Inspection on 17/01/07 for Park House Care Home

This inspection was carried out on 17th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Park House Care Home 29/11/07

Park House Care Home 02/05/07

Park House Care Home 29/09/06

Park House Care Home 11/11/05

Park House Care Home 31/08/05

Park House Care Home 25/01/05

Park House Care Home 19/05/04

Park House Care Home 24/02/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Emmanuel Christian Care Home 1 Palm Grove Prenton Birkenhead Wirral CH43 4UU Lead Inspector Jeanette Fielding Unannounced Inspection 17th January 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Emmanuel Christian Care Home Address 1 Palm Grove Prenton Birkenhead Wirral CH43 4UU 0151 652 1021 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Four Seasons (Emmanuel Christian Care Home) Ltd *** Post Vacant *** Care Home 111 Category(ies) of Dementia - over 65 years of age (41), Old age, registration, with number not falling within any other category (70) of places Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 70 (OP - Nursing Care), 8 (OP - Personal Care) in the overall number of 70 41 (DE/E) Four named service users under the age of 65 years for OP Nursing Care 29th September 2006 Date of last inspection Brief Description of the Service: Emmanuel Christian Care Home - Park House, is located in a quiet residential area of Birkenhead. The home is owned by Four Seasons (Emmanuel Christian Care Home) Ltd. The home is registered to provide general nursing care to forty elderly persons on the second floor, general nursing care to thirty elderly persons on the ground floor and dementia nursing care to forty one persons on the first floor. Personal care may be given to eight service users within the total of 111 persons. The home provides single en-suite accommodation to all service users and has several lounges on each floor. There are an adequate number of toilets and bathrooms. Access to the upper floors is via the two passenger lifts and several stairways. The home is accessible by public transport and there are a variety of local shops nearby. The home employs qualified nurses and care staff to provide care to the service users. There are separate domestic, laundry, catering, maintenance and administration staff. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over three days by Mrs Jeanette Fielding and Mr Les Smith. A total of 52 inspector hours were spent in the home. During the inspection, records relating to the care required by and afforded to service users were inspected. Additional tools and documentation to enable the staff to establish service users’ needs and prepare care plans have been provided by management. Improvements in the documentation were found in some areas although some documentation is outdated and some care needs were difficult to identify. These particular records would benefit from review and update. Considerable improvements have been made to the staff files. All necessary vetting and checking has been made on new staff and training records are now in place. The procedure for handling complaints could not be confirmed as being in line with the home’s policy. Records of complaints are held, although little is recorded of the action taken in response. Some areas of the premises are maintained to a good standard. Bedrooms are personalised and homely but attention is needed to provide a comfortable communal environment on one floor. Attention is required to cleanliness in some areas. The handling of medications remains an area of concern with some practice remaining unsafe, despite enforcement action. Recent enforcement action by CSCI has also been taken in relation to staff training and activities. Compliance has been achieved. No new admissions have been made to the home since the last inspection. What the service does well: What has improved since the last inspection? A strong management structure has now been put in place to provide information, support, supervision and direction to the staff. Unit managers have been appointed and are currently employed on a supernumerary basis. A high number of activities have been provided and service users are given the Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 6 choice as to whether they participate. Staff records are now detailed and informative and provide full information as required. A new catering manager has been appointed and all meals are now prepared from fresh goods with some frozen foods being available to offer greater choice. Special diets are prepared according the individual needs and tastes of the service users. Health and safety records are all in place. 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. The summary of this inspection report can be made available in other formats on request. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide require review and update to ensure that current and prospective service users have full and accurate information regarding the service and facilities provided. EVIDENCE: The Service User Guide contains basic information regarding the home’s services and facilities. However, the guide would benefit from a review to reflect changes that have taken place within the home. The Statement of Purpose also requires an update and review to reflect the recent changes within the home. The brochure, available to service users in the foyer of the home, does not reflect Park House. The photograph within the brochure depicts Grove House, an adjacent registered care home that does not fall within the registration of Park House. It is not specific to Park House. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 9 CSCI have been advised that these documents are being reviewed and the amended copy will be made available very soon. Service users who are funded by a local authority are issued with a contract with the authority. Copies of the home’s terms and conditions of residence have been issued to all service users or their relatives. These documents require signing and returning to the home. It is recommended that a mechanism be put in place to ensure that these are duly signed by the appropriate person and returned in a timely manner. No new admissions have been made to the home since the last inspection. No pre-admission assessments for new service users were therefore inspected. Prospective service users or their relatives are encouraged to visit the home prior to making a decision regarding their care provision. This gives the prospective service user the opportunity to view the bedroom and communal areas and to meet staff and other service users. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Limited action has been taken by the nurses to ensure that care plans provide accurate information regarding the needs of service users and has the potential for placing service users at risk through poor care provision. Little improvement has been made in the safety of service users regarding the handling of medications. Service users are placed at risk due to the failure of nurses to follow policies and procedures and to maintain accurate records. EVIDENCE: An individual plan of care is prepared for each service user. Attempts have been made to improve these plans; however, on the first and second floors, some are poorly developed and do not provide sufficient information to inform staff regarding the care required by the service users. Considerable improvements have been made to the record keeping on the ground floor. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 11 Assessments of service users are undertaken to identify their care needs, and new documentation has been provided to enable those needs to be recorded. Further information specific to the care needs require to be recorded. On some files, little or no information was recorded resulting in a lack of information available to complete an effective care plan, improved and accurate information which is specific to the individual user Second floor. On the front page of the care plans, information is recorded to inform staff of the specific interventions to enable staff to provide the appropriate level of care. The care plans had been reviewed and changes to the care needs identified in the evaluation section of the plans. It may not be feasible for staff to read all reviews to identify the change in need of the service user. This information should be recorded on the front page. The plan should be changed to indicate current needs in care provision and not amended on the back of the form or on subsequent pages. This would facilitate easier access for staff. The care plan for one service user states that they are to be nursed in bed and slide sheet used to move them. The daily report makes reference to the service user seated in an armchair on three occasions and assisted to the toilet on one occasion. This was discussed with the nurses on duty who were unaware of the information recorded in the daily report. One member of staff suggested that the report for a different service user had been recorded in the wrong file. The assessment form for the same service user reports that a preference has been expressed for personal care to be given by male care staff. This is not recorded in the plan of care and the daily record indicates that female staff have provided personal care. The care plan for this service user states that a daily bed bath is to be given. The record sheet for November 2006 which is completed by staff to indicate the care given, shows that only twelve bed baths were given and on eighteen occasions, the service user was just washed. The service user had been visited by a Speech and Language Therapist three weeks prior to the inspection and recommended specific details regarding the diet. This information was not recorded on the care plan and has the potential for an inappropriate diet to be given. The service user requires eye care due to an infection. No record is made of this care being given, of the care required or of the member of staff who delivers the care. Information regarding eye care packs and the solution required to provide this care was requested from staff. The inspectors were informed that only tap water was used and that no cleaning packs were available. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 12 Two care files contained bed rail consent forms that had not been completed appropriately. This failure to complete documents accurately had been raised with the staff and management following the inspection of 27th September 2006 and has not been addressed. The forms have been signed by the service user’s representative but there is no indication as to whether rails are to be used or not. The policy for the use of bed rails has recently been reviewed by Four Seasons. One service user has a diagnosis of dementia but there is no mental health assessment. No plan of care has been prepared in relation to the dementia or instructions to staff on how to deal with those specific care needs. First floor The care plans have not been re-written but only added to on the evaluation page to include information regarding the changes required to the plan. In view of this, many of the care plans require re-writing to ensure that up to date information is clearly recorded. Little information is recorded on the progress or deterioration in the mental health of service users who have dementia. Little information is recorded in relation to aggression or challenging behaviour. There are no specific actions identified as to diffusing events involving conflict. Specific records are provided for staff to record the personal hygiene care given to service users. The care plan for one service user states that they were to be given two showers each week. During the