Inspection on 03/02/10 for Park Hills Nursing Home

This inspection was carried out on 3rd February 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Park Hills Nursing Home 17/05/10

Park Hills Nursing Home 15/12/09

Park Hills Nursing Home 19/10/09

Park Hills Nursing Home 15/09/09

Park Hills Nursing Home 30/04/07

Park Hills Nursing Home 31/01/06

Park Hills Nursing Home 21/07/05

Park Hills Nursing Home 01/02/05

Park Hills Nursing Home 09/08/04

Park Hills Nursing Home 03/06/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Park Hills Nursing Home 199 Chamber Road Oldham Lancashire OL8 4DJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Steve Chick     Date: 0 9 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Park Hills Nursing Home 199 Chamber Road Oldham Lancashire OL8 4DJ 01616246671 F/P01616246671 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Barbara Rogers Name of registered manager (if applicable) Mrs Barbara Rogers Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 17 Date of last inspection Brief description of the care home Park Hills Nursing Home provides 24 hour nursing care and accommodation for up to 17 people over the age of 65 years. Mrs Barbara Rogers is the registered owner and manager of the home. 1 5 1 2 2 0 0 9 0 17 Over 65 17 0 Care Homes for Older People Page 4 of 29 Brief description of the care home 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 that 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 floor 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. A copy of the homes last inspection report was available from the main entrance area of the home. The weekly fees ranged from £338.70 to £535.81 dependent on the package of care required. Further details regarding fees and other information about the home are available from the manager. No additional charges are currently made. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero star. This means the people who use this service potentially experience poor quality outcomes. We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at Parkhills Nursing Home knew that the visit was going to take place. For the purpose of this inspection three service users were interviewed in private, as were three relatives of service users. Additionally discussions took place with the deputy manager and senior nurse on duty. We visited on a second day, by appointment, when three staff members were interviewed in private. We also looked at information we have about how the service has managed any complaints, what the service has told us about things that have happened in the Care Homes for Older People Page 6 of 29 service, these are called notifications and any relevant information from other organisations. We also asked the management of the home to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA told us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, some of these comments have been included in the report. We undertook a tour of the building and looked at a selection of service user and staff records as well as other documentation, including staff rotas, medication records and the complaints log. Since the previous key inspection we have undertaken two random inspections (unannounced visits which look at specific aspects of practice) done by a pharmacy inspector, to check how medicines were being handled. We have not received any complaints about the service since our last Key Inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? All the requirements made at the last Key Inspection had been addressed. The process for reviewing and updating service users care plans and other documentation which clarifies their needs and helps to maintain a consistent approach from staff was more effective. The team were actively addressing ways in which social activities can be tailored to meet the individual needs of people living at the home. The complaints procedure had been redrafted to help clarify that service users, or their representatives, could get any complaint or concern addressed by the management of the home, not just formal complaints. Staff (and management) training had improved significantly since the last key inspection. Due to the relative lack of up to date training in the recent past, several Care Homes for Older People Page 8 of 29 staff still needed updates in several areas, but these were being planned for and booked. Staff recruitment practices were being undertaken in line with the legal requirements for vetting potential staff members. While there was still room for improvement, the management team had demonstrated that they understood what was required and were striving to achieve. However, the failure to address effectively the serious shortfalls in medication practices remained a major concern. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are assessed before moving to the home to ensure that their needs can be appropriately met. Evidence: The deputy manager showed us the new pro forma which had been developed since last key inspection, to record the pre admission assessments of prospective service users. We were told that there had been no new admissions since the previous key inspection. Relatives who we asked confirmed that staff had made an assessment before their relative had moved to the home. All staff who we asked told us they were confident that service users needs were assessed to ensure that those needs could be met by the staff team. Staff who we asked expressed the view that they were competent to undertake the tasks expected of them. Care Homes for Older People Page 11 of 29 Evidence: Park Hill does not offer intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were met in connection with their dignity and privacy being maintained. However the failure to implement consistently, procedures relating to medication, put people at potential risk of harm. Evidence: We looked at a selection of service users files. All had a written care plan, which had been reviewed within the preceding four to six weeks. The care plans presented as covering a comprehensive range of needs or potential needs. Some detail which we saw was particularly good, including, for example, drawing staffs attention to nonverbal methods of communication used by one service user who had lost the power of speech. In another example they were good records of observations of the deteriorating health of a service user who was subsequently and appropriately, admitted to hospital. We were told that a new system of recording a range of significant issues for each service user, such as a check that pressure relieving equipment was working effectively and that food supplements were given appropriately, had been introduced Care Homes for Older People Page 13 of 29 Evidence: since the last key inspection. By looking at a sample of these records it was apparent that some food supplements were either not being given, or