalow, to ensure that all kitchens have adequate facilities for service users to store and prepare their own food and that such faciltiies
DS0000002238.V268848.R01.S.doc Version 5.0 Palmwood Court Care Home Page 20 are safe for use. 5. YA18 15 When a service user requires some level of assistance with personal care rather than simply identifying this on a support plan there must be enough detail on how that need is to be met. (This is an outstanding requirement from the previous inspection, initial timescale 31/08/05 not met.) Ensure there are suitable arrangements are in place for the safe administration and recording of medicines, with particular attention to what appropriate action is required of staff when gaps on Medication Administration Records are identified. (This is an oustanding requirement from the previous inspection.) Ensure that there are internal arrangements in place so that staff files are made available for inspection. Ensure staff are appropriately supervised. 31/01/06 6. YA20 13(2) 08/12/05 7. YA34 17(3)(b) 31/01/06 8. YA36 18 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Palmwood Court Care Home DS0000002238.V268848.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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