CARE HOMES FOR OLDER PEOPLE
Park House The Parade St Marys Isles of Scilly TR21 0LP Lead Inspector
Lynda Kirtland Paul Freeman 13 June 2005 10.15 am 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 House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Park House Address The Parade St Marys Isles of Scilly TR21 0LP 01720 422699 01720 422699 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) Council of the Isles of Scilly Mrs Lesley Catherine Burrows Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11), Physical disability over 65 years of age (2) of places Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14 September 2004 Brief Description of the Service: Park House provides long-term care to older people and is situated in the town of St. Mary’s and very close to the sea front. The home has a progressive attitude to community contact, which they actively encourage at every opportunity. The style of care provided is based upon service users individual needs within which empowerment; dignity, rights and maximising independence are central features. The Home is also committed to ensuring that changing needs are recognised and that the care provided is adjusted accordingly. There are strong links with the carers and friends of service users and the setting has a flexible approach to visiting arrangements. Admissions to the Home are of a planned nature and to assist this process up to four people a day can attend for Day Care and short-term residential care is also available if the resources permit. All service users bedrooms are for single occupancy and the home provides pleasant and comfortable furnishings and décor in all private and communal areas. There is limited outdoor space for service users however, access to the beach is in close proximity for service users if they wish to append time in the open air. Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspectors visited Park House on the 13 June 2005 and spent the day at the home. This was an announced visit. On the day of inspection 9 service users were resident in Park House. The inspectors met with all service users and 2 representatives, a number of staff and the registered manager to gain their views on the service that Park House provide. In addition the inspector was provided with 5 completed comment cards from service users and 3 from relatives in respect of their views on the service. The inspectors examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. What the service does well: What has improved since the last inspection?
Since the last inspection the registered manager has worked to address eight areas of improving standards of care within the home that were identified in the previous report. The registered manager and staff have developed and improved the following areas of care: developing a informative homes statement of purpose and residents guide; expanding the range of activities in the home; improving the complaints process; updating the furnishing of the home by redecorating the kitchen, repairs to a toilet area and ensuring that water temperatures are safe for all residents.
Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 6 Residents and their relatives were all complimentary about the care that the home provides. The inspectors were not concerned by the level of care or skills displayed by staff throughout the inspection. It is encouraging that access to staff training has appeared to increase. The registered manager and staff have developed care plans significantly. Further development to this area of work is needed to provide staff with the information they require to meet individual needs of residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 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 House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 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) 1,2,3,4,5, Park House has detailed information, which informs representatives about the services that they provide. The home completes an assessment of prospective they are able to meet the person’s needs. The home obtaining assessments that have been completed by makes the assessment arrangements unsatisfactory. EVIDENCE: service users and their residents to make sure experience difficulties in statutory agencies. This The registered manager has updated Park House Statement of Purpose and Residents Guide to reflect the services that they provide. The registered manager agreed to review the presentation of these documents so that they can be accessible to a larger audience. The homes statement of terms and conditions between the home and residents in the main meets the requirements of the national minimum standards. However some amendments are needed: these were explained to the registered manager who agreed to make the necessary changes. From discussion with residents and their representatives, it was evident that they are consulted in Park House pre admission assessment. The home aims to meet with the prospective residents prior to admission in the community.
Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 9 From inspection of four residents files the registered manager agreed that information from referring agencies is lacking to assist in the pre admission assessment. The consequence of this is that the home admits residents with partial knowledge of the individuals’ physical, emotional, social, educational and leisure needs. The registered manager agreed that she would attempt to address this with relevant referring agencies. A months trail period is offered to all new residents after which a review is held with all parties present to consider if the placement is appropriate and if so a long-term placement will be provided. Residents and their representatives commented that they felt that they received a ‘nice welcome’ to the home. From inspection of recently admitted residents to Park House this demonstrated the ‘moving in/settling in’ period and what support/assistance was provided. Throughout the inspection the inspector observed staff that displayed skill in communicating and providing personal and emotional care to residents. Staffs have attended recent training in respect of moving and handling, fire and are planning to attend an adult protection course. The registered manager acknowledged that further training in older peoples care remains on going i.e. dementia. Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10, 11 Care plans need to be more detailed to make sure that resident needs and choices are met. Residents’ health needs are met in a satisfactory manner. The staff at the home builds positive relationships with residents that are based upon the residents dignity and privacy. EVIDENCE: Since the previous inspection the registered manager and staff have developed care plans significantly and they now show more clearly care needs. They still need to be developed further so that the individuals care plan accurately describe what staff interventions are needed to approach a specific care need and meet the preferences and choices of residents. The arrangements for care planning and risk assessments for service users need to be reviewed and developed further. Monthly reviews of care plans were seen. In the main care staff commented that the new style of care planning was informative and assisted them in their work. From discussion with residents they commented that they felt that they received satisfactory care. Positive links are maintained with the local primary health care services and the General Practitioners and District Nurses regularly visit the home. Residents stated that they felt that all their health needs were identified,
Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 11 appropriate action taken, and follow up treatment provided by the home and local health services was ‘excellent’. From inspection of the accident book it was noted that there has been a number of falls/ incidents involving particular residents. The registered manager has monitored the number of falls and agreed to develop the risk assessment process further to identify how these incidents can be minimised in the future. Specific equipment for example to assist in moving and handling of service users are available in the home and staff receive training in how to use this equipment. Staff confirmed that specialised mattresses and other equipment are gained from health service. Park House outlines in its statement of purpose and service users guide its philosophy on promoting service users rights, privacy and dignity. Inspectors noted that the atmosphere of the home and residents appeared to be relaxed. Residents and their relatives commented staff ’ were ‘kind’, and that the management team ‘listen’ to any issues they have. From inspectors observations of staff throughout the inspection it was noted that staff approached and interacted with service users in a professional yet sensitive manner. Residents confirmed that they have a choice as to when to rise/ retire to bed, receive their mail unopened, have access to a private phone and can receive visitors in private. Residents and their relatives’ wishes in the event of their health deteriorating, or in the event of their death are recorded by the home. Park House has satisfactory policies in this area. Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 12 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 Park House provides a programme of activities to promote and encourage the pursuit of residents social, educational and leisure needs. Flexible visiting arrangements are in place and visitors are welcomed at the home. EVIDENCE: Since the previous inspection the registered manager and staff have reviewed the level of activities in the home and have developed an activity book. This shows that planned activities do occur, and some are on ad hoc bases. From discussions with residents the majority commented that there is ‘enough to do’ during the day. Residents recalled a variety of activities that are provided: i.e. games and pastoral services. The inspectors observed some residents enjoying the beach, others sitting in the sun, and some indoors socialising throughout the inspection. There is a flexible visiting policy and residents determine where they meet with their guests. Visitors commented that they are welcomed to the home. Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 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) 16,18 Park House has an appropriate complaints and whistle blowing policy. Residents, their representatives and staff are confident to raise any concerns. The policy and procedure for protecting resident against abuse needs to be improved. EVIDENCE: Since the previous inspection the registered manager has reviewed and amended the homes complaints policy and procedure. These are now satisfactory. From discussion with residents, their representatives and staff no concerns were raised. The arrangements for protecting residents against any form of abuse remain in the process of development. The registered manager agreed to ensure that the policy is written in line with DOH ‘No Secrets Guidance’ as well as the Local Authorities Adult Protection Procedure. The registered manager stated that staff would be attending training in the area of abuse. Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 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, 21,22,25 Park house maintains a safe and comfortable environment for all that reside at the home. The redecoration arrangements must be improved. EVIDENCE: From inspector’s observations plus residents and their representative’s comments about the homes décor and furnishings, it was noted that Park House aims to maintain an attractive and homely atmosphere. The registered manager stated that the main lounge and corridor areas need ‘freshening up’ as do some bedrooms. A planned redecoration programme is needed. A recommendation in respect of ensuring that decoration to covered pipe work has been identified. A requirement in respect of reviewing door widths to service users rooms remains in progress. The previous recommendations in respect of redecoration of the kitchen area and repair to a toilet area have been undertaken. Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 15 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) 27,28,29,30 Park House ensures that suitable trained staffs are employed in sufficient numbers at all times. The recruitment checks are not carried out as required by regulation. EVIDENCE: From discussion with residents and their representatives and staff plus inspection of staff rosters, it is evident that there are planned sufficient staffs on duty at all times. There are no concerns about the experience or manner in which the staff provide care. Residents spoke positively about the care that staffs provide. The registered manager is aware that residents needs are becoming more complex and therefore further skills in the areas of dementia and memory loss need to be gained. The registered manager aims to include this training as she develops staff’s individual training profiles. Seventy five percent of staff hold a NVQ certificate at a minimum of level 2, and 12 staff have a first aid certificate. From inspecting staff files and in discussion with staff it was evident that the staff team had a variety of experience, skills and qualifications. The home has suitable recruitment procedures. In the main relevant pre employment checks were undertaken. The registered manager was reminded that two references must be gained prior to employment of staff and that statement of terms and conditions of employment must be kept on the individuals file. A review of job descriptions is in progress.
Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 16 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) 31,32,36,37 The registered manager provides a structure, which creates an open, positive and inclusive atmosphere. The registered manager has insufficient dedicated management time to fulfil the management responsibilities of the home. It is also not satisfactory for Park House to be used as an out of hour’s service for the Social Services Department. This arrangement potentially compromises the requirements of registration. EVIDENCE: Comments from residents and staff in respect of the registered manager were positive, seeing her contribution to the home as valuable, supportive and a ‘good listener’. All felt they could approach her with any concerns or queries. A requirement in respect of the registered manager having allocated dedicated management time has been re-notified. This report clearly demonstrates that due to the registered manager having minimum supernumerary time to undertake management tasks and address the statutory requirements and
Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 17 recommendations that limited progress on the development of the service has been made. Residents, their representatives and staff stated to the inspectors, that the registered manager is competent and the care provided is to a good standard but records and documentation do not confirm this currently. In addition the registered manager informed the inspectors that Park House has been used as a contact for emergencies as a out of hours service. This has had repercussions on ensuring sufficient management cover in the home. CSCI will arrange to meet with the Responsible Individual and registered manager to discuss the importance of this further and to explain the possible legal consequence if this is not responded too. Previous requirements in respect of the Responsible Individual to provide monthly reports on the home, update records and policies are re-notified. In addition it is recommended that supervision sessions be recorded. Records held by the home are stored in a confidential manner and in line with the Data protection Act. Staff and service users records must be developed further to meet the requirements of the national minimum standards. Environmental Health and fire Inspections are carried out. Form these inspections no issues wee identified. The registered manager was reminded that fire doors must not be wedged open as was observed on the day of inspection. Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x 2 2 x x 2 x STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 3 x x x 2 2 2 Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 12(1)(a)( 2)(3) 14(1)(2) Requirement Timescale for action 30/09/05 2. OP4/OP30 3. OP7/OP8 4. OP18 5. OP25 6. OP22 needs assessements must be detialed and specialist assessments must be obtained. This requiremtn is re-notified to you. 18(1)(a)(c Individaul staff training and )(i) development assessments and profiles must be introduced and kept in respective staff files. A written annual training progrmamme must aslo be established. This requirements is re- notified to you. 14(2)(a)( Service users care plans and risk b) 15 assessments must be developed (1)(2)(a)( further and recorded in a b)(c)(d) mannner that meets the standards and requirmetns. 12(1)(a)( Adult protection policy and b)(2)(5)(b proceedures must be amended ) 13 (6) to meet the national minimum stanadrds. This is re notifiedd to you, 23(1)(a) A written agreement regarding the terms and conditions of the heating and water provision must be established. This is re notified for the sixth occasion. 23(1)(a)( The arrangements for storage 2)(L)(N) and door widths must be reviewed and aporapite steps
D52-D04 S35370 Park House V220909 130605 Stage 4.doc 30/10/05 30/09/05 30/10/05 30/08/05 30/11/05 Park House Version 1.20 Page 20 7. OP29 8. OP31 19 (1)(2)(3) (4)(5)Sch 4 (6) 26(1)(3)( 4)(5) taken to ensure they meet the standards and requirements. This requiremtn is re-notified to you. All pre employment checks must be carried out before staff members commence work. The responsible individual must provide written reports of his monthly visit as required by the minimum standards. This is re notified to you for the fourth occasion. The registerd manager must be allocated dedicated management time. This statutory requirement is re notified to you Park House must not be used as a out of hours service. Records must be kept in line with the requirements as set in Schedule 3 and 4 of the national minimum stanadrds. This is renotified to you. Fire doors must not be wedged open A planned redecoration progamme must be in place. 30/09/05 30/09/05 9. OP31 18(1)(a) 30/08/05 10. 11. OP31 OP37 10,18(1)( a) 17, Sch 3 &4 30/10/05 30/10/05 12. 13. OP38 OP19 23(4) 23(2)(d) 30/08/05 30/10/05 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. 2. 3. 4. Refer to Standard OP2 OP21 OP29 OP29 Good Practice Recommendations The homes statement of terms and conditions should be reviewed and amended. Boxed in pipe work should be painted. This is re-notified to you. Job descriptions should be reviewed to ensure that they accurately reflect the post holders tasks, duties and responsibilities. This is re notifed to you. A copy of staffs of terms and conditions of employment should be placed on individual files.
D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 21 Park House 5. OP36 A record of supervision sessions should be kept. this is re notified to you Park House D52-D04 S35370 Park House V220909 130605 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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