not being signed for. The deputy manager and senior nurse on duty were confident that this was a recording issue, and not a failure to provide the care required. Another example was seen where a risk assessment pro forma for the use of bed rails had been used. The answer to one question on the form was given as no which, according to the form, should have triggered a review of the safe use of the bed rails, but no review had taken place. Discussion with the deputy manager indicated that the answer to the question should have been yes in which case a review would not have been triggered. This had not been identified as an error, which undermined the effectiveness of the use of that sort of tool. There was insufficient evidence that the managerial systems in place to identify any gaps or errors in records (and consequent potential gaps or omissions in care) were sufficiently thorough. Information in the care plans to indicate the active involvement of the service user or their representatives, was inconsistent. In one example seen the care plan had been signed by the service users husband, but another one we looked at had no signature from either the service user or their relative. Not all visitors who we spoke to could recall being involved in discussion about the care planning for their relative. However, neither did they feel excluded from the process and most talked about good communication between themselves and the staff team. Staff who we asked told us that service users were involved, subject to their ability, in discussions about their care. Staff who we asked, told us that the combination of their personal knowledge of service users, written information in the files and a verbal handover at each change of shift meant they were confident that they had up-to-date information in connection with each service user. There was good documentary evidence that service users had access to the full range of medical services available in the community. All service users and visitors who we spoke to expressed confidence that medical support, beyond that provided by the qualified nurses on duty, was obtained if necessary and in a timely manner. This was also the view expressed by staff who we asked. All service users and visitors who we asked, told us that the privacy and dignity of service users was maintained. This was also confirmed by observation and discussion with staff. Service users who we asked were all positive about the attitude and approach of the staff team. Care Homes for Older People Page 14 of 29 Evidence: Following the last key inspection, two random inspections had been carried out by a pharmacy inspector to look in detail at the management of medication in the home. Part of this visit was carried out by a Pharmacist Inspector over approximately seven hours. Their role was to check how medicines were being handled because we found serious shortfalls at our last visit that meant some people were being placed at unnecessary risk of harm. As a result of that visit, we sent a warning letter expressing our concerns and actions that the service must take to improve. Overall we found little had changed and we still found mistakes that were placing the health and wellbeing of people at unnecessary risk of harm. At the end of the visit we took photocopies of some of the records due to the serious nature of our concerns about the handling of medicines within this service. We found several gaps on the current medicines records and other mistakes that meant the records were not accurate. We saw that some medicines were not given at the correct time with regard to food and drink intake because staff had not followed the written instructions. We found that staff had handwritten some entries onto the medicines charts when medicines had been received from hospital. These entries did not include all the warnings necessary to give these medicines safely and they had not been checked and signed by another member of staff. We found that clear explanations had not been recorded when medicines were not given, for example, if they were refused. These issues had all been highlighted at the last two visits. Inaccurate records can lead to serious mistakes that can place peoples health and wellbeing at risk of harm. We found that the medicines fridge was not keeping medicines within the correct temperature range (2-8C). Medicines are likely to spoil and may be dangerous to use if they are not kept correctly. We looked at how controlled drugs (medicines that can be misused) were being handled and whilst there were improvements, we still found some shortfalls. The controlled drugs cupboard was still not compliant with the law. This was a serious concern because we had found this problem at our last two visits. Controlled drugs must be stored safely to help prevent mishandling and misuse of these powerful medicines. We carried out detailed checks of some stocks and records and found that whilst medicines supplied by the pharmacy in special blister packs were usually given correctly, medicines contained in traditional bottles and packets could not always be accounted for. We saw evidence that some medicines had been signed for, but not actually given, whilst others could not be accounted for. In some cases it was not possible to tell whether or not the medicines had been given correctly. The health and well being of people living in the home is at serious risk of harm if medicines are not given as prescribed. Care Homes for Older People Page 15 of 29 Evidence: We saw no improvement in the way medicines and staff competency were audited (checked). There were no recorded audits and no evidence that staff had been formally observed giving and recording medicines. This meant that problems had not been found and rectified by the manager. Given the continued mistakes it was evident that some staff still need to have their competency formally assessed to make sure they have the necessary skills to handle medicines safely. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate social contacts and activities are facilitated within the home which give service users the opportunity for social fulfilment. Evidence: We were told by the deputy manager and staff who we asked, that routine communal social activities are rarely organised. This was also confirmed by discussion with visitors and service users, however it was not presented to us as a problem by anyone we spoke to during this visit. The potential for the staff teams approach to activities, to be improved, had been identified by the management team, in the AQAA submitted to us. This included seeking the input of Age Concern to advise on possible approaches or strategies to look at alternative ways of providing meaningful social interaction for the service users. Staff told us that they often spent one-to-one time with service users and although this was recognised as a valued activity, it was rarely, if ever, recorded as such. There was documentary evidence of life story work having been undertaken with some service users. This is a valuable tool to help ensure that service users continue to be recognised and treated as unique individuals. Care Homes for Older People Page 17 of 29 Evidence: All visitors who we spoke to told us that there were no unreasonable restrictions on visiting and that they were made to feel welcomed by the staff team. One visitor told us they were made to feel welcome by staff and another described being welcomed by the wonderful staff. No service user who we spoke to during this visit expressed dissatisfaction with the apparent minimal level of communal activities. Service users who we asked told us that when they stayed in their room it was because that was where they chose to be. On the day of our first visit to the home we were told that service users had been asked not use the communal facilities, as a means of helping to control an outbreak of diarrhoea. On our second visit to the home more people were seen using the lounges. During the unannounced visit to the home we sampled the lunch. This was pleasantly presented and tasty. There was no specific alternative recorded on the menu although when we spoke to the Cook, they were clear that a range of alternative meals would be available if anyone did not like the menu option. Other staff who we asked, confirmed this to be true. Service users who we asked, said that they liked the food and confirmed that their individual tastes were catered for. One service user cited as an example of this, that they did not like their food swimming in gravy and this was remembered by staff when her food was prepared. Visitors who we asked, told us that as far as they were aware, their relatives enjoyed the food provided. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected from abuse or exploitation by the homes policies and practices and are confident that any complaints they may have would be dealt with appropriately. Evidence: Parkhills has a complaints procedure which had been redrafted since the last key inspection. This was to make it clearer that any concern or complaint will be dealt with including informal ones. Discussion with the deputy manager indicated that no complaints had been recorded since the previous inspection. It was recommended that keeping a record of even minor or informal expressions of dissatisfaction can be a useful management tool. This record may help identify potential areas of improvement in the service and to demonstrate that constructive criticism of the service is welcomed. All service users and visitors who we asked, expressed the view that they could complain and any complaint would be dealt with. Similarly staff who we asked, were confident that any complaints they passed on to senior staff would be followed up. We were told that four staff had had specific training in the protection of vulnerable adults. We were also told more staff had been booked on to appropriate training in the near future. Similarly staff who had, or were undergoing NVQ training would be receiving input in connection with the protection of vulnerable adults. Care Homes for Older People Page 19 of 29 Evidence: All service users and visitors who we asked told us that service users were safe at Parkhills. One service user, when asked, told that they felt 100 safe. Staff who we asked, demonstrated an understanding of the need to be vigilant to protect service users from potential abuse and exploitation. Whilst not all staff knew the detail of the homes whistleblowing policy, all who we asked, were confident they would, if necessary, pass on any concerns to senior staff and ensure they were investigated. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. Evidence: During this unannounced key inspection visit we undertook a tour of the building. This included communal areas and some service users bedrooms. All areas of the building appeared to be appropriately heated and ventilated. Service users rooms presented as personalised, reflecting the individual tastes of the occupant. No remedial issues were identified in connection with the fabric or fittings of the building. The building presented as clean and tidy, with no unpleasant smells. Service users, visitors and staff who we asked, said this was the normal state of the building. One visitor said that among the best things about Parkhills was that it looks like a home, not institutional ... always spick and span. Two other visitors also included the cleanliness of the home as being amongst the best things about Parkhills. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skills mix of staff on duty promotes the independence and wellbeing of service users. Evidence: We were told that staffing levels were usually provided on the basis of: -- one nurse and three carers between 08:00 -- 14:00; one nurse two carers between 14:00 -22:00 and one nurse and one carer between 22:00 -- 0 8:00. We were given a copy of the staff Rota for the week beginning the 18th of January 2010 as evidence of this. The manager and deputy manager told that, given the numbers and dependency of service users, they believed that these staffing levels were appropriate to meet the needs of each service user. Staff who we asked told us that they believed enough staff are available to meet the needs of service users. Service users who we asked, told us that staff responded to the call bell in a timely manner. We were told by the manager that five carers held the National Vocational Qualification (NVQ) III and one held NVQ II. We looked at a small sample of certificates to verify this information. We were also told that the remaining seven carers had been put forward to undertake the NVQ course. Staff who we asked, confirmed that they either held an NVQ or had been put forward for it. Care Homes for Older People Page 22 of 29 Evidence: There was documentary evidence of a significant improvement in training, particularly around issues relating to nutrition, tissue viability and dementia care. Staff who we asked, told us they had received a lot of training opportunities recently. They also told us that senior management was supportive and encouraged staff to undertake training. Staff also told us they felt confident that, if necessary, they could seek and would get, professional support and advice from colleagues and management. We were told that staff recruitment practices were now undertaken in line with the legal requirements for vetting staff who work with vulnerable adults. We looked at a small selection of staff files and documentation was seen which confirmed that appropriate checks were being undertaken. One example was seen where the Criminal Records Bureau (CRB) disclosure had identified some offences were on record. The deputy manager told us that this had been discussed with the staff member and taking account of the circumstances, a decision had been made that the convictions did not indicate that the person would pose a risk to service users. The responsible individual would be better able to demonstrate that they were protecting the interests of service users if this decision had been recorded at the time it was made. Service users were complimentary about the staff team. One person said staff look after me right well. Another service user said that although at one time they hadnt been happy with one particular staff members approach they were getting on better now. This person also said they are all good with me. One relative told us that the staff were always very pleasant and said the staff and care were amongst the best things about the home. Another relative said, when asked what was the best thing about the home, [the] very nice people who run it. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the manager is competent to run the home, the system for ensuring that all staff follow the correct procedures at all times, and taking action when shortfalls are identified, are not sufficiently robust. Evidence: The proprietor, who is also the registered manager, has had many years experience of managing a care home. Since the last key inspection there appeared to be significant improvements in many areas of management and administration. This included the manager and senior colleagues undertaking various training courses to update their skills and understanding, which they reported as being interesting and valuable. However there remained serious concerns about the way in which the management systems within the home had failed to effectively and consistently address the identified shortcomings with the storage and administration of medicines in the home. Since the last key inspection Parkhills had been visited by one of our pharmacy inspectors who had made further requirements in connection with the storage and Care Homes for Older People Page 24 of 29 Evidence: administration of medication. Following their visit, we sent a letter to clarify the actions which needed to be taken to comply with the necessary minimum standards. Despite this, the pharmacy inspector who visited on this occasion found that there were still outstanding areas which needed to be addressed. This is reported on in more detail in the health and personal care section of this report. All the requirements and recommendations made as a result of the last key inspection (completed before the pharmacy inspectors visits) had been addressed, although some require further work. In particular this extra work related to providing clear evidence that consistent auditing of care practice was maintained and action taken to ensure staff maintain acceptable levels of practice. There was good documentary evidence that appraisals and staff supervision had commenced. This was also confirmed by staff members who we asked. There was written evidence that a quality assurance exercise had been undertaken by the home including information from surveys completed by service users and relatives. A brief report of this had been completed and we were told it was planned to report on this at the next relatives meeting. It was recommended that a copy of the report was put on the home noticeboard so that relatives unable to attend the meeting could still read it. The deputy manager had some awareness of the relatively new legislation in connection with safeguarding any service users who are subject to any Deprivation of Liberty as a part of their assessed care needs. We were told that no service user was subject to this. We were also told by the deputy manager that a training course had been identified to further enhance senior managers understanding of this legislation. We were told that no money was held on behalf of service users. If personal items not covered by the fees, were purchased for any service user, they are then invoiced for it. Staff who we asked, told us they were clear about the expectation that they should report any health and safety concerns to management. Staff also told us that there was always a supply of personal protective equipment, such as disposable gloves and aprons, to minimise the risk of cross infection. We were told in the AQAA that all the necessary maintenance of equipment, including lift and hoists had been undertaken within the preceding 12 months. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must be given to people as prescribed This is important because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. 20/11/2009 2 9 13 Controlled drugs must be stored in a cupboard that meets the requirements of the law. This will help prevent mishandling and misuse. 20/01/2010 3 9 13 Accurate records of all medicines received into the home, given to people and disposed of must be kept. This will help make sure all medicines can be fully accounted for. 20/11/2009 Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 There must be an effective 26/03/2010 system for training and testing the competency of all staff (including carers who apply creams) to ensure that staff are capable of performing these tasks safely. This is to ensure that staff are competent to perform the necessary tasks 2 9 13 Medication must be stored at the correct temperature at all times so that it does not spoil and remains safe to use. This is so that medication remains safe to use. 26/03/2010 3 9 13 There must be a robust system of auditing (checking) all aspects of handling and recording medicines within the service so that areas of weakness 26/03/2010 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action are identified and action taken to improve. This is to ensure the health and well being of service users is maintained. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The responsible individual should ensure that systems are in place which enable the management team to demonstrate that any shortfalls in good practice would be identified and rectified in a timely manner. The responsible individual should ensure that handwritten entries on medication administration records are checked and signed by a second member of staff to reduce the risk of mistakes. The registered person should ensure that staff are encouraged to record periods spent in one-to-one activities with service users as a legitimate and important social activity. The responsible individual should ensure that a record is maintained of all complaints, including informal ones, to demonstrate how the matter was resolved and any consequential improvement to the service. The responsible individual should ensure that any decision to employ someone where information is available which may question their suitability, is clearly recorded, together with an explanation of the reason why. 2 9 3 12 4 16 5 29 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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