CARE HOMES FOR OLDER PEOPLE
Park Hills Nursing Home 199 Chamber Road Oldham Lancashire OL8 4DJ Lead Inspector
Tracey Rasmussen Announced 21st July 2005 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 Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Park Hills Nursing Home Address 199 Chamber Road Oldham OL8 4DJ 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) 0161 624 6671 0161 624 6671 Mrs Barbara Rogers Mrs Barbara Rogers Care Home 17 Category(ies) of Physical Disability (3), Physical Disability over registration, with number 65 years of age (17), Terminally Ill (17) of places Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 3 service users between the ages of 18 to 55 to be admitted to the establishment. 2. One registered nurse to be on duty throughout 24 hours. Date of last inspection 1 February 2005 Brief Description of the Service: Park Hills Nursing Home provides 24 hour nursing care and accommodation for up to 17 service users over the age of 65 years. Mrs Barbara Rogers is the registered owner. The home is situated approximately one mile from Oldham town centre and is reasonably close to local amenities such as shops, pubs and local schools. Bus services are also available close by. The home is a Victorian property which has been extended at the rear. Entrance to the home is by a purpose built ramp at the side of the building. Well maintained Gardens are available outside the property. The home provides 17 single bedrooms, on both the ground and first floors, and the majority of these are south facing. A passenger lift and other aids, such as hoists, are available. There are three bathrooms. On the ground floor there is a choice of a large lounge/dining room or a smaller quiet lounge
Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over five hours on the 21st July 2005 by one inspector. A tour of the home took place and care and staff training records were seen. Five of the 17 residents, three visitors (close relatives) and two staff were spoken to. Eight relative comment cards, six resident comment cards and two GP comment cards have been returned to the CSCI and all contain positive responses. Verbal feedback of the findings from the inspection was given to the office manager at the end of the visit. What the service does well: What has improved since the last inspection?
The owner manager continue to with an ongoing redecorating and renewal programme.
Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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 Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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 Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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) 3 and 4 Residents needs are assessed before they move into the home. The home can confirm they can meet the needs of the resident on admission. EVIDENCE: A sample of care files were examined and all had some form of community care assessment or nursing assessments and these were supported by the home’s own assessment of the resident’s needs. Staff at interview were knowledgeable about resident’s needs and aware of the resident’s preferences regarding when and how care needs were to be met. Relatives and residents spoken to said they were positive about the service provided and were warmly complimentary about the staff. Comments such as “They are always willing to help” was heard from different residents and relatives and similar comments were recorded in the comment cards received by the CSCI. The home does not provide intermediate care.
Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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 and 11 Resident’s privacy and dignity are respected. Residents care needs and end of life care is of a high standard, however the care planning records are insufficient to evidence the level of care that is provided. Medication practices are safe. EVIDENCE: The home offers a specialist service for people who require end of life care. Residents and relatives were very positive about the quality of the care they received. Residents who were very dependent and required full care were maintained comfortable in bed. The residents who were very dependent appeared very comfortable and peaceful. Night wear clothing and bedding looked fresh and clean and bedrooms were pleasant and tidy. Residents said they were, “treated with dignity and respect” and visitors said they were made to feel welcome. Another resident said, “ I have found staff
Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 10 very kind and caring”. Similar written comments were also received by the CSCI about the service at Park Hills. The quality of the care service the home provides was not reflected in the care plan records. Two care plans were examined and both comprehensively identified the resident’s needs. However, care interventions were not always specific and only provided an overview of how care was to be delivered for example one wound care plan recorded that pressure relieving aids were to used and the wound was to be desloughed and dressed daily. Information explaining what pressure relieving aids and what desloughing procedure and dressings to be used was not recorded. Evaluation of the healing progress of the wounds was not recorded. Some assessment such as moving and handling and nutrition had not been consistently recorded and evaluation of care plans not undertaken on a regular basis. The home medication procedures and practices were briefly reviewed. The home’s procedure for medication is one of direct administration from the original dispensed medication packages. Medication sheets are handwritten and there are good systems of medication ordering and tracking in place. Records of controlled drugs were maintained appropriately. The home also has systems in place for the safe disposal of medication. Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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 and 15 Residents lifestyle choices and social needs are respected. Family and friends are welcome in the home at any time. The quality of food provided to residents is good. EVIDENCE: Park Hills does not provide a service, which offers daily social activities to residents. The emphasis of the service is on care and comfort to people who are nearing the end of life. Staff did spend time with resident’s in providing care in a unhurried manner. Resident’s spent most of their time in their bedrooms and they confirmed that this was their choice. One resident did say she felt she had “nothing to do and was bored”. Discussion with this resident did identify that she was informed that the home would not offer a social activity care service. The resident’s relative did confirm that it had been suggested that a different care environment could be sought but the resident had refused this. Visitors said they were made welcome at the home and were seen popping in and out of the home most of the day.
Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 12 Residents and relatives were complimentary about the meals provided in the home. The home’s cook ensured the meals provided to residents were enjoyed. Residents confirmed choices were available. Very few resident’s sat in the lounge/dining room but had their meals in their own rooms. Assistance with meals was provided discreetly and unhurriedly. The kitchen was spotlessly clean. Stocks of fresh fruit and vegetables were available. All pies, cakes and pastries were home made. Lunch was homemade steak pudding with fresh cabbage, new potatoes. One resident said he was grateful that the home provided him with a pureed meal, which he said was “enjoyable”. Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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) 16 and 18 Residents can be confident that complaints will be treated seriously and they are protected from abuse. EVIDENCE: Residents, relatives and staff were clear that they could discuss any issues and concerns with the manager or nursing staff and were confident that these would be addressed quickly. The home had received no complaints. Staff at interview confirmed they had received training in abuse both at the home and as part of NVQ training. Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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, 21, 22, 24, 25, 26 Residents live in a clean, safe, well-maintained and comfortable home, which has aids and adaptations to meet their needs. EVIDENCE: A full tour of the home was not undertaken however the home was very clean and maintained to a good standard. Records of routine and contracted maintenance were available. At the time of this visit decorators were in the home decorating all areas in the home. The communal lounge/diner is comfortable and reflects a normal home environment with a leather suite and chairs and a traditional dining suite. Outside of the home has pleasant and well maintained garden areas. Residents and relatives said they were comfortable in the home. Suitable aids and adaptations are available in the home. Bedrooms were personalised according to the resident’s preference.
Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 15 Park Hills has a comprehensive policy to prevent the risk of cross infection policy and undertakes screening of new admissions to the home to detect MRSA. Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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, 28, 29 and 30 Staffing levels were sufficient to meet resident’s needs. Residents are in safe hands but staff training records are poor. Staff vetting procedures are safe. EVIDENCE: Residents and relatives said they felt they were in safe hands. One relative wrote, “The staff are wonderful” and “…I can sleep at night knowing (my mum) is loved and cared for”. The home’s rotas identify that staffing levels are maintained in the home at a consistent level to meet the needs of the residents. Staff at interview said that there was good team work and if the home was short staffed then they pick up extra shifts to help cover the rota. Two residents, one relative and one resident comment card did state that they thought the home was short staffed at times. They also said that it was normally the same staff on duty who knew them and knew what their care needs were. Staff training systems are in place and these consist of new staff working closely with the manager, nurse or an experienced care assistant. But records of induction training in accordance with a National Training Organisation for care practices were not available.
Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 17 The home continues to be committed to providing NVQ training and up until recently the home had over 50 of care staff with NVQ training. The home accesses external trainers to train new staff in moving and handling and this has resulted in a delay for new staff to receive accredited training in safe moving and handling. Employment records contain the necessary documentation required to ensure safe employment practices. The home is in the process of up grading all it documentation processes. Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 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) 32 and 38 The management of the home promotes the health, safety and wellbeing of the residents. EVIDENCE: Resident’s relatives and staff were all complimentary on how the home is run. All said, the manager and nursing staff offered support and advice. One GP wrote on a comment card, “Excellent, are always good to deal with”. Health and safety records were available. The home is in the process of up grading all the records to one system. General work place risk assessments did need further development. Fire safety records were available and records of staff fire drills maintained. Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 19 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 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x x x 3 Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 20 No 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 7 Regulation 14, 15 Requirement Timescale for action 31/08/05 2. 8 12 14 15 12 13 14 18 3. 8 4. 30 The registered person must ensure that residents care plans are recorded comprehensively with specifc care interventions which reflect risk assessements The registered person must 31/08/05 ensure that wound care plans contain specific information detailing size, depth and type of wound. The registered person must 31/08/05 ensure care plans detail the type and settings of pressure relieving aids used for each resident. The registered person must 31/08/05 ensure that all staff receive detailed induction training on commencement of their employment. 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 38 Good Practice Recommendations The registered person should ensure risk assessments are more detailed.
F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 21 Park Hills Nursing Home 2. 3. 4. 5. 6. 38 The registered person should ensure that fire drills are undertaken at different times of the day so that all staff have an opportunity to respond. Park Hills Nursing Home F54-F04 Park Hills S25447 V224924 210705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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