month of December, the records show that only two showers were given and on ten days, no record of personal care was recorded at all. One service user was identified as requiring physiotherapy. However, there is no record to support physiotherapy has been given. There is no evidence that service users relatives or representatives have been involved in the review of their care in any meaningful way. Three relatives were spoken to independently. Only one said that they were aware of visits by the doctor but felt that this was because they visited every day. None of the relatives spoken to were aware of the monthly reviews of the care plans and said that they had not been involved with them. One relative said that she knew what level of care was required as she regularly told the staff what was needed. It is evident that nurses are failing to record the care given to service users to demonstrate that their assessed needs are being met. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 13 The poor quality of the care plans has been discussed with the management teams at the home in the feedback given following the last four inspections. This has been further discussed at meetings held with the senior managers of Four Seasons Healthcare Ltd. Requirements have been made for up to date and relevant care plans to be prepared in the inspection reports of the last four inspections. A statutory enforcement notice has been issued in respect of care planning. The requirements of the enforcement notice have been partly met. Discussion took place with a care assistant who is currently working towards NVQ at level 2. During the discussion, the care assistant was advised to read risk assessments and care plans with reference to a topic relevant to his training. The care assistant had not read any of the care files and said that he was not aware that he had permission to do so. He was given information regarding the tasks he was to perform by the trained nurses and thought that the care files were only accessible to the nurses. This was raised with the acting manager and peripatetic managers as an area of concern. The managers stated that all staff had been instructed to read the care files to give them information regarding the care needs of the service users. It was apparent that this information had not been effectively communicated to all staff. One entry in the key worker diary demonstrated empathy and awareness.. A care assistant had recorded that a service user was feeling very low and had become distressed. The care assistant recorded how she had sat with the service user for over fifteen minutes to provide comfort, support and reassurance. The service user had then settled and slept throughout the night. Four service users were observed to be seated in armchairs, three in corridors and one in the lounge. None of the service users were wearing slippers or shoes but all were wearing socks. It is known that three of these service users are mobile but had not been fitted with appropriate footwear to reduce the risk of accidents. Medications. The medications on all floors were inspected. Ground floor. Medications were well managed on this floor. All records were up to date and well maintained. Records of all medications entering or leaving the home were up to date and accurate. Medication Administration Record sheets (MAR’s) were well maintained and signed appropriately. Two signatures were recorded on handwritten entries to verify the accuracy of the medications and regular audits of medications undertaken by the unit manager provided evidence that quality monitoring of medications was in place. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 14 First floor. All nurses throughout the home have been given additional training relevant to the safe administration, however, it is evident that some nurses have failed to follow the home’s procedure for handling medications safely. Record keeping was generally poor. One service user is prescribed Co-codomol tablets with one or two tablets to be administered four times each day. No record is held of whether one or two tablets are administered. This prevents nurses from assessing the effectiveness of the medication and will impact on the accuracy of medication audits/stock control. One service user is prescribed Diazepam to be given rectally in the event of an epileptic fit. No details are recorded on the MAR sheet or in the care plan of the time after onset of the fit that the medication is to be administered or if repeat doses may be given. A separate sheet is attached to MAR sheets to give details of specific medications that are prescribed on a when necessary basis. This sheet identifies that two Co-codomol dispersible 8/500 can be administered four times each day but the MAR sheet does not identify that this medication has been prescribed by the GP. The blister pack in which the tablets are dispensed by the pharmacist for one service user did not contain sufficient tablets for the whole month. No information was recorded to indicate that this medication was not to be given after a certain date and the MAR sheet was signed by staff to show that the full amount of medication had been dispensed. There was a shortfall in the number of tablets provided to the home but the nurses, who have responsibility for checking that the correct medication was provided, failed to notice, report and correct the shortfall. A service user was prescribed Co-codomol tablets. Two tablets were to be given on a when necessary basis. Three signatures were entered on the MAR sheet but a count of these tablets indicated that only three tablets had been administered. The nurses must ensure that the dose prescribed by the doctor is administered safely. Altering doses of medication should only be done with the consent of the prescriber. The MAR sheet for one service user is prescribed Paracetamol