Inspection on 02/05/07 for Park House Care Home

This inspection was carried out on 2nd May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Park House Care Home 29/11/07

Park House Care Home 17/01/07

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 2nd May 2007 09:15 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.V331205.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. Emmanuel Christian Care Home DS0000032923.V331205.R01.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 Interim Manager in post. 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.V331205.R01.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 8th January 2007 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 Health Care Limited. 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 elderly 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 adequate numbers 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 and maintenance staff. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over two days by a regulation manager, two regulatory inspectors and a pharmacy inspector. A total of 41 inspector hours were spent in the home. The inspection was led by Jeanette Fielding, Regulatory Inspector who was accompanied on the first day by Jennifer Tweedle, Regulation Manager and on the second day by Helen Carton, Regulatory Inspector and Maggy Howells, Pharmacy Inspector. During the inspection, records relating to the care required by and afforded to service users were inspected. Staff records were inspected and were found to be in order and to contain evidence of training. A tour of the building provided evidence of on going improvements to provide a homely environment for the service users. All areas of the home were clean and well maintained. Décor and furnishings are of a good standard throughout the home. Service users, relatives, staff and management were spoken to during the inspection and all comments were positive about the changes within the home. Menus show that a nutritious diet is offered to all service users and that a choice of meal is available. The inspectors were advised that a review of the menus is to take place. Medications are handled in accordance with the homes’ policy and procedure and are now administered safely. What the service does well: What has improved since the last inspection? Considerable improvements have been made since the last inspection. Detailed care plans are now in place for all service users. These are informative and contain full risk assessments together with risk management Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 6 strategies. Daily reports completed by staff are informative and provide evidence of the actual care given. A full staff compliment is now employed and all new staff have been recruited in line with the homes policy and procedure and the advice given by the Criminal Record Bureau. A high number of training events have recently taken place with all staff having training in adult protection. Staff records are now up to date and contain all necessary information. Service users health care needs are met and care is given by staff in a sensitive way. All aspects of handling, recording and administering medication within this service had significantly improved. All nurses have been assessed as competent to deal with medications. The home is clean, bright and welcoming and is well maintained. Health and safety issues are addressed and all safety records are now in place. A new manager has been appointed to the home who is qualified and experienced. 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.V331205.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 Emmanuel Christian Care Home DS0000032923.V331205.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): 1 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Service User Guide would benefit from review to ensure that current and prospective service users have full information in line with the updated Statement of Purpose. EVIDENCE: The Statement of Purpose has been reviewed and updated to reflect changes that have recently taken place within the home. This document is extremely detailed and is available to be viewed in the reception area. The Service User Guide has not yet been reviewed and updated. This document would benefit from review to include a summary of the updated Statement of Purpose. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 9 The fees for the home range between £389 and £578 per week. In addition to this is the fee in respect of the nursing element, as assessed, for those service users accommodated for nursing care. No new service users have been admitted to the home since the last inspection. No pre-admission assessments for new service users were therefore inspected. The home does not accommodate service users for intermediate care. Emmanuel Christian Care Home DS0000032923.V331205.R01.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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in the care planning process, and the supporting documentation, provides staff with full information to enable them to provide the appropriate level of care to each individual service users and to promote a good quality of life. EVIDENCE: All care plans have been reviewed and updated since the last inspection. New documentation has been provided for some plans and all plans inspected were found to be organised and up to date. The care plans now include full information regarding the specific care needs of each service user and are appropriate to their individual health, personal and social care needs. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 11 All care plans are now laid out in a specific order, with an index at the front of the file to enable staff to access appropriate information with ease. This format is used for all service users throughout the home. Ground Floor. This unit provides general nursing care for elderly persons. The care plans in this unit were generally good at the last inspection and have continued to develop and improve. Care plans are detailed and informative to give full information to the staff. The plans are reviewed each month and as necessary in line with service users changing needs. Risk assessments are in place and risk management plans have been prepared to reduce or remove any potential risks to the service users. Wound management plans are in place and photographic records are used to provide evidence of improvement or deterioration of wounds. The services of the Tissue Viability Nurse Specialist is sought and records are held of any