Inspection on 22/11/05 for Park Farm Lodge Care Home

This inspection was carried out on 22nd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Park Farm Lodge Care Home 12/09/07

Park Farm Lodge Care Home 31/05/06

Park Farm Lodge Care Home 27/06/05

Park Farm Lodge Care Home 25/01/05

Park Farm Lodge Care Home 08/06/04

Park Farm Lodge Care Home 19/11/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Park Farm Lodge Care Home Park Farm Road Tamworth Staffordshire B77 1DX Lead Inspector Mrs Sue Mullin and Mr Peter Dawson Announced Inspection 22 November 2005 9:45am 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 Park Farm Lodge Care Home DS0000045160.V263455.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. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Park Farm Lodge Care Home Address Park Farm Road Tamworth Staffordshire B77 1DX 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) 01827 280533 01827 288544 Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Laura Ann McCormick Care Home 80 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 40 Dementia (DE) - Minimum age 60 years on admission Date of last inspection 27th June 2005 Brief Description of the Service: This is a purpose built care home with nursing which can accommodate 80 service users in the above categories. The home is situated on the outskirts of Tamworth and there is a bus stop outside the main entrance, facilitating easy access for visitors.Local towns are accessible by car or public transport.There are two levels, which can be accessed by lifts or stairs. There are wide corridors with grab rails fitted throughout the building. The gardens are accessible by wheelchairs and are well maintained, appropriate seating facilities are provided.There is adequate communal space for service users and all bedrooms are single occupancy with en suite facilities, they are in excess of 10 sq. m of useable space required. Bathrooms and toilets are appropriately situated and bathroom and toilet doors are painted in alternative colours, which assists service users in locating them.The interior of the property is well maintained; clean and the décor is set to a good standard.Communal areas are spacious and comfortable.Small, quieter sitting areas are available on both floorsAdequate parking is available to the front and side of the property. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspection officers undertook this announced inspection over a period of one day. The home is divided into two separate units: the ground floor, which provides general nursing care and the first floor, which provides nursing care for people suffering from dementia. For ease of reading and reviewing the findings of the inspection, throughout the majority of the report, each unit is referred to individually. Moorcroft unit is a 40-bedded EMI section. Registration is for dementia care only; there is no registration for mental disorder. At the time of the inspection there were 38 people in residence, 33 assessed as requiring nursing care. There were two vacancies but there is a small waiting list. The unit is divided into two groups for care purposes. There are keypad locks for safety on all entrances/exits. The two units divide with keypad locks. Residents are free to wander and several do so, safely. Downstairs there is a 40- bedded General section and at the time of the inspection, staff were providing general nursing care to 31 people and personal care only to 4 residential people. There were 5 vacancies. The home has a registered care manager in place and on both floors there are unit managers in place. All three managers are first level nurses and were supernumerary for the whole of the inspection and provided valuable and knowledgeable information and assistance throughout. The regional manager, also a first level nurse was present throughout the day and took an active part in the inspection process. Not all of the National Minimum standards were examined on both floors during this inspection, as they had been assessed at the previous inspection this year. Relatives spoken to during the inspection made very positive comments about the care provided at Park Farm Lodge. However, some written feedback forms from relatives and residents to the Commission, indicated that improvements could be made in the provision of food, staffing and activities. Some felt that they could be better informed about care issues. These issues were concentrated upon during the inspection and both inspectors felt that minimum staffing levels were maintained at all times, however, as the staff now double up in pairs to provide care particularly on the EMI unit, it may appear to some people that there are less staff available. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 6 This was discussed at length during the inspection and the management have confirmed that they are seeking further statistics to determine the impact this staffing system has on the provision of care and staff availability. The Commssion will monitor this on an on going basis. The provision, choice and quality of food was checked and all relatives and residents spoken to confirmed their satisfaction. Activities provided in the home were also determined and it appeared that some residents and relatives felt that any 1: 1 time spent with a resident and the activity coordinator, did not constitute as ‘activites’. However, such sessions were very much enjoyed and formed part of the leisure programme within the home. In relation to good effective communication to relatives when there are any changes in a resident’s physical or mental condition, this continues