suppositories when necessary. He is also prescribed Paracetamol capsules, one or two every four to six hours when necessary. Further prescribed is Dihydrocodiene tablets when necessary. A homely remedies list is attached to this service users’ MAR sheet which gives nurses permission to administer two Paracetamol tablets if necessary. No information was recorded to ensure that the service user was Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 15 not given an excessive dose of painkillers and this poor documentation has the potential to place the service user at risk. The MAR sheets have not been appropriately completed for a further two service users to indicate whether one or two tablets have been administered when the GP has prescribed a variable dose. One service user was prescribed Haloperidol liquid. The strength of the liquid is 2mg per 1ml. The 100ml bottle was dated as having been dispensed by a pharmacist on 3rd January 2007. The service user was prescribed .4 ml twice daily. Nineteen doses had been signed for on the MAR sheet to indicate that these had been administered and would indicate that a total of 7.6 mls had been administered. A measure of the amount of liquid remaining in the bottle showed that only 61 mls remained. This is a shortfall of 31.4 mls. This shortfall gives cause for serious concern. No record was held in the received medications book to show the actual date that the medication had entered the home or of the amount. Both the unit manager and trained nurses on duty were unable to account for the shortfall. Second floor. The MAR sheet for one service user identifies the incorrect room number. This has the potential for administration of an incorrect medication. One service user was prescribed Oramorph 10mg in 5 mls. The dose to be administered was 2.5 to 5mls every four hours if necessary. The nurses have failed to record the actual amount administered preventing an accurate audit from being undertaken. The poor standard of medication administration and recording has been discussed with the management teams at the home in the feedback given following the last three inspections. It has been further discussed at meetings held with the senior managers of Four Seasons Healthcare Ltd. Requirements have been made for medications to be dealt with safely and accurately in the inspection reports of the last three inspections and a statutory enforcement notice has been issued in respect of the medications. The home remains unable to demonstrate that service users are protected and supported through safe practice. Service users are accommodated in single bedrooms, each having en-suite facilities. Personal care is given to service users in their bedrooms or in the bathroom as appropriate. Staff must ensure that doors are fully closed when giving personal care to ensure the privacy and dignity of service users. Service users spoken to during the inspection said that they felt their privacy and dignity were respected and that the staff did all they could to help. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 16 Care is given to service users by both male and female care staff. Some Social Assessments identify the preference of the service user or their relative regarding the gender of the care giver but no evidence was seen to indicate that staff had been made aware of this preference or that it was met. Social Assessments are completed by family members to give staff greater information regarding service users’ life history and individual preferences. The forms for three service users identified that they had been involved with the church prior to their admission and would benefit from services being provided to meet their spiritual needs. There is a lack of evidence to show that service users spiritual needs are met. The inspectors were informed that ministers visit the home to provide services for a very small number of specific service users and that these services were provided in the privacy of their bedroom. There was no evidence to suggest that service users were given the opportunity to worship according to their religious preference or to participate in religious activity. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made progress to improve the provision of a varied and well balanced menu and now offers a choice of meals that meets service users tastes and choices. Meals are not served appropriately or in a timely manner which may have an impact on service users well being. An improved programme of activities now ensures that service users are offered a range of social and stimulating activities. EVIDENCE: Since the last key inspection, the home has recruited an additional activities co-ordinator on a part time basis. This co-ordinator works primarily on the EMI unit and was observed to be providing activities and stimulation to a small group of service users. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 18 A full time activities co-ordinator provides recreational to the service users accommodated for general nursing care. Records are held of the service users involved or those who have chosen not to participate. Discussion took place with the acting manager with regard to one activities coordinator working with service users whilst they were at the hairdressers and the records show that this mainly involved transporting them in wheelchairs. Visiting the hairdresser, whilst an activity in itself, is part of the personal care given to service users. Service users who do not visit the hairdresser should not be denied activities due to the co-ordinator undertaking transportation duties. An increased number of activities are now provided through outside entertainers and service users spoken to during the inspection confirmed that enjoyable activities were provided over the Christmas period. A list of the activities programme is displayed on all notice