Inspection on 17/10/07 for Park House

This inspection was carried out on 17th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 28/02/07

Park House 11/01/06

Park House 08/09/05

Park House 15/02/05

Park House 16/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Park House 1 Walton Park Bexhill-on-sea East Sussex TN39 3NH Lead Inspector Caroline Johnson Key Unannounced Inspection 17th October 2007 09:30 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 Park House DS0000021183.V352654.R01.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. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Address 1 Walton Park Bexhill-on-sea East Sussex TN39 3NH 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) 01424 211258 01424 732404 britheadoffice@hotmail.co.uk Mrs Jacqueline Brittain Vivienne May Tree Care Home 7 Category(ies) of Dementia (7) registration, with number of places Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the maximum number of service users to be accommodated will not exceed seven (7). That service users accommodated will be older people aged sixty-five (65) or over on admission. That only service users with a dementia type illness will be accommodated. 28th February 2007 Date of last inspection Brief Description of the Service: Park House is a detached property situated approximately one mile from Bexhill town centre. Accommodation is on two floors with a stair lift fitted to assist service users to have access to the first floor accommodation. The home has a large garden, which is shared with the care home next door that is owned by the same proprietor. The home is registered to accommodate up to seven older people who have a dementia type illness and the registered owner is Mrs J Brittain. The fees for the home as of 28 February 2007 range from £368 to £420 per week. However, the proprietor stated that the fees were being reviewed. Additional charges are made for hairdressing, chiropody and dry cleaning. The home ensures that copies of the inspection report are made available upon request and there is always a copy available in the home to refer to. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the inspection process an unannounced site visit was carried out on 17 October 2007 and it lasted from 09.30 until 4.45pm. The manager was on leave at the time of the inspection. However, an extra care worker was brought in to free up a senior member of staff to facilitate the inspection. In addition the owner spent part of the day at the home. Time was spent speaking with two care staff individually in private. There were also opportunities to meet with the residents in the lounge and dining room and to observe staff interactions with the residents. A wide range of documentation was seen including the care plans for three residents. In addition records held in relation to menus, complaints, medication, health and safety, staff training and quality assurance were seen. A full tour of the building was carried out. Following the inspection attempts were made to contact the relatives of three residents to seek their views on the quality of the care provided. However contact was only achieved with two relatives. Comments received included that ‘staff are caring, very impressed with the home’ and physically their relative is ‘looking very well and putting on weight. ‘There is a stable staff group and staff phone if there are any concerns or if they need anything’. What the service does well: What has improved since the last inspection? The office, which was originally in the dining room, has moved to the small conservatory and there is now additional seating in the dining area. The result is a more spacious environment for the residents and a choice of seating areas. A new dishwasher has been purchased for the home and as staff previously carried out the task of washing dishes this should now speed up the process. Following consultation with Environmental Health a new procedure for taking washing to the laundry area has been implemented thereby reducing the risk of any cross infection. An additional staff member is employed to work at least four evenings a week and this is shortly to be increased to seven evenings a week. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park House DS0000021183.V352654.R01.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 Park House DS0000021183.V352654.R01.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 good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives are provided with appropriate information upon which to make a decision about accommodation. EVIDENCE: Since the last inspection the statement of purpose has been updated and it now includes information about the owner and the manager and their skills and qualifications. One relative spoken with stated that one of the main reasons for choosing Park House was the size and how it was more like an ordinary domestic house. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. Some of the risk assessments in place are inadequate and do not safeguard against the risk of accidents/incidents occurring. EVIDENCE: Two care plans were examined in detail and another was partly examined. It was evident that the plans were reviewed and updated at regular intervals. The owner had also examined the care plans a few days prior to the inspection and highlighted any areas that needed to be updated. When residents’ needs changed, for example when a resident had become aggressive, a CPN was called in and arrangements were made for this resident to have their medication reviewed and the situation was resolved. Weights are monitored monthly and in one case when it was noted that the resident was not eating Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 10 well, a food journal was kept and emphasis was placed on ensuring that an adequate diet was taken. Care plan meetings are generally held annually and relatives are invited to these. Records seen showed that in some cases these were overdue but the owner had highlighted that they were to be planned. Staff observed in the course of their duties were courteous and spent time with residents chatting and ensuring that their needs were met. A staff member advised that the district nurse visits as and when required. One of the residents has diabetes and staff check their blood sugar once a week. A staff member stated that the resident’s blood sugar readings have been stable but they were not clear what action should be taken if the reading were too high or too low. Another staff member who only works part-time in the home stated that as far as she knew the machine for checking blood sugars was new and had not been used yet. She advised that she had not had any training on diabetes. The risk assessment in place in relation to diabetes is not clear. The risk is not clearly defined and it does not state the action to be taken if the resident’s blood sugar reading is too high or too low. One resident suffers from epilepsy but this is well controlled. One of the staff on duty had received training on the subject but another had yet to receive training. There was no risk assessment in relation to epilepsy and no information about the type of seizures that this resident has experienced. Staff were able to describe the seizures they had witnessed. A chiropodist visits the home every six months. Since the last inspection two of the staff have attended a course on risk assessment. The arrangements in place for the storage and handling of medication were in order. The home has recently purchased a new controlled drug cupboard. A staff member stated that all staff had attended training on medication in recent months. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a good range of activities in place to ensure that residents are kept stimulated. A review of the vegetarian menu is required to ensure that residents receive a varied and balanced diet. EVIDENCE: The activity programme for the week prior to the inspection showed that residents were offered a range of interesting activities including a visit from the Land Army Girls, card games and board games, decorating a pumpkin, a visit from the hairdresser and poetry reading. Emphasis has been placed on trying to improve record keeping in this area and there was evidence that staff are now recording the level of participation of each resident. One resident advised that she has a newspaper delivered each day and she enjoys spending the morning reading the paper. As the home is next door to another home owned by the same owner they join together whenever an external entertainer is booked and this generally happens once a month. A Holy Communion service is held once a month and a lay minister also visits the Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 12 home once a week. The hairdresser visits once every other week. A staff member stated that one of the residents likes to call out the numbers when playing bingo. Visitors are welcomed to the home at any reasonable time. Staff generally interacted well with the residents. One resident was given regular reassurance as she had had a flu injection. Residents were given the opportunity of where to have their lunch and a staff member was heard to ask a resident if their drink was strong enough. The main menus showed variety and appeared well balanced. Two residents are vegetarian and there is a separate vegetarian menu. There was a very heavy reliance on quorn and other frozen products. This menu needs urgent review. One resident was given the choice of what type of sandwich they wanted and they were able to state their choice. When the resident was asked to go to the dining room they stated ‘no’. Each of the three staff on duty tried in turn repeatedly to persuade the resident to go to the dining room for their lunch and eventually the resident shouted at one of the care staff. The sandwiches were then brought to the resident who continued to doze in the chair. When pressed further the resident stated ‘yes I want them but on my own’. Eventually this choice was respected. It was noted later, on reading through the daily records, that this resident had had an extremely large breakfast. It was acknowledged that it is difficult to judge when to encourage someone who is a poor eater to eat and when to accept that this person has made a definite choice not to eat. Clearer guidance needs to be provided in this resident’s care plan. It was not clear in one resident’s care plan if they were vegetarian. A staff member stated that this resident claims to be vegetarian but they will eat ham. A relative of a resident spoken with after the inspection advised that whilst they don’t see the food served they have been advised that their relative is eating well and they are putting on weight. Park House DS0000021183.V352654.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures in place enable anyone wishing to make a complaint to do so. EVIDENCE: The complaint procedure is clear and it is on display in the home. Records showed that there have been no complaints since the last inspection. The last recorded complaint was in March 2006. No complaints have been made to the Commission about this home. The two relatives spoken with stated that they had no complaints about the home. The staff training matrix showed that all but one staff member received training on the protection of vulnerable adults in 2007. There is a policy in place on the protection of vulnerable adults. Park House DS0000021183.V352654.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained but attention needs to be placed on ensuring that the kitchen is kept clean at all times and that all equipment is kept in good working order. EVIDENCE: Since the last inspection the office has moved from the dining room into the small lounge. There is now a seating area to the rear of the dining room. Having a separate office means that the manager can take calls and meet with relatives and staff in private. Bedrooms seen were decorated to a good standard. Some of the residents brought photos and ornaments when they moved in and this ensures that the rooms are very homely. At the time of Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 15 inspection there were two vacancies but it was expected that they would be filled in the near future. A new dishwasher had been delivered and was due to be fitted within the coming days. It was noted that the door on the cooker was not closing properly and the cooker needed to be cleaned. Staff spoken with advised that it was still working. The microwave and the exterior of the fridge were also dirty. There was a cleaning rota on the wall showing when tasks were due and who carried them out. A new tumble drier had been installed in the laundry. Staff advised that since the last inspection they now take washing through the front door and around the back to the laundry rather than through the kitchen area. Apart from the kitchen area all other areas seen were clean. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 good. This judgement has been made using available evidence including a visit to this service. The emphasis placed on staff training will be of benefit to the residents and with further training on diabetes and epilepsy this will improve even further. EVIDENCE: There are two care staff on duty throughout the working day. In addition to this the manager has six hours a week dedicated management time. A cleaner is also employed to work two mornings a week. There is one waking night carer on duty. In addition the staff rota seen showed that four evenings a week there is an additional worker between the hours of 7pm to either 9pm or 10pm. The owner confirmed that this would be increased to seven evenings a week. At the time of inspection there were five residents. The staff training matrix was not fully up to date and the owner confirmed that since the last update a number of staff have attended further training courses. Emphasis has been placed on ensuring that all staff receive mandatory training and in recent months a number of the staff team have also received training on the Mental Capacity Act and some are booked to attend future courses. Two staff are also booked to attend a course on Alzheimer’s disease. Further training needs to be arranged in diabetes and epilepsy. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 17 The training matrix showed that three staff have completed NVQ at level two or above. A member of staff spoken with advised that she has agreed to do NVQ level three and is waiting on confirmation of the start date. As the manager was on leave there was no access to staff files. However, the owner brought a staff file from another care home as the carer concerned works in both homes. The file contained an application form, two references, job description, identification, pova check and details of induction. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 good. This judgement has been made using available evidence including a visit to this service. The home’s quality assurance system is good but it is not currently used to its full potential. EVIDENCE: The registered manager has completed NVQ at level three and four. Staff spoken with stated that they are ‘well supported’ by the manager. Within the staff file seen there was evidence that the staff member had received supervision on a regular basis and one of the staff spoken with also confirmed that she receives regular supervision. The second carer advised that she Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 19 works between two homes and she has received supervision in the other home but not in Park House. Staff meetings are held on a monthly basis. Minutes for the last meeting were seen and it was noted that advice was included for staff on the action to be taken to manage a resident who displays a particular behaviour at mealtimes. Having discussed this advice with the owner it was agreed that the advice given to staff needs to be reviewed. As part of the home’s quality assurance system a series of audits are carried out on a quarterly basis by the manager. Records showed that audits on activities, care plans, medication, personnel files, risk assessments, health and safety and food and fluids had all been carried out in September 2007. Very few action points were raised as a result of the audits. The owner as part of her Regulation 26 visits also periodically checks progress on care planning and on the other areas referred to above. As stated previously the owner had identified a number of areas in care plans where updating was required. Many of the areas referred to should have been picked up in the quarterly audits. In addition some of the areas raised in this report should also have been picked up in the quarterly audits. The owner advised that she had recently carried out a Regulation 26 visit but the report was still being typed up. The last report available was for July 2007. Satisfaction questionnaires were also sent to the relatives of the residents to seek their views on the quality of the care provided in the home and feedback was given on the outcome. Following the inspection attempts were made to contact the relatives of three residents to seek their views on the quality of the care provided. However contact was only achieved with two relatives. Comments received included that ‘staff are caring, very impressed with the home’ and physically their relative is ‘looking very well and putting on weight. ‘There is a stable staff group and staff phone if there are any concerns or if they need anything’. The home has a good history of reporting any notifyable events. However, one incident was noted that had not been reported. The home had however, dealt with the incident well and had taken appropriate action. Bath temperatures monitored on the day of inspection were within agreed safety limits. Records show that the home monitors hot water temperatures on a regular basis. In relation to fire safety, fire drills are held regularly and the last drill recorded was in June 2007. The evaluation carried out refers to staff safety only and there is no reference to the residents. Tests are carried out on a weekly basis in relation to call points, alarms and emergency lights. Staff received instruction in fire safety in August 2007. Following the last inspection specialist advice was sought in relation to the stair gates and the advice obtained was that it is acceptable as long as staff have immediate access to keys and it is part of fire drills that gates are open. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 20 There was a wide range of certificates in place showing that equipment and gas and electric had been serviced at regular intervals. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 21 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 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 X 2 Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 13(4a,c) Requirement Staff must receive training in writing risk assessments so that they are explicit including the perceived level of risk and any action taken by the home or staff to minimise the risk of an accident/incident occurring. [This was a requirement of the previous inspection timescale 30/04/07 and it has been partly met in that two staff received training. However a risk assessment carried out in relation to diabetes must be reviewed and updated and a risk assessment in relation to epilepsy must be drawn up]. The vegetarian menu must be reviewed and updated to ensure that it is varied and well balanced. The kitchen area must be kept clean. Staff must receive training on diabetes and those not yet trained must receive training on epilepsy. A review must be carried out of DS0000021183.V352654.R01.S.doc Timescale for action 15/12/07 2. OP15 17(2) Sch 4 para 13 23(2d) 18(1,c,i) 30/11/07 3. 4. OP26 OP30 15/11/07 30/12/07 5. OP33 24(1) 30/12/07 Page 23 Park House Version 5.2 the home’s quality assurance system to ensure that it is thorough and that shortfalls are identified along with the action to be taken to address issues. 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. Refer to Standard OP19 OP38 Good Practice Recommendations The cooker should be checked to ensure that it is in good working order. A more thorough evaluation should be carried out in relation to fire drills. Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Park House DS0000021183.V352654.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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