to be developed in the home. The home strive to include all relatives in the care planning process and this is evident in many of the care plans examined and also confirmed by talking to visiting relatives on the day of the inspection. What the service does well: What has improved since the last inspection? There is a new Clinical nurse Manager on the EMI unit. She is a registered mental nurse has considerable experience in previous EMI settings. Focus is on meeting the needs of a very dependent and at times challenging client group. The needs of residents are actively identified and any problems observed are acted upon. Action plans have been implemented to meet those needs, long and short-term care plans drawn up and these are reviewed regularly. Recording incidents on the EMI unit has improved greatly and documentation provided to the Commission is more detailed and comprehensive. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 7 Gradually the manager and staff are able to compile an analysis of any incidents and events occurring on the unit, identifying any trends or triggers, which may affect the mental status of residents in their care. Medication processes have been completely reviewed and new robust systems are in place to ensure that all medication received in to the home is received, stored and administered fully in line with NMC requirements. New systems have also been introduced, for the disposal of medication from nursing homes in accordance with recent legislation. 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. Park Farm Lodge Care Home DS0000045160.V263455.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 Park Farm Lodge Care Home DS0000045160.V263455.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): 3,4, Residents receive a thorough assessment of their needs prior to them moving into the home. EVIDENCE: EMI A recently admitted gentleman had settled well into the home and staff had been helpful and supportive during this period. They had no complaints or concerns about the care provided at Park Farm Lodge. Pre-admission procedures had included visits to the home by relatives. A pre-admission assessment had been carried out by the home also prior to admission. The individual files of two residents were seen, both of the files showed that there had been a thorough assessment of residents needs undertaken prior to admission. Community Care Assessments (where applicable) are undertaken by the Social Services Department prior to the referral being made. Park Farm Lodge Care Home DS0000045160.V263455.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): 7,8,9,10 The home has the individual needs of each resident at heart, and appropriate care is provided to meet those needs in a way that residents like. This ensures that they feel safe living at Park Farm Lodge and confident in the staff. EVIDENCE: EMI Care plans contain the required comprehensive information to provide care. Sample records were seen and contained good examples of pre-admission assessments adequately completed to make an assessment of need. There were examples of good social histories completed by relatives wherever possible or staff if no relative available. Care plans are generally signed by residents/relatives. Care plans are reviewed on a monthly basis. Nutritional/Waterlow assessments were in place and risk assessments relating to falls and other resident activity were well documented in care planning information. All reviewed with care planning information on a monthly basis. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 11 Several residents required total care some are bedfast. Some require tissue viability management, which was not discussed/records seen on this visit. These had been found to be adequately managed on the last inspection. Health care records recorded all chronological interventions by health care professionals. Daily notes are completed for all residents for each staff shift. Records seen were to a good professional standard. All residents have a 24-hour care chart, which carers complete to indicate personal care provided and diet and fluid indicators. Where there are concerns about weight loss and to ensure good hydration, fluid/food intake charts are established with detailed recording. In relation to a resident reviewed as part of the inspection process, there had been severe weight loss (6 stones 4 lbs currently) but the person was still being weighed monthly, which was the homes normal routine. It is a requirement of this report that where there are concerns about weight loss residents must be weighed weekly to closely monitor any changes. The fluid intake monitoring of this resident showed intake was below the required daily minimum. The home will check that recording is accurate and the matter addressed possibly with the help of a visiting daily relative. It was found that drinks were not available in the person’s bedroom; this will be remedied by the home. It is required that where there are concerns about fluid intake – drinks are constantly readily available in bedrooms and in the lounge areas to ensure maximum opportunity for fluid intake. There are several current residents with behaviour management needs. This includes physical aggression towards both residents and staff. In relation to the most severe instance, which was discussed – the home have taken the appropriate steps to involve the GP, CPN, Consultant Psychiatrist and Social Worker. Medication has been reviewed, changed and increased upon the initiation of the home. There has been 1:1 staff input at crucial times of behavioural difficulties. The home has managed this