boards throughout the home and a further copy of the list is given to all individual service users. A good supply of activities equipment is provided and is mainly stored in the lounge on the ground floor. A new mobile library service is being arranged to give service users the opportunity to choose their own reading material. Visitors are welcome to visit the home at any time and discussions took place with relatives who were visiting at the time of the inspection. The visitors confirmed that they were enabled to assist in the care of their relative and two said that they assisted with feeding their relative. All confirmed that the staff were grateful for the assistance they gave and further stated that they enjoyed being involved with their relative’s care. The inspectors were informed that service users were free to go to bed and rise at a time of their choosing. One member of staff commented that, in practice, service users were attended to in order of priority and that some service users had to wait longer than they would have preferred. Since the last inspection, a new catering manager has been employed. All meals are now prepared from fresh produce which is supplemented with frozen vegetables to enable out of season foods to be provided. The kitchen was extremely clean and organised and menus have been changed to ensure that all service users are offered a choice of meals. The catering manager has ensured that full information had been gathered regarding special diets and these are now provided as needed. The meals observed appeared appetising. All catering staff are working towards the ‘Better Food, Better Business’ certificate and should complete this in the near future. Currently, only the catering manager holds appropriate qualifications. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 19 The inspectors observed service users taking lunch on the first floor. The inspectors were seated at a desk at the nurses’ station outside the dining room. One service user was served her lunch at 1.10pm. The meal was sausage, vegetable and potato. The service user was seated in a lounge style chair and was slumped down in it. The meal was placed at a table in front of her but was at eye level. The service user did not make any attempt to eat the meal or to give any indication that she knew it was there. Staff who passed her spoke in passing and asked her to eat her lunch. The meal sat on the table untouched until it was cold. One member of staff took the meal away and replaced it with a meal of curry and rice. The member of staff spoke to the service user and said that perhaps she would prefer this meal instead. Again the meal remained untouched and no member of staff was seen to assist the service user to eat her meal. The care file for this service user reports weight loss and requires that she be weighed each week. The service user has only been weighed 2 to 4 weekly and continues to lose weight. The inspectors also observed the meal being served on the second floor of the home. The meal was transported to the dining room from the main kitchen in a heated trolley. The trolley was plugged in the dining room to ensure that the food stayed hot. Tables had been set with cloths and cutlery but there were no condiments or cruet sets. No drinks were being served with the meal and this was raised with staff by the acting manager. Fruit juice was then served to the service users. The meal is due to be served at 1pm but by 1.50 pm, not all service users had been given a meal. One service user who is nursed in bed was banging a plastic cup on his bed table and shouting for his meal. The acting manager requested that one of the staff serve the meal and feed the service user. Two more requests were made before the meal was served. This is of particular concern as this service user has diabetes and requires meals at regular intervals. The trolley was removed back to the kitchen at 1.55pm, denying service users the opportunity to request additional food if they were still hungry. The activities co-ordinator was observed to be rushing some service users to complete their meal as an activity was due to take place in one of the lounges. In the cupboard underneath one of the sinks in the dining room, the inspectors found an outdated tin of prunes and outdated hot chocolate mix. These were disposed of. The sink in the other dining room was extremely dirty and required cleaning. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive complaints procedure but there is little evidence that this has been followed to ensure the protection of service users. EVIDENCE: The home has a comprehensive complaints procedure. Information on how to make a complaint is displayed on the notice board in the foyer and is detailed in the service user guide and statement of purpose. Some issues raised by relatives had been recorded on complaints forms. These appeared to be comments rather than complaints and so it proved difficult to establish the number of actual complaints received by the home. The complaints process had not been followed in respect of investigation, record keeping and response to complainants and so it was not possible to establish if the complaints procedure had been followed appropriately. It is to be commended that all issues, even minor ones, that are raised are recorded, however, it is advised that a more appropriate means of recording outcomes and action taken is put in place.. 