CARE HOMES FOR OLDER PEOPLE
Park House The Parade St Marys Isles of Scilly TR21 0LP Lead Inspector
Paul Freeman Unannounced Inspection 30th October 2006 10:00 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 Park House DS0000035370.V318233.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 DS0000035370.V318233.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Park House Address The Parade St Marys Isles of Scilly TR21 0LP 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) 01720 422699 01720 422699 Council of the Isles of Scilly Mrs Lesley Catherine Burrows Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11), Physical disability over 65 years of age (2) of places Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up 2 adults with a Physical Disability (PD [E]) Service users not to exceed a maximum total of 11 Date of last inspection 28th February 2006 Brief Description of the Service: Park House provides long-term care to older people and is situated in the town of St. Marys and very close to the sea front. The home has a progressive attitude to community contact, which they actively encourage at every opportunity. The style of care provided is based upon residents individual needs within which empowerment; dignity, rights and maximising independence are central features. The Home is also committed to ensuring that changing needs are recognised and that the care provided is adjusted accordingly. There are strong links with the carers and friends of residents and the setting has a flexible approach to visiting arrangements. Day Care and short-term residential care are also available if the resources permit. All residents’ bedrooms are for single occupancy and the home is comfortably furnished. There is limited outdoor space for service users. However the town centre and a beach is in close proximity to the home. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned key inspection took place on 30 October 2006 and 31 October 2006. The purpose of the inspection was to consider the work that had been undertaken on the requirements set at the last inspection on 28 February 2006 and to inspect other core standards. Therefore some of the key standards considered included care planning, the administration of medication and food. The registered manager, residents and staff were consulted about the services and facilities provided. The environment, records and documents were also considered. There are many aspects of the facilities and services that are good and the service is focused towards the residents and users lead provision. Improvements are required in certain areas and historically the providers have a proven record of developing any areas that fall below the required standards. What the service does well:
Prospective residents are assessed to make sure the provider is able to meet their needs, preferences and choices. The prospective resident is invited to participate in the assessment and the views of their relatives or representatives and any specialist workers involved are taken into account. Good arrangements are in place to meet residents’ health needs and health professionals regularly have contact with the residents. Residents are also able to manage their own medication when this is safe. Where staff assists residents the medication is held in secure facilities and is safely administered by trained staff. Residents are very positive about the care and support provided and it is evident that positive and trusting relationships exist between the staff and residents. Residents also stated they were always treated with dignity and respect. Residents said they felt in control of their lives and were confidant that staff positively responded to their requests and any directions they give about the care they receive. It was also evident that residents are able to make their own decisions and are treated in a dignified and respectful manner by staff. Residents and visitors were very positive about the varied and nutritional menu provided. Residents commented on the good standard of food provided which reflects the resident’s choices and preferences and promotes good health. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 6 There are no barriers to residents or visitors raising any concerns or complaints. Suitable procedures are also in place to positively deal with any issues. The environment is appropriately maintained and decorated and residents said it was comfortable and homely. A good standard of cleanliness and hygiene is maintained and residents are provided with appropriate disability equipment to assist their independence. This includes a stair lift between the two floors. There are two communal areas on the ground floor and a number of bathrooms and toilets are distributed throughout the home. These facilities are within a reasonable distance from communal areas and residents bedrooms. Residents’ bedrooms are appropriately furnished and all of the rooms have been personalised by the occupant. Sufficient numbers of suitably trained staff are on duty each day and night to meet the needs of residents. Good arrangements are also in place to select, vet and recruit new staff that safeguard residents. New staff completes a programme of induction training. The home is well run and managed in a manner that promotes the best interests of the residents. Residents have confidence in the registered manager who they said was approachable and acted promptly on any issues that were raised. The registered provider has also recently appointed a new responsible individual to supervise the management of the home. The providers have put in place suitable arrangements to measure and review the quality of the services and facilities provided. In addition there are reliable arrangements in place for the staff and mangers to informally consult with residents and their visitors about the care and support provided. There is also a range of policies and procedures in place that promotes safe working practices that are designed to make sure that every reasonable step is taken to protect residents and staff. What has improved since the last inspection? What they could do better:
Although the kitchen is decorated to a suitable standard the kitchen units are beginning to show signs of wear and tear and would benefit from replacement or refurbishment.
Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 7 The arrangements to protect residents from abuse require improvement to make sure a robust policy and procedure is in place to safeguard residents. The manager said that any concerns would be reported to the statutory authorities for investigation. Improvements are required to the call bell system to make sure that residents are safeguarded. In addition some of the locks on the communal bathrooms are not appropriate and require improvement in order that residents’ dignity is not potentially compromised. The door widths in the home should be improved so that wheelchair users have easier access around the home. The induction training for new staff needs to be more detailed to make sure the staff member has the appropriate skills, competencies ands knowledge to provide the care and support required. The risk assessment and risk management arrangements need further improvement in order that residents are safeguarded. The providers also need to make sure that fire drills and staff training in fire safety measures occurs on a regular basis. This will make sure staff have the knowledge and skills to safeguard residents. 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 DS0000035370.V318233.R01.S.doc Version 5.2 Page 8 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 DS0000035370.V318233.R01.S.doc Version 5.2 Page 9 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): The standards considered are 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident is assessed to make sure the provider is able to meet their needs, preferences and choices. EVIDENCE: Each prospective resident is assessed to make sure the provider is able to meet the person’s needs, choices and preferences. All prospective residents are invited to participate in the assessment process. In addition their relatives or representatives are also consulted and the views of any professionals involved with the individual are taken into account. This makes sure the providers have a comprehensive picture of the care and support required and
Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 10 assures prospective residents and their representatives that their needs will be met. The providers do not offer a dedicated intermediate care or rehabilitation service. The manager said the home is committed to helping residents retain their independence as far as possible. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 11 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): The standards considered are 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. Each resident has a care plan that details their needs and the care and support required and provides staff with clear guidance about the care and support necessary. Good arrangements are in place to meet residents’ health needs and medication is safely and securely managed. This makes sure that residents’ health is promoted. EVIDENCE: Each resident has a care plan that details their needs, preferences and choices and the provider has continued to improve and develop the plans. The plans are regularly reviewed to make sure the appropriate care and support is
Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 12 provided. The plans also provide staff with reasonable information, guidance and direction about the care and support required. It is however advised that where residents have more complex needs more detailed directions are provided for the staff. Residents were generally satisfied with the care provided and it is apparent that positive and trusting relationships have been established between the staff and residents. Residents also stated they were treated with dignity and respect and were able to direct the care provided. The care staff said they found plans to be informative and provided useful information about the residents needs. Good arrangements are in place to meet residents’ health needs and medical services are promptly accessed when required. Residents said they had confidence in the staff regarding their health. It was also evident that health professionals regularly visit the home and during the inspection District Nurses, General Practitioners and the Chiropodist attended. Residents are also able to administer their own medication when it is safe to do so. Where staff assist a resident, medicines are held in secure facilities and good records are maintained. The registered manager who is a qualified nurse has also trained the staff to administer medication safely. There are suitable arrangements to dispose of medication that is no longer required and control drugs are appropriately managed. The provider’s have also established a suitable policy and procedure to guide, direct and inform the staff. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 13 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): The standards considered are 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise control over their lives and direct the care and support provided. A varied, balanced and nutritional diet is provided that promotes residents health. EVIDENCE: The residents stated they felt in control of their lives and the patterns of daily living are flexible. The residents also said that staff positively responded to their requests and any directions they give about the care they receive. It was also evident that residents are able to make their own decisions and are encouraged to maintain their independence as far as possible. The arrangements for visitors are flexible and it was evident that staff warmly receive visitors. Residents’ social and recreational needs are also taken into account and there are no barriers to residents accessing the community when
Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 14 it is safe. In addition a range of recreational pursuits are provided at the care home for the residents that wish to participate. The registered manager has plans to further improve and develop opportunities. A varied nutritional menu is provided that reflects the resident’s choices and preferences, which is also seasonally adjusted. Residents are able to choose the food they wish to eat at each mealtimes and the provider regularly consults with residents about the food. One residents described the meals as “wonderful”. Residents and visitors were very satisfied with the meals provided and commented that a good standard was maintained at all times. The catering staff has been suitably trained and the kitchen is clean and hygienic. The equipment in the kitchen is regularly maintained and serviced and satisfactory health and safety practises are in operation. The kitchen furniture is showing signs of wear and tear and requires improvement. The registered manager said that plans were being put in place for the work to be undertaken within the next financial year. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 15 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): The standards considered are 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A suitable complaints and whistle blowing policy is in place and there are no barriers to residents, their representatives or staff raising any concerns. The policy and procedure for protecting residents against abuse needs to be improved to make sure residents are safeguarded. EVIDENCE: The providers or the Commission have received no complaints since the last inspection visit. A satisfactory policy and procedure is in place to deal with any complaints and the provider is committed to dealing with any issues or concerns in a positive and efficient manner. Residents said there were no barriers to raising any concerns or complaints and they were confident that any issue would be dealt with promptly and to their satisfaction.
Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 16 The arrangements for protecting residents against any form of abuse remain in the process of development. The registered manager agreed to ensure that a policy is written that meets the DOH ‘No Secrets Guidance’ as well as the Local Authorities Adult Protection Procedures. The registered manager stated that plans had been established for staff to receive training about abuse. A satisfactory whistle blowing policy is also in place. This enables staff to raise any issues or concerns about abuse to a third party if for any reason they are not able to raise the issues directly with the providers. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 17 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): The standards considered are 19, 21, 22, 24, and 25. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A comfortable and homely environment that is regularly maintained is provided for residents. Some additional improvements are required to promote residents dignity and to make sure residents are safeguarded. This includes appropriate locks on bathrooms and a suitable call bell system EVIDENCE: The providers have recently commissioned an external audit of the environment and this has highlighted areas that require improvement. Plans are currently been established for work to be undertaken on a priority basis.
Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 18 This includes the refurbishment of the kitchen and the redecoration and replacement of carpets and furniture. The environment is maintained to a reasonable standard and it is evident that a programme of redecoration and replacement is in place. Residents and visitors said they were very satisfied with the facilities provided which they described as homely and comfortable. There are two communal areas on the ground floor, a sitting room and a lounge/dining room that meet the required standards. The rooms are comfortably furnished and decorated to a reasonable standard. Residents’ bedrooms are also suitably furnished and equipped and residents are able to bring their own furniture. Therefore the bedrooms have been personalised by the occupants. The bedrooms door widths however need to be increased to promote access for wheelchair users. There are a number of bathrooms and toilets distributed throughout the home and all are within a reasonable distance of the communal areas and residents bedrooms. These facilities are also maintained to a satisfactory standard. In two of the bathrooms there were no adequate locks provided and this requires attention to promote the dignity of residents. The home is clean, hygienic and maintained to the appropriate standard. There is a range of disability equipment provided at the home to assist residents to maintain their independence. In addition arrangements are made for individual residents to be assessed by a specialist worker for aids or disability equipment where required by their individual needs. Each room has a call bell system but this is only functional when the resident is in bed. This requires improvement so that residents can easily access assistance when they are in their bedrooms. Interim measures have been taken by the providers to make sure residents are safeguarded. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 19 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): The standards considered are 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. Sufficient numbers of appropriately trained staff are on duty at all times to meet the needs of residents. Robust recruitment, selection and vetting arrangements are in place that make sure staff have the required skills and that residents are safeguarded. Newly appointed staff completes an induction programme. This requires improvement in orser that a comprehensive package is in place that safeguards residents. EVIDENCE: Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 20 There are sufficient numbers of staff on duty each day and overnight. There are no concerns about the experience or manner in which the staff provide care. There are currently some staff vacancies and the substantive staff has filled any shortfalls. Additional staff are currently in the process of recruitment. Residents spoke positively about the care and support staff provided. The residents said they found the staff to be reliable, responsive and skilled in the manner they undertake their duties. The provider has made further improvements to the recruitment, selection and vetting arrangements that now meet the required standard. All new staff undertakes a programme of induction but the records do not clearly confirm that staff has the required competencies to provide the standard of care required. In addition it is recommended the providers adopt the induction training arrangements recently introduced by Skills for Care. The providers have also established an annual training programme for staff to make sure that staff has up to date knowledge and the appropriate skills to safely meet residents needs. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 21 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): The standards considered are 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. The home is well managed and satisfactory arrangements are in place to monitor the quality of the services and facilities provided. A range of measures is also in place to promote safe working practises. Improvements are required in regard to risk assessment and management and fire training for staff. This will further safeguard residents. EVIDENCE: Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 22 The home is well run and managed and residents said they felt in control of their lives. Comments from residents and staff in respect of the registered manager were positive, seeing her contribution to the home as valuable, supportive and a ‘good listener’. All felt they could approach her with any concerns or issues. In addition the manager has been allocated dedicated management time but this has been recently interrupted due to staff vacancies. The Responsible Individual who represents the registered provider has recently changed and the manager clearly has confidence in the post holder. Residents and visitors are regularly consulted about the services and facilities provided as part of the providers quality assurance arrangements. The manager is currently in the process of recording the findings and this will be available to the residents and visitors. The providers will assist residents to manage their personal allowances where no other third party is available. The monies are held in secure facilities and appropriate records are maintained. The records are also audited on an annual basis. A range of measures is also in place to promote safe working practices and this includes a number of policies and procedures. Arrangements have also been established to positively manage risks that staff and residents may experience. Although the arrangements have improved there continue to be occasions where more attention is required in assessing and planning for the changing needs of residents. The equipment and services at the home are regularly serviced and maintained and this includes the fire detection arrangements. However the records indicate the staff is not undertaking fire training at the frequency recommended by the Fire Brigade. This requires improvement so the staff group has a clear understanding of their roles and responsibilities. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 23 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 X X 3 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 2 3 3 2 2 X X X 3 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 X 3 X 3 X X 2 Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP15 Regulation 13(4)c16( 2)g 12,1a,b,2, 5b,13,6 Requirement The kitchen units must be maintained to a suitable standard. Adult protection policy and procedures must be amended to meet the national minimum standards. Appropriate locking mechanisms must be fitted to communal toilets and bathrooms. Appropriate call bell arrangements must be in place in each service users bedroom. The provider must ensure that newly appointed staff have structured induction training. Robust arrangements must be in place to assess and manage risks at the home or experienced by service users. Fire training and drills must be undertaken on a regular basis that reflects good practise
DS0000035370.