situation very well but the person still presents some risk to other vulnerable residents and may ultimately, have to concede that his needs cannot be met in this setting. The home are acutely aware of the risks to other people in this situation. There was a requirement of the last report to provide training for staff on the EMI unit with training in the Management of Violence & Aggression. Ten staff from the home have since completed a 2 day external course on this training. A relative prepared a documentation of events he had brought to the attention of the home over the past year. The relative was seen by the Inspector and discussed in detail his previous concerns. These related to falls, personal care, provision of bed guards, restraint safety, continence care etc. The relative ultimately indicated that in all matters raised, he had been listened to and all issues been adequately addressed. The point the gentleman was raising was that he is a daily visitor and has the opportunity to closely monitor care and raise his concerns. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 12 Bed guards are always subject to risk assessment, discussed with relatives who sign consents. A request for restraint in the instance mentioned above to ensure the safety of the person whilst sitting in lounge chair or wheelchair was discussed by the home with relevant professionals and put into place with signed request/consent from the relative. The Occupational Therapist is to visit and offer further advice. The safety of the resident has been the paramount consideration and the actions appropriate. General Unit The individual care plans showed that their care needs relating to health, personal and social care had been appropriately recorded. The care plans have individual plans of care for addressing assessed needs, covering all aspects of care required by the individual resident. Records showed that the care plans are reviewed on a monthly basis. The care plans have sections to record all health professional appointments, such as GP visits, District Nurse, chiropody, dental, ophthalmic etc. These were completed following visits. The daily contact sheets also recorded how each person was each day, and there was an audit trail to show if someone was not well that the GP had been contacted. Discussions with the residents evidenced that they consider that their health needs are well met by the home. Residents were complimentary about the home and the staff and the way that they are treated. Several residents have lived at the home for a number of years now, and each said that the staff continue to treat them well, that they are on hand if required but allow each person their privacy and opportunity to be as independent as they can. A staff member was asked about the care practices in the home, and it was clear that she had a good understanding of the needs of the residents and how to uphold their privacy and dignity Medication was inspected on the EMI unit. Medication processes have been completely reviewed and new robust systems are in place to ensure that all medication received in to the home is received, stored and administered fully in line with NMC requirements. New systems have also been introduced, for the disposal of medication from nursing homes in accordance with recent legislation. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 13 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): 12,13,14,15 Residents choose the pattern of their day and the lifestyle that they wish, having a range of activities provided that they choose according to their own tastes. They are encouraged to retain control over their lives and to accept visitors as they please, and they enjoy their meals and mealtimes. The attention to individual choice paid by the home means that the residents are contented with their lives at Park Farm Lodge. EVIDENCE: EMI There are a range of activities provided by the Activities Co-ordinator who provides activities in small group or 1:1 situations. These are necessary and appropriate for this resident group with limited concentration spans and recall. External activities are very limited due to the high dependency needs of residents and staffing implications. There is a safe enclosed garden area where residents who have a propensity to wander can do so. Unfortunately the EMI unit is on the first floor restricting immediate access and having implications for staffing if the area is used – in theory a good facility – in practice – not practicable due to location and staff time. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 14 One visitor has drawn attention to this matter; fortunately she was able to use the facility with her relative. The home may not wish to consider the rearrangement of the two units to allow easy access. Previously the EMI unit occupied space on two floors allowing garden access. There is an open visiting policy. Visitors were seen arriving and moving comfortably and freely around the home. Some seeing their relatives in the lounge areas, other in bedroom areas providing privacy as they wished. There are two dining areas – the unit is divided into two separately staffed areas. The dining areas are adequate for the needs of residents. There was an unhurried mid-day meal observed, served by care staff. A number of residents require staff assistance with eating and this was done in a sensitive way, there was no time limit and some residents seen still at the dining tables long after most people had finished eating. Some residents had meals in bedrooms because of high dependency needs and other seen to have the miday meal in the lounge area