60 of staff have received training on adult abuse, however, a small number of incidents have taken place within the home that have not been appropriately referred to the Adult Protection Team nor were the incidents reported to CSCI within appropriate timescales. Links with external agencies i.e. CSCI, Adult Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 21 Protection Teams, are weak with little evidence that the service is open and proactive in the area of protection. Care files give clear details of the action to be taken for service users who are at risk but appropriate action to protect those service users was not recorded. Care practices, and failure to provide the appropriate level of care, to some service users places them at risk. The home is therefore unable to demonstrate that service users are protected from harm or abuse or benefit from individualized care delivery. The inspectors were advised that all service users were now listed on the electoral register. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of décor and furnishings within the home are good to provide a homely environment for service users but one area of the home has been neglected and does not meet the standards expected for use by service users. EVIDENCE: Emmanuel Christian Care Home – Park House, is a modern, purpose built nursing home which provides accommodation to service users on three floors. All service users are accommodated in single bedrooms with en-suite facilities, some of which having showers. The home meets the required standards in respect of space and facilities. Each floor provides service users with lounges and dining rooms that are decorated to a good standard. The inspectors undertook a full tour of the premises. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 23 Ground floor. This floor was found to be clean throughout. This floor is registered to accommodate 30 elderly persons for general nursing care. Only 17 service users are accommodated and is staffed for full occupancy. This reduction in occupancy level has given the staff time to improve standards. All areas were clean and well maintained. First floor. This floor is registered to accommodate 41 elderly persons who require nursing care due to their dementia. Some improvements have been made with respect to orientation in the unit. Toilet doors have been repainted to make them more easily identifiable to service users. One toilet door, near to the dining room, was painted in line with an orientation programme. The inspectors noted that a draw bolt had been fitted to the outside of the door thereby preventing service users from accessing it. A draw bolt was also fitted to the inside of the door. Inspectors were advised that this toilet was for staff use. It is not acceptable to provide facilities, identified for use by service users, and deny them access. In the event of a service user entering this toilet, they could be placed at risk if they used the draw bolt to lock the door. All toilet and bathroom doors are fitted with locks that can be opened from the outside in the event of an emergency, however, this one toilet has the potential for placing service users at risk. One of the lounges has been changed to provide a sensory room. This is a quiet area for service users and has been fitted with sensory lighting. The other lounge was first inspected at 09.20 am. The seat cushions on twelve of the armchairs had been placed on their edges, thereby indicating that they were not available for use. One armchair did not have a seat cushion. Only two armchairs were available for use, one being a recliner chair but was underneath the mobile hoist. The inspectors looked underneath the one armchair seat cushion and found a number of used tissues and food debris. The cushion on the recliner chair was removed and an exceedingly large amount of food debris was found. This was reported to one of the managers of the home, who requested that staff attend to it. A further inspection of this chair at lunchtime showed that the seat cushion had been replaced with one which did not have a cover on it, but the chair had not been cleaned. Again, one of the managers requested that it be attended to. A third request for the chair to be cleaned resulted in success, although the quality of the cleaning process was poor and debris still remained. The carpet in this lounge was extremely dirty and stained. The home has effective carpet cleaning machines and cleaning staff were observed to be Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 24 cleaning corridor carpets. No attempt was made during the inspection for this carpet to be cleaned. It is essential that this carpet be cleaned or replaced if the cleaning process is not effective as it detracts from an clean environment for the service user. No televisions are currently available in the lounges. The home has ordered a wall mounted television for one lounge and are awaiting delivery. The inspectors requested to see those bedrooms that would be available in the event of a prospective service user or their family visiting the home. One bedroom contained the clothing and personal effects of a service user who was now occupying a different room. It is essential that service users have full access to all their personal property. One bedroom was found to be in an extremely poor condition. The décor was damaged and what appeared to be excrement was found on the wall and on the back of the door. The chair in this room collapsed when sat on. The other bedrooms inspected were not suitable for occupancy. Clothes belonging to other service users, personal items and toiletries were found in these rooms. It was noted that no raised toilet seats were provided on the first floor and none of the service users had been assessed with regard to toilet aids. Appropriate assessment and the provision of suitable equipment would enhance the facilities provided for service users and aid those with mobility difficulties. The home provides sufficient toilets for use by service users. Staff on the first floor stated that one of the baths was not available for use as it was not accessible via the hoist. Second floor. A number of bedrooms contained bed rail bumpers where no bed rails were in use. These had been stored at the side or on top of wardrobes. With the exception of the dining areas, this floor was maintained in a clean condition. All bedrooms in the home are fully furnished and new ‘Profiling’ beds are being provided where the use of bed rails has been identified as necessary. All rooms are central heated and have windows that can be opened to provide natural ventilation. The home is generally well lit but some of the bedrooms Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 25 are dark. One service user has continually asked for increased lighting in her room to aid her visual difficulties but this has not yet been provided. No offensive smells were found in the home and appropriate arrangements are in place for the disposal of general and clinical waste. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The use of agency staff to cover shortfalls in staff numbers does not provide consistency of care to service users. Improvements have been made to the recruitment procedure and training opportunities to assist in protecting service users. EVIDENCE: The home provides both qualified nurses and care assistants to provide care to the service users. The home also employs domestic, catering, laundry, maintenance and administration staff. The nursing and care staffing levels within the home have been agreed with CSCI and remain in effect regardless of the number of service users accommodated. Unit managers have been appointed on each floor and are supernumerary. The role of the unit managers is to oversee the care required by and afforded to service users and to supervise the staff teams. Recommendations have been made for the Unit Managers to undertake management training to assist them in leading, supporting and supervising the staff team. Evidence is held of staff supervision, however, some concerns were raised with the acting Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 27 manager in relation to the quality monitoring of care provision and the knowledge competency of some of the staff. Improvements have been made to the staff records since the last inspection. These are now organised and informative although some still require photographic identification. Assurances were given that the home will obtain its’ own camera rather than share one with the adjacent care home to amend this situation. The home has a policy and procedure for the recruitment of new staff and the files of six staff who had been employed since the last inspection were inspected. All files contained the required information and documents. POVA First clearances were obtained for all staff prior to commencement of employment and Criminal Record Bureau checks were in place. A structured induction training programme is now in place and a new induction workbook in place. This document is comprehensive, although may be daunting due to its size and the evidence of the work and evidence required to complete it. Training is now in place and up to date with the planned training programme. The home has two members of staff who are trained as trainers in Manual Handling to facilitate speedy training for new staff. New trained nurses have a preceptorship programme established when the commence working at the home. Medications training has been given to all nurses and some of the care assistants, however, due to the shortfalls identified during the inspection, the competency of trained nurses, should be reviewed. The home now employs a development coach to co-ordinate induction and foundation training. The coach is also responsible for identifying training needs amongst all staff and, where necessary, implementing this in house together with accessing external training opportunities. The number of care staff who hold NVQ qualifications is a cause for concern with less than 10 of staff holding this qualification. It is essential that this be addressed. Six of the laundry staff and two domestic staff hold NVQ at level 2. A high number of agency staff are used by the home and the inspectors were advised that a programme of recruitment is underway to provide consistency of care to service users. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a strong management structure within the home at present to promote a high level of support to staff which will enable them to provide an improved level of care to service users. EVIDENCE: There is currently no manager registered in respect of the home. The day-today management of the home is currently being undertaken by a peripatetic manager. Another peripatetic manager, and a regional manager support her. A general manager to support the manager of Park House, and the adjacent Grove House has recently been appointed. All are experienced managers and are qualified to undertake the management of the home. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 29 The management team have clearly been involved in supporting staff and providing them with the tools necessary to meet the needs of the service users. Documentation, equipment and changes to the staff team have been implemented by the management team to give staff the opportunity to improve care provision and enhance the quality of life of service users. The managers are accessible to all staff, service users and relatives each day. Relatives and service users meetings are held on a regular basis and these have been changed to offer meetings for the service users on each floor of the home. General meetings will be held for all relatives and service users in due course. Regular audits are taking place to evaluate the home and to identify areas that require improvement. Comments cards are available on the notice board in the foyer of the home and give the opportunity for both positive and negative feedback. Books are provided on each of the floors for service users or visitors to comment or to communicate with the unit managers and catering manager. Customer surveys are conducted from head office and these