CARE HOMES FOR OLDER PEOPLE
Park Grange Neville Avenue Kendray Barnsley S70 3HF Lead Inspector
Jayne White Unannounced 1 July 2005 08:45am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Park Grange Address Neville Avenue Kendray Barnsley S70 3HF 01226 286979 None Not known Park Care Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Steven Chance PC Care Home Only 36 Category(ies) of OP Old age - 36 registration, with number of places Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17 March 2005 Brief Description of the Service: Park Grange is a care home providing personal care and accommodation for 36 older people. Park Care Limited owns the home. The home occupies a central position in Kendray, near Barnsley close to local shops and other amenities. The home is a three-storey building. The home has 22 single bedrooms and seven double bedrooms. There is a passenger lift. The home has a garden area that is well maintained and accessible. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over seven and a half hours from 8:45 to 16:15. Opportunity was taken to make a partial inspection of the premises, inspect a sample of records, observe care practices and talk to residents, staff, and the manager. The majority of residents and staff were seen during the inspection and the inspector spoke in more detail to two of the staff on duty about their knowledge, skills and experiences of working at the home and four residents about their views on aspects of living at the home. What the service does well: What has improved since the last inspection? Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 6 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 Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3. Standard 6 is not applicable to this home. Residents had a written contract/terms and conditions with the home. Residents who had moved into the home had had their needs assessed to ensure the home were able to meet their needs. EVIDENCE: The inspector sampled one resident’s contract. The contract contained all of the required information and the resident had signed the contract. Residents who had moved into the home had had their needs assessed to confirm the home were able to meet their needs and the home was appropriate for them. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 Residents did have an individual plan of care, however, in one instance this did not reflect the care provided. The daily report lacked detail and did not correlate with the action required within the care plan. Records of visits with healthcare professionals were noted in the care plans and observation and discussions with residents and staff, of care practice identified residents’ health care needs appeared to be met. The homes recording of the quantity of medicines received into the home were unsatisfactory. Residents themselves said that they were satisfied with the care they were receiving and that the staff were very good, friendly and helpful. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 10 EVIDENCE: Three care plans were inspected. The plans reflected needs identified in the initial assessment. There was evidence of assessments of risk, which included the action required to reduce risk, however, nutritional risk assessments were not in place. There was evidence that residents and/or their advocates had been involved in the formulation of the plan. Whilst the plans contained a range of information and identified the action to be taken by staff to meet residents’ needs the daily report was brief and on one did not reflect the action required identified in the care plan. Discussions with staff and the manager identified the action required was not carried out and the manager said the plan needed reviewing. It had been reviewed on 28 June 2005, three days previously. The quality of record keeping did not reflect the actual quality of care being given, which residents said was really good. The care plans inspected demonstrated who was dealing with the residents’ financial affairs. They did not confirm whether this was part of legal process or the preference of the service user. A previous requirement made in relation to this issue has been carried forward. Residents spoken to were satisfied with the care delivered by staff and discussions with them identified their health needs were met. Staff spoken with were aware of the health care that individuals needed and appointments with GPs, hospitals and specialist services were noted in the care plans. Programmes were in place for those with continence needs and staff said residents’ skin was monitored for development of pressure areas. Residents were well dressed in clean clothes and appeared to have received an acceptable level of personal care. The medication record of one resident was inspected. Procedures for the recording of medicines received in the home were not satisfactory as the amount of medication and the date it was received had not been recorded. Discussions with staff and inspection of staff training records identified staff had had training to administer medication. Medicines were securely stored within treatment rooms. A comment made by a resident in regard to administration was ‘they bring me my tablets and give them to me properly’. Staff interacted well with residents and furthermore they were observed closing bedroom and toilet/bathroom doors when attending to residents. All the residents spoken with said that staff were very good, friendly and helpful. There was a pay telephone for the use of residents situated in a corridor area off the main lounge. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Residents were satisfied with their lifestyle within the home and that they were able to make their own choices about their care where possible. Residents spoken with confirmed that they were able to have visitors at any time and were able to see their visitors in private. Residents were pleased with the meals they were served. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 12 EVIDENCE: Activities were organised both within and outside the home to provide social and mental stimulation for residents. Residents were observed to enjoy the activities provided. Care plans did not specifically address social care needs of residents. Advocacy services that will act in the residents’ interests, on their behalf were advertised on the notice board in the entrance hall. Observation of the relationships between staff and residents indicated that carers did promote residents’ choice and enabled them to maintain control over their lives where possible. Comments made by residents about the home included ‘marvellous here’, something to look forward to – going to sleep is boring’, ‘good place’, ‘whatever you want you get really – like a hotel’ and ‘plenty to do’. Residents were encouraged to bring with them personal possessions and their possessions were documented in the individual plan of care. A varied diet was provided. Residents confirmed that they were asked for their food choices for the day. Fluid and food intake was monitored. Residents’ comments included ‘meals pretty good’, ‘dinner and breakfast are nice’, ‘never hungry’ and ‘can order tea and supper’. There was no assessment of the nutritional needs of residents. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) See below EVIDENCE: Outcomes for this section of the report were not inspected and will be checked at the next visit. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 24 & 26 On the whole the living environment was clean and the lounge, dining room and corridor areas well decorated and maintained. The home offered a comfortable standard of accommodation and residents had their personal possessions around them. Some maintenance of the building was still required to maintain a satisfactory living environment. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 15 EVIDENCE: The location and layout of the home was suitable for it’s stated purpose and residents were satisfied with the home environment and that it met their requirements in a comfortable and homely way. Residents’ comments about their home included ‘rooms lovely’, ‘décor beautiful – couldn’t be better’, ‘hoovered everyday and kept clean’ and ‘bed always clean’. No adverse comments were made about the day care service provided by the home and that the service ‘intruded’ the residents’ lounge area - a number of permanent residents had come to the home on day care initially. Residents had access to all indoor and outdoor facilities. There were some bedrooms accessed by steps. Previous inspections had identified these would only be occupied by residents who did not have mobility problems. There was sufficient equipment and aids and adaptations provided to meet the needs of the residents. Since the last inspection some decoration and refurbishment had been carried out including the downstairs corridor and the homes front porch, which now portrayed a better first impression of the home. The dining room carpet that was carpet tiles is now showing gaps and although regular cleaning has taken place since the last inspection, remained dirty. This distracted from the otherwise pleasant environment and meals which residents said were very good. A specialist bath was chipped where it closes and needs repairing or replacing to prevent injury and the spread of infection. The residents’ bedrooms seen were well decorated and personalised. The home had purchased locks to replace locks to drawers in residents’ bedrooms that would be more domestic in character and in keeping with a home environment. Staff had attended training on infection control and during discussions with staff they could describe some systems that were in place to control the spread of infection. Laundry facilities were sited away from food preparation areas. Inspection of the site noted clothes that were left on the floor, which did not promote the control of infection and old soap powder residue was around the washers. Information submitted to CSCI did not confirm the homes water systems met requirements. The home had an up to date clinical waste contract in place. Comments about the laundry service included ‘laundry done nice here’. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Staffing levels appeared to be sufficient to meet the residents’ health, personal and social care needs. Improvements were required to the recruitment process to adequately protect the welfare of residents who lived at the home. Staff were undertaking a range of training to ensure they were competent to carry out the tasks required, however, to ensure carers knowledge and practices remain up to date updating training in moving and handling was required. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 17 EVIDENCE: The inspector examined the home’s rota for the week of the inspection, which evidenced that agreed levels of staff were being maintained. Since the last inspection information had been provided to explain the codes used on the rota. This was on display alongside the homes rota. Comments about staff included ‘staff smashing – they’re not officious – easy going, but they know what they’re doing’, ‘staff treat you lovely – they look after everybody and treat them like they would like to be treated – like a big family’ and ‘staff do jobs well – nothing too much trouble’. One staff file was inspected, as there had been no staff recruited since last year. The file did not contain all of the information required, including a full employment history and written explanation of any gaps in employment, evidence that staff had been provided with the General Social Care Council Code of Conduct and Practice, documentary evidence of training and qualifications and evidence that the person is mentally and physically fit to work at the care home. This did not demonstrate that the recruitment process was sufficient to adequately protect the welfare of residents who lived at the home. The home had a training plan and individual training records were maintained. Training had taken place for moving and handling, infection control, food hygiene, medication, health and safety, first aid, fire training and adult abuse, however, care must be taken that these are updated as required as the moving and handling was last done in January 2004 and carers were observed inappropriately moving and handling a resident. The manager stated approximately forty four per cent of staff were trained to at least NVQ Level 2 in Care. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36, 37 & 38 Residents were satisfied with the management of the home. There are quality assurance systems in place and the outcomes in discussions with residents demonstrate the home was run in the best interest of the residents. The owner did not demonstrate they conducted their own quality assurance. The accounting systems in place demonstrating how monies were dealt with by the home were inadequate and not up to date, therefore confirmation that residents’ finances were adequately safeguarded could not be confirmed. Improvements were required with some of the records kept by the home to safeguard residents’ rights and best interests. The record for supervision did not demonstrate staff were appropriately supervised. An audit of fire drills by staff, servicing of the gas system and hoist, and action taken to address the requirements on the fixed electrical service were required before it could be confirmed the health, safety and welfare of both residents and staff were promoted and safeguarded. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 19 EVIDENCE: The manager was a qualified nurse and had approximately 15 years experience in residential management. He did not hold NVQ level 4 in Management. One resident described the home as ‘well organised’. The home had a quality assurance policy in place that had been reviewed in January 2005. The policy identified quality was judged by resident surveys, complaints, meetings, care plans, reviewing the statement of purpose, policies and procedures, reports, the environment and the annual development plan. Residents that were spoken to were all satisfied with the service provided. Regulation 26 visits as required by the owner to demonstrate their findings of the quality of the service provided were not being completed and a copy sent to the CSCI. The manager said personal allowances were paid to residents on a weekly basis. A separate record of this transaction was completed until 29 July 2005, however, signatures that these had been paid had only been made until 20 May 2005, therefore, verification of the amounts had been paid could not be made. In addition the record only contained one signature. The record of monies held on behalf of a resident was maintained with the balance and monies correlating. The description of where the monies came ‘in’ and ‘out’ from was inadequate. There were safe facilities to store the monies. A system for staff supervision was in place. Supervisions did not always take place at the required frequency. The record of supervision was inadequate as it did not describe what was discussed and any outcomes or actions to be taken as a result, thus not demonstrating development of staff that should reflect in improvements in care practice. The home had a health and safety policy. On the day of the inspection no fire exits were blocked and hazardous substances were securely stored. All staff had not participated in fire training/drill at the required frequency which could mean residents are not in safe hands should a fire arise. Records demonstrated servicing for fire extinguishers, the lift and clinical waste were in place. The servicing of fixed electrical circuits identified the overall assessment as unsatisfactory and 15 items required urgent attention and the servicing for the gas and hoist was out of date. The manager stated he thought the work required on the fixed electrical wiring had been completed but this could not be verified. Some staff were observed inappropriately mobilising a resident, although staff had had training in moving and handling. To ensure staff remained up to date in their moving and handling techniques training did need updating. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 x x x 2 x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x 2 x 1 2 2 1 Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Care plans must reflect the care provided and include nutritional risk assessments. The daily report must contain sufficient detail and correlate to the care identified in the plan. The date and quantity of all medicines received into the home must be recorded. The corridor areas showing signs of wear and tear must be redecorated. The dining room carpet must be replaced. The identified bath must be repaired/replaced. The hasp and padlock type locks on service users furniture must be replaced. Previous timescale of 30 June 2005 not met. Dirty laundry must not be placed on the laundry floor. All parts of the laundry must be kept clean. A thorough recruitment check as required by the regulations and
J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Timescale for action 30 September 2005 2. 3. 4. 5. 6. 9 19 19 19 24 13 23 16 & 23 23 12 30 September 2005 31 July 2005 28 February 2006 30 November 2005 30 September 2005 30 September 2005 30 September 2005 30 September
Page 22 7. 8. 9. 26 26 29 13 & 23 23 19 Park Grange Version 1.40 10. 11. 30 33 18 26 12. 35 17 13. 35 17 14. 35 17 15. 16. 17. 36 38 38 18 23 13 18. 38 13 standards must be made. Previous timescale of 30 June 2005 not met. Where required moving and handling training must be updated. The registered owner must submit a report of the unannounced monthly visits to the home. The record of personal allowances paid to residents must be recorded at the time of the transaction and kept up to date. All financial transactions relating to residents must be verified by two signatories, one being the resident where possible. The description of where monies have been received from and the purpose for which they have been used must be more descriptive. Staff supervision must take place at the required frequency. All staff must receive fire training/drills at the required intervals. Confirmation is required that work identified as requiring urgent attention on the fixed electrical service has been completed. Servicing of the gas systems and hoist must be undertaken. 2005 28 February 2006 31 October 2005 31 October 2005 31 October 2005 31 October 2005 31 March 2006 31 October 2005 31 October 2005 31 October 2005 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 26 Good Practice Recommendations The manager should provide evidence that the home complies with the Water Supply (Water Fittings)
J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 23 Park Grange 2. 3. 31 36 Regulations 1999. By 2005 the manager has a relevant management qualification. That the supervision record details the areas discussed in detail and any outcomes or actions to be taken as a result of the supervision. Park Grange J51 S18250 Park Grange V235314 01.07.05 UI Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Ground Floor, Unit 3 Waterside Court Bold Street Sheffield, S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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