supported by staff or some seen to be assisted by visiting relatives. General Unit All of the residents spoken with said that they enjoyed their lifestyle in the home and that they could make their own choices about how they conducted their day. In discussion residents confirmed that they got up in the morning when they wanted, that breakfast was flexible and that they all went to bed at different times depending on their preference. All spoken with confirmed that they could receive visitors at any time. A visitor told the inspector that he was always made most welcome. Another resident and his wife, who was visiting on this occasion, chose to sit in their bedroom for some privacy. Residents, relatives and staff spoken to all stated that the food is good. The inspector noted that residents enjoyed their hot evening meal during the inspection, which looked appetising and nutritious. At Park Farm lodge the kitchen staff provide a variety of cooked breakfasts each day and as such on 5 days a week produces their hot main meal in the evenings. Twice a week the hot meal is served at lunchtime. Residents confirmed that there was always a choice provided. The menu records were not inspected at this visit, but they have been seen on every other occasion and have always showed a good variety of well-balanced food. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 15 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): 16,18 The home has procedures in place to respond to complaints. This means that residents and relatives can be confident in management and know that should they have any concerns that they will be dealt with promptly and appropriately. The home also has policies and procedures on reporting any allegation of abuse. The management in the home are currently focusing on situations where there is any unexplained injury, particularly occurring on the EMI unit. This is being undertaken in an open positive way, with the involvement of the Commission. The home is in the process of updating all staff in the theory and practical methods of moving and handling residents, to maximise residents comfort when undertaking personal care duties. EVIDENCE: There is a complaints procedure in the reception area of the home, which is clear and concise and meets the requirements of Regulation 22. EMI Several complaints have been received by the Commission and have been investigated. A complaint relating to care practices and delivery is currently being investigated. A matter is currently being investigated under the Adult Protection procedures. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 16 Some residents have sustained unexplained bruising in the home and these were reviewed during this inspection. Potential causes may be falls, or handling issues relating to resistance to care. The new Clinical Manager is monitoring recording and reporting these matters to the Commission. All instances are being reviewed on an ongoing basis. It is very important that all staff have training in Moving & Handling techniques and appropriate updating training. Relatives spoken to during the inspection made very positive comments about the care provided at Park Farm Lodge. Some written feedback forms from relatives to the Commission indicated that improvements could be made in areas of food, staffing and activities. Some felt that they could be better informed about care issues. The importance of listening to matters raised at an early stage by relatives was discussed with Managers and the action required to address matters at that stage. This may avoid later more serious complaints. The importance of all relatives knowing the names of named nurses/key worker may be important to ensure that relatives known who to speak to about their concerns. This list has recently been revised and the home intends to write to all relatives informing them of the names and functions of the key staff involved. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 17 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): 19,20,21,23,24,25,26 The home is very clean, pleasantly decorated and well equipped and residents can enjoy their surroundings. There were two areas of concern one internally and one externally that did not fully ensure residents safety. EVIDENCE: EMI There is a good standard environment. All bedrooms are for single use and all have en-suite facilities. The home is generally bright and spacious with wide corridor areas, adequate lounge and dining facilities. There are two bathrooms with assisted facility and two shower rooms on the unit providing excellent bathing facilities. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 18 The shower rooms are spacious and have excellent walk-in facility. There are folding low doors fitted to the entrance to the shower area. A requirement was made at the time of the last inspection to repair/replace the doors to a shower area. This has not been done and it was noted on this visit that the doors on both shower areas are defective presenting a potential hazard. Discussion with the Manager agreed that the doors may be removed to ensure safety. Their purpose is not to protect dignity/privacy. A sample of bedrooms were seen to provide good accommodation, adequately furnished and equipped and they were well personalised reflecting the individuality of residents. An important provision for this client group. All bedrooms were clean with high standards of hygiene and adequate cleaning routines in place. There is a high incidence of continence management required in this unit by definition. Some continence issues relate to behavioural matters and present even greater problems of odour control management. Domestic staff were seen to be carrying out regular cleaning of particular areas and deep-cleaning of some bedroom and lounge areas to ensure an odour-free environment. At the time of the last inspection 3 bedrooms were made subject to requirements to replace the floor-coverings due to mal-odours. This has been done with new flooring provided. No mal-odours were evident during this inspection. A requirement to remove items from the sluice areas was made in the last report. On this visit there were several items still stored in sluice areas. These must be removed in the interests of infection control. General Unit The ground floor presents as a very comfortable, pleasant home in which to live. A full tour of the home was not undertaken at this visit. However, communal areas were bright, warm and comfortable. The general décor was very pleasant as were the fixtures and fittings, with comfortable lounge chairs that met the needs of the residents, and well-equipped and pleasant dining rooms. Several resident’s bedrooms were seen and found to be homely and personalised with private possessions. With the exception of the hallway, all carpets and floor coverings were appropriate. (The hallway carpet was being replaced the day following the inspection; confirmation of this was given in the presence of the inspectors). It was observed throughout the visit that all parts of the ground floor seen were clean and hygienic. The inspector was engaged in conversation with a relative, who shared his concerns with the layout and up keep of the secure garden area in the middle of the home. A tour of this area was undertaken and it was noted that some of the paving stones had shifted causing some unevenness and was a trip hazard. The gardens and shrubs were also in need of some attention. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 19 This was discussed with the management at the feedback of the inspection and it was determined that due to the Company not securing a contractual agreement on the up keep of the grounds, these had been maintained on an ad hoc basis. The maintenance man who works 40 hours a week had been attempting to undertake some of the gardening work, but had been off sick for some time and as a result this had compounded the situation. The care manager confirmed that some residents and relatives had made remarks about the condition of the gardens and these concerns had been relayed to the regional manager, who had taken up the issue with the company but this had not yet been resolved. A requirement has been made to ensure that all external areas are maintained in a safe and tidy manner. This will be checked on the next inspection. The home provides adequate space for car parking. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 20 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): 27,28,30 The home maintains the minimum levels of care staff. Ancillary staff are adequate to meet the needs of the residents. Training programmes continue and are an ongoing practice in the home. EVIDENCE: Both nursing floors as staffed in the same way as follows: 8am – 2pm early shift = Two qualified nurses and six care staff 2pm – 8pm late shift = One qualified nurse and six care staff 8pm – 8am night shift = One qualified nurse and three care staff These are the required minimum staffing numbers required and comply with the staffing notice issued prior to 2002. The care manager is fully supernumerary in a full time post and both unit managers have 6 hours supernumerary time per week. The catering, domestic and laundry hours were determined and found to be appropriate for the size of the home and the needs of the residents. The home have an activity organiser for 30 hours per week. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 21 The home also has a full time administrator and 40 hours allocated to maintenance cover. (The maintenance man has been on sick leave for some weeks and currently the home have been receiving a half-day a week in this role). EMI Unit At the time of the last inspection it was noted that there was no RMN trained nurse at nighttime. The Manager reported that efforts were being made to provide at least some RMN care at nighttime. This situation must be made clear in the statement of purpose. There are many high dependency residents on this unit and the presence of several residents presenting challenging behaviours has implications for staffing levels. It was noted that at one time 1: 1 staffing was provided for a particular resident. Staffing inputs need to be constantly reviewed in the light of changing dependency levels. Staff were observed to provide care in a sensitive and professional way. A resident who struck another resident was seen to be appropriately dealt with by swift diversion of interest and removal to another area, in a very caring and appropriate way. Staff remained calm and reassuring but quickly diffused the situation in an excellent way. There has been staff training in the management of violence and aggression as required in the last report. Most staff on this unit have taken advantage of this training, others may need to be persuaded. POVA training has also been delivered to the majority of staff. Moving & Handling training, including updates are required urgently on this unit as mentioned previously in another section of the report. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 22 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): 31,32,33,38 Due to the lack of manual handling, fire training and health and safety checks not being fully up to date, this could potentially put residents at risk of harm. However, management have assured the inspectors that these shortfalls will be rectified in the very near future and written confirmation will be provided to the Commission. EVIDENCE: EMI There is a new Clinical nurse Manager on the EMI unit. She has considerable experience in similar relevant settings. She showed a depth of knowledge of the needs of residents and is closely monitoring those areas of care and practice highlighted in complaints and arising from feedback from relatives. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 23 She shows a level of competence and concern to monitor the overall dependency levels of the unit, in particular the challenging behaviours of some residents, which may put other residents at risk. She has made changes in the reporting of clinical issues and established a reporting/monitoring role where there are concerns about health care needs, which require immediate and/or ongoing interventions. This unit has been without an appointed Unit Manager for sometime and the impression is that some issues have been allowed to drift. The new appointment is providing a positive lead and focus upon areas of concern expressed by relatives and of concern to the Commission. A requirement to provide a first-aid trained person on duty at all times has not been addressed. The Registered Manager will now take the appropriate action. Maintenance record and health and safety issues Records seen and approved on the day of the inspection include; • Waste transfer confirmation • Nurse call service reports • Legionalla testing • Fire extinguisher test • Hoist service reports • Gas servicing certificate • Lift service report (including dumb waiter) • Portable appliance testing The nurse call system used in the home is sounded on both floors despite which floor it is activated. This has caused some concerns in that residents may be disturbed unnecessarily, with constant buzzers being sounded and secondly it can give the impression that no one is answering the buzzers. This was discussed at previous inspections and the home has confirmed that this system cannot be altered to work independently on two separate floors. The accident records were discussed and the inspectors were impressed with homes philosophy on the importance of maintaining comprehensive individual records of accidents/incidents. An analysis was currently being undertaken and any trends noted. All substances hazardous to health were stored correctly and information on COSHH data sheets was on display. Domestic staff spoken confirmed that they had received training in this area. Moving and handling and fire training records were examined in detail and it was determined that several members of care staff have not received yearly updates. This must be rectified as soon as practicably possible. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 24 Unfortunately the maintenance man has been off sick for some time and worked a 40-hour week. The company had only provided a half-day cover in his absence this had had resulted in a lapse of weekly fire alarm testing, emergency lighting testing and contravened the fire authorities regulations. The care manager had been under the impression that the hot water tests had been undertaken, however confirmation was given by the part time handy man that he had not undertaken such tests for the previous month and this was further evidenced in the gaps on the documents seen on the inspection. Requirements were made for these tests to be commenced with immediate effect. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 25 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 X X 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 2 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 X 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 1 Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 26 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 8 Regulation 12(1)(a) Requirement Where there are concerns about weight loss residents must be weighed weekly to adequately monitor progress. Drinks (cold) should be constantly available to all residents in bedrooms and communal areas but particularly where fluid intake is being monitored. All staff must receive moving and handling training as a matter of urgency. Updating training must also be provided for staff. All staff must receive yearly fire training The housing in both shower areas on EMI to be repaired/replaced/removed to ensure safety. (Previous timescale not met) Remove items stored in the sluice area on EMI in the interests of infection control. (Previous timescale not met) A first aid trained person must be on duty at all times. (Previous timescale not met) DS0000045160.V263455.R01.S.doc Timescale for action 22/11/05 2 38 13(5) 23(4)(d) 01/12/05 3 21 13(4)(a) 10/12/05 4 26 13(3) 22/11/05 5 38 13(4)(c) 22/01/06 Park Farm Lodge Care Home Version 5.0 Page 27 6 19 23(2)(o) 7 38 23(4)(c) (v) 13(4)(a) The responsible individual must 22/01/06 ensure that all external areas are maintained in a safe and tidy manner. The home must ensure that the 22/11/05 fire alarm system is tested weekly; the emergency lights and hot water temperatures are tested monthly. These must be documented. 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 8 Good Practice Recommendations It is recommended that all relatives be informed of the changed names of named nurses/key workers and their functions. Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Park Farm Lodge Care Home DS0000045160.V263455.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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