are sent to service users and relatives to evaluate the level of service provision. The current senior management of the home is strong and effective in relation to improvements, however, the management of individual units requires immediate and ongoing improvement. The performance management of individual unit managers requires attention. Documentation relating to money held on service users behalf was inspected. Receipts for expenditure i.e. hairdressing and chiropody, are held and the money held in a non-interest bearing account. The organisation is looking at the feasibility of accessing an interest bearing account for service users. Statements are sent to service users or their representatives on a regular basis. The amount held on service users behalf is currently excessive and relatives are being contacted to enable them to transfer money into a separate private account for those service users whose balance is high. The fire risk assessment for the home was not available. Fire drills for staff have not been conducted in line with the recommendations of Merseyside Fire Authority and should be undertaken every six months for day staff and every three months for night staff. The certificate to verify the safety of the Fire Extinguishers was not available for inspection. All other safety certificates were in place and up to date. Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 1 2 3 2 2 3 3 3 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 3 3 2 2 2 Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 6(a) Requirement The registered person must ensure that the Service User Guide and Statement of Purpose are reviewed and amended to reflect recent changes within the home. Timescale for action 30/04/07 2 OP7 15(1)&(2) 30/04/07 The registered person must ensure a service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. This remains outstanding from inspections of 30/8/05, 11/11/05, 16/05/06 and 27/09/06. The registered person must promote and maintain service users’ health and ensure access to health care services to meet assessed needs. The Registered Person must make arrangements for the recording, handling, safekeeping and safe DS0000032923.V325888.R02.S.doc 3 OP8 12(1)(a) 01/03/07 4 OP9 13(2) 01/03/07 Emmanuel Christian Care Home Version 5.2 Page 32 administration of medicines within the home. 5 OP9 13(2) The Registered Person must ensure that staff administering medication use the guidance issued by the Royal Pharmaceutical Society and NMC in respect of the safe receipt, administration and disposal of medicines in the home. The Registered Person must ensure that clear and accurate records are maintained for all aspects of medication handling. 01/03/07 6 OP9 13(2) 01/03/07 7 OP9 13(2) The Registered Person must 01/03/07 ensure medication is administered in strict accordance with the prescriber’s directions. The Registered Person must ensure all medication is accounted for. The Registered Person must ensure that a full review of the ordering procedure is undertaken to ensure that medication is available when required for residents The Registered Person must ensure that all nurses administering medication must have their competence assessed before continuing to administer medication The Registered Person must ensure that meals are provided to service users at appropriate time intervals and/or at a time of their choosing. DS0000032923.V325888.R02.S.doc 8 OP9 13(2) 01/03/07 9 OP9 13(2) 01/03/07 10 OP9 13(2) 01/03/07 11 OP15 16(2)(i) 30/04/07 Emmanuel Christian Care Home Version 5.2 Page 33 12 OP16 22(4) The Registered Person must ensure that complaints are dealt with promptly and effectively. The Registered Person must ensure that service users are protected from abuse through deliberate intent, negligence or ignorance, and that all incidents in are recorded in accordance with written policies. The Registered Person must ensure that the location and layout of the home is suitable for its stated purpose; with particular reference to the availability of lounge areas. The Registered Person must ensure that toilet facilities, identified for service users use are made available with appropriate locks. The Registered Person must ensure that bathroom facilities are suitable for use by service users who require the use of a hoist. The Registered Person must ensure that the carpet in the first floor lounge is maintained in a clean condition. The Registered Person must ensure that armchairs are maintained in a clean condition. The Registered Person must ensure that all areas of the home are maintained in a hygienic manner. The Registered Person must DS0000032923.V325888.R02.S.doc 30/04/07 13 OP18 13(6) 01/03/07 14 OP19 23(2)(a) 30/04/07 15 OP21 23(2)(c) 30/04/07 16 OP22 23(2)(f) 30/04/07 17 OP26 23(2)(d) 30/04/07 18 OP26 23(2)(d) 30/04/07 19 OP26 16/(2)(j) 30/04/07 20 OP30 18(2) 30/04/07 Version 5.2 Page 34 Emmanuel Christian Care Home ensure that all staff are appropriately supervised. 21 OP31 8(1)(a) The Registered Person must 30/04/07 ensure that an application to register a manager for the home is submitted to CSCI. The Registered Person must 30/04/07 ensure that records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. This is with particular reference to the Fire Risk Assessment, evidence of fire drills and the fire extinguisher certificate. 22 OP37 17(2) Schedule 4 (14) 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 OP28 Good Practice Recommendations A programme of NVQ training should be implemented for care staff to ensure that a minimum of 50 hold this qualification. It is recommended that the unit managers be given the opportunity to undertake management training. 2 OP30 Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Emmanuel Christian Care Home DS0000032923.V325888.R02.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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