recommendations made, or of changes in treatment that are required to promote healing. The daily records completed by the staff provide evidence of the actual care given by the care staff, and nurses, and these records are detailed and informative. First Floor. This unit provides nursing care for elderly people who have dementia. The care plans for service users have greatly improved since the last inspection. Information is now recorded on how the individual service users’ dementia is displayed and of the action to be taken by staff to meet their specific needs in relation to this. Some service users are identified as being at risk from themselves, other service users or the activities of daily living and specific risk management plans have been prepared in respect of these. Instructions are recorded for staff with regard to the use of the service users name and time and place as appropriate. Care plans and risk assessments are in place for the environment, communication, eating and drinking, washing and dressing, mobilising, sleeping, elimination, activities, safety in bed and any relevant nursing needs. Assessments are also now in place with regard to capacity and consent in preparation for the implementation of the Mental Capacity Act which takes effect in October 2007. Some of service users have general nursing needs, together with their dementia, and the care plans contain information on how these needs are to be met. Daily records completed by the staff are detailed and informative and provide evidence that service users identified care needs are being met. Records are held of visits to, and by, other healthcare professionals and records are made of any changes to be made to their care. Service users family’s are encouraged to give details of the service users past life and of their individual preferences as the service users do not have the ability to express these themselves. This information also provides staff with greater understanding of the individual, their lifestyle, their family and their past life to enable a more person centred level of care to be given. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 12 Second Floor. This unit provides general nursing care to elderly people. The care files on this floor have also been improved to provide full information regarding service users needs. Full details are recorded of the care required by and afforded to service users. All tests on blood sugars of those service users who have diabetes have been made in accordance with the plan of care and are recorded appropriately. Throughout the home, new documentation is held on the actual care given to service users, records of nutritional and fluid intake and of regular turning of those service users who are at risk of developing pressure sores. These are now held in individual booklets and stored in the service users own bedroom. These booklets provide clear evidence that the assessed needs of the service users are being met. Service users who are at risk of falling out of bed are risk assessed. Profiling beds are provided for those service users who require rails to prevent them falling or if they require to be moved whilst in bed to ease pressure on particular areas of the body. A small number of service users have been assessed as unsuitable for the use of bed rails and have been provided with beds which can be lowered to the floor. Mattresses are placed at the sides of these beds to ensure that the service user does not sustain any injury if they roll from the bed. These assessments, and the use of appropriate beds, have dramatically reduced the number of falls and subsequent injuries as a result. Pain assessments are undertaken on some service users and discussion regarding this took place with the Unit Manager on the dementia unit. He explained that a system was in place for some service users but that a different form of assessment was being considered for all service users who are unable to express, or understand, that they have pain. This will provide staff with a greater understanding of service users needs and may identify when pain is the cause of challenging behaviour which can then be dealt with appropriately. All analgesics are given on the advice of the GP who will provide a prescription giving details of the dose and frequency of medications wherever necessary. Records are held on all files of referrals made to external healthcare professional which includes GP’s, Tissue Viability Nurse Specialists, Continence Advisor, Chiropodists, Dentists and Opticians. Some service users have been referred to the Occupational Therapist for assessment with regard to the chairs. These service users are unable to use normal armchairs due to their postural or medical condition and require the use of speciality chairs which are suited to their needs. The visit from the Occupational Therapist was awaited at the time of the inspection. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 13 Staff spoken to at the time of the inspection were now enthusiastic about their work. They said that the atmosphere within the home was now less strained and that they were more organised and effective in their work. Staff were observed to be spending more time chatting with service users and were sensitive to their needs. The medications within the home were inspected by a Pharmacy Inspector. Medication was stored safely and hygienically within the home. Only trained, competent staff were responsible for the handling and administration of medication. This reduces the risk of medication errors and helps to protect the health and wellbeing of residents. Records, including Medication Administration Record charts (MARs) were generally clear and accurate. A sample audit of records and stock showed that medication was given as prescribed. Where necessary, MARs contained personalised guidance for the use of creams and ‘when required’ medication so that individual residents were given their medication correctly. It was recommended that the recording of creams and other external preparations be reviewed so that clear, accurate records of the use of these preparations are kept. Regular checks were carried out by senior staff to ensure that the quality of medicines management within the home continued to improve. It was evident from observation at the time of the inspection that service users privacy and dignity were respected. Personal care is given to service users in their bedroom or in the bathroom as appropriate. Bathrooms and toilet doors are fitted with locks that can be opened from the outside in the event of an emergency, although service users who are unable to attend to personal matters alone are assisted by staff. The inspectors observed one member of staff speaking to a service user, who has dementia, in a very caring manner. The member of staff maintained eye contact, held the service users hand and reassured the service user when telling her what she was going to do. One member of staff was assisting a service user to take lunch in an inappropriate manner. This was raised with the acting manager who dealt with the matter immediately. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the menus and presentation of meals to provide a greater quality service provision and ensure service users nutritional well being. EVIDENCE: The home employs two activities co-ordinators, one full time and one part time. At the time of the inspection, the part time co-ordinator was off sick resulting in the full time member of staff providing activities and stimulation to all service users. He had re-organised his schedule to ensure that all service users were given the opportunity to participate in activities and a written record of the activities that each takes part in was maintained. Service users spoken to confirmed that they were offered the activities and were given the choice as to whether they participated. The home provides a good range of books, board games and activities opportunities and external entertainers visit the home regularly. Time is spent with service users in groups or on a one to one basis. The programme of activities is displayed on the notice board in Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 15 each of the units and a further copy of the programme is given to all individual service users. Ministers now visit the home on a regular basis and provide services for all service users as they wish. Some service users are taken out by their relatives but one relative spoken to said that she had not seen any of the service users taken out by staff to the nearby park or to the shops where they could enjoy ‘people watching’ or make purchases of their own choosing. One service user who is cared for in bed on the second floor of the home has a television in the room but is unable to see it due to the rails and bumpers on the profiling bed. Consideration should be given to raising the television to enable the service user to see it. Friends and relatives are encouraged to visit the home has often as possible. Some relatives have chosen to assist in the care of their relative and visit the home at mealtimes so that they can help. This is appreciated by the staff and is a comfort to the relatives who wish to make a contribution to their relative‘s care. Service users are encouraged to take control over their life, and risk management plans are in place to assist them to do this. Choices are offered in all aspects of daily life and the care plans now include individual preferences regarding time of rising and going to bed. Staff spoken to confirmed that service users choices were now respected and that every effort was made to respect their preferences. A cooked breakfast is available on request although the inspectors were advised that few service users requested this and were happy with cereal or porridge and toast with tea or a drink of their choosing. A number of relatives spoke about the meals and said that their relatives would not comment to me, but had said that the meals were better than they used to be with the exception of the vegetables. These were hard and not appetising. One relative said that it was just fashionable to have ‘al dente’ vegetables, but older people liked them to be cooked properly. One service user said that the soup was ‘thick and a bit like glue’. Soft foods and special diets can be provided on the advice of the GP, dietician or at the request of the service user. Service users choose their meal in sufficient time for the catering staff to prepare it, although some change their mind when the meal is served. Sufficient food is provided to each unit to allow for this or if a service user requested a second helping. One service user who takes a soft diet said that there was often little choice as many of the foods that they used to enjoy, were not available in soft form. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 16 Nutritional assessments are undertaken on all service users and daily monitoring of food intake is recorded where necessary. These records were found to provide evidence that fortified foods and food supplements are given appropriately together with a record of fluid intake. Service users are weighed regularly to monitor and ensure that they have sufficient nutrition. New weighing scales have recently been provided and the weight records indicate that the previous scales may have been faulty and given false readings; consequently all service users are now monitored in respect of their weight, as it is not possible to accurately monitor weight gain or loss over a longer period. Only one set of sit-on scales have been provided and are required to be taken to each floor to weigh the service users. Consideration should be given to providing appropriate equipment on each floor. The meals are prepared in the main kitchen on the ground floor and are transported to the units in commercial Bain Marie’s. The meals remain hot until they are served. Discussion took place with the acting manager with regard to the meals. The manager stated that the menus were to be reviewed and that every effort was being made to prepare all meals using fresh products which is supplemented with frozen vegetables to enable out of season foods to be provided. The review of the menus is to take place following discussion with service users and their relatives in order to include the preferences and choices of service users. Meals are served either in the dining room or in the service users own bedroom as appropriate. Dining tables were attractively laid with table centres and condiments appropriate to the meal being served. The inspectors observed the meals being served during the two days of the inspection and, apart from one incident, staff were noted to be assisting service users with their meals in a dignified way. They sat at the table next to the service user and used appropriate cutlery. The meal was not rushed and service users were given time to enjoy their meal. The meals seen appeared appetising. The menus provide evidence that a varied and balanced diet is offered to all service users. Some service users were served their meal in their bedroom and this was done so appropriately with assistance being given as necessary. The main kitchen was clean and organised and sufficient food stocks were available. Fresh foods are delivered to the home on a regular basis. The dining rooms on each of the units were clean and sufficient cutlery and crockery was provided. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 17 The inspectors were concerned to note that staff handbags and coats had been placed in cupboards in the service users dining rooms. Lockers are provided in the staff room but it appears that these cannot be locked. The storage of staff personal items in these dining room cupboards is not acceptable as these areas are neither secure nor appropriate. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 18 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Training has been given to all staff on adult protection and adult abuse to ensure that service users are protected from abuse. 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 the Statement of Purpose. A low number of complaints have been received by the home since the last inspection. The records show that these have dealt with appropriately and within the timescale detailed in the procedure. Extensive training on adult protection and adult abuse has been given to staff. All staff have undertaken this training and new staff who have recently been appointed have been given training as part of their induction training programme. The home has a copy of Wirral Borough Councils’ Adult Protection Information book together with a copy of No Secrets (a guidance document for service providers). Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 19 Detailed risk assessments have been undertaken on service users to protect them and comprehensive risk management plans have been put in place. Staff spoken to during the inspection confirmed that they had undertaken the training and were able to demonstrate that they were aware of the different types of abuse and of the action that would be taken in the event of this being suspected. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 20 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): 19, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of décor and furnishings remains good and improvements have been made to the ambiance of the home to provide a pleasant and safe environment for the 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 have 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. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 21 The inspectors undertook a full tour of the premises. All areas were found to be well maintained with the exception of one shower room on the second floor which would benefit from some redecoration and removal of stains from the floor. Improvements have been made to the lounges to provide comfortable, homely areas and all carpets and furnishings were found to be clean and in good condition. One lounge on the first floor has been provided with sensory lighting and is used as a quiet area for service users. Televisions are provided in all other lounges and background music is provided in corridors and some lounge areas. Dining rooms are appropriately laid out with appropriate furniture which is in good condition. Refrigerators are provided in dining rooms but it was noted that some staff had chosen to store their lunches in these. No staff names had been placed on these items and so it was not possible to identify those items which belonged to staff or service users. Bedrooms had been personalised by service users, their relatives and the staff with pictures, photographs and items of memorabilia to provide a warm and homely environment. Additional care has been given for those service users who are accommodated due to their dementia to provide items to stimulate their memory. Staff pay particular attention to assist those service users who do not have family to help personalise their rooms. Vacant bedrooms were found to be laid out in preparation for viewing by prospective service users and their family. These rooms were attractive, had recently been redecorated and had colour co-ordinated curtains and bedspreads. Responsibility for ensuring that all rooms are colour co-ordinated has been given to the housekeeping team who ensure that sufficient supplies of each design are available. Work continues to take place to provide a stimulating environment for those service users who have dementia. Doors to toilets have been painted turquoise to clearly identify them. On one corridor, pegs have been fitted to the walls and the staff have hung handbags and hats on them. Observation of service users showed that they enjoyed wearing the hats and carrying the handbags around. The staff stated that they were free to touch and take these as they wished and that service users appeared to be calmer as these items would normally have belonged to another service user and taken from them to be returned to their owner. The success of this has triggered ideas for other corridors on the first floor and a decision has been made for the next area to be focussed on transport. Other ideas are now being considered. All rooms are central heated and have windows that can be opened to provide natural ventilation. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 22 Hoists and aids are provided by the home to assist service users. These are regularly serviced to ensure the protection of service users. All areas throughout the home were clean and no offensive odours were noted. The improvement plan for the home includes the replacement of extractor fans in bathrooms and toilets to provide a more effective ventilation system. Additional work is being undertaken within the grounds of the home. One seating area is being improved and colourful flowers are being planted. Raised flowerbeds are to be fitted and the small herb garden is to be extended. The garden area presents as a problem to those service users who have mobility difficulties as the home is set on a hill and so ramps are provided around the grounds. A secure garden area is provided although this area has not yet been improved. Shrubs are provided in all garden areas but these do not provide any colour. One tree in the garden has died and has been earmarked for removal but this work cannot take place as a bird has nested in it. The tree will be removed later in the year. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff morale is improving and sickness levels have reduced to provide service users with a consistent approach to care and improve their quality of life. EVIDENCE: The home has recently held a major recruitment drive to recruit both qualified nurses and care assistants. Approximately 6 weeks prior to the inspection, 900 agency care staff had been used in one week to cover shortfalls in the staff numbers. In the week immediately prior to the inspection, no agency staff were required as the home had employed a full complement of staff. All new staff were required to complete an application form prior to interview. Records are held of the interview and successful candidates then had two references taken. Protection of Vulnerable Adults registers were checked and Criminal Record Bureau checks applied for. Due to the significant shortfalls in staffing levels, staff have been recruited utilising the advice on the CRB website relative to exceptional circumstances. All future staff must have full CRB clearance prior to commencing work at the home. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 24 A unit manager is employed on each of the floors to oversee the care of service users and to supervise the staff. These hours are supernumerary. Arrangements are in place for two of the managers to undertake an NVQ in management at level 4 whilst the other manager is currently training to be a Tissue Viability Nurse Specialist. The unit managers work closely, and take responsibility for auditing each other’s unit. The unit managers are responsible for supervising the qualified nurses, who, in turn, supervise the care staff. A high number of training courses have been provided for all staff to increase their knowledge and understanding of the care required by the service users. Evidence of training opportunities was seen in each of the units and in the staff room. Details of individual training is displayed and it was evident from the number of staff who had put their names on the list that they are enthusiastic to further their career. Care staff are now enthusiastic about working towards NVQ qualifications as the number of care staff who hold this is below an acceptable level at present. The home provides both qualified nurses and care assistants to provide care to the service users. The home also employs housekeeping, catering, laundry, maintenance and administration staff. A head of housekeeping position has been created and a member of the housekeeping team was successful in attaining this position. She is responsible for overseeing and supervising her team and for monitoring the standard of cleanliness within the home. The housekeeping staff have made requests for training and the acting manager is currently looking to see what is available as there is no NVQ qualification at level 2 in this field of work. The catering team are managed by a catering manager who is responsible for all food purchases and the meals prepared for service users. The catering staff and the kitchen assistants have all made requests to undertake NVQ training. The laundry staff continue to be effective in providing a good quality service for the home and service users personal clothing is carefully laundered. A full complement of laundry staff is now provided. Training has been given to all staff on adult abuse to ensure that service users are protected. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35 and 38. 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 in place which is well supported by the senior staff within the home to ensure that service users are protected and given a good standard of care. EVIDENCE: A new manager has been appointed to the home and had been in post for only four weeks at the time of the inspection. The peripatetic manager, who had been responsible for the home for the previous six months, during the period of improvement, was planning to leave the home to take up another position Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 26 for the company on the day following the inspection. An application to register the new manager should now be submitted to CSCI. A new position of General Manager has been created to oversee both Park House, and the adjacent Grove House which is also owned by Four Seasons Healthcare. The role of the General Manager is to oversee the running of the two homes and to support the individual managers. It is evident from discussion with the management team, from observation at the time of the inspection and from the records held that the service is now run in the best interests of the service users. The home holds small amounts of money for service users in a resident’s bank account which is independent from the home. Some service users were noted at the last inspection to have excessive amounts of money in this account which was not interest bearing. Arrangements have been made for these service users to have their own accounts which will gain interests. This has been arranged with the support of family members and advocates. The fire risk assessment for the home has now been completed and regular fire prevention training is given to all staff together with fire drills and training on the action to be taken in the event of fire. Tests are made on the fire detection equipment and a record of these tests is held in the home. All safety certificates were in place and up to date. It is strongly advised that secure facilities be provided for staff personal items in accordance with the requirements of The Workplace (Health, Safety and Welfare) Regulations 1992. Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 27 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 N/A X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 28 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 OP38 Regulation 8 (1) Requirement The Registered Person must ensure that an application to register the manager of the home is submitted to CSCI. Timescale for action 29/06/07 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 OP1 Good Practice Recommendations The Service User Guide should be reviewed and updated to reflect the recent changes within the home and of the service provided. The recording of the administration of creams and other external preparations should be reviewed to ensure that clear, accurate records of the use of these preparations are kept. Consideration should be given to the provision of suitable weighing scales in each of the units. Appropriate and secure facilities should be provided for staff personal items. 2. OP9 3. 4. OP22 OP38 Emmanuel Christian Care Home DS0000032923.V331205.R01.S.doc Version 5.2 Page 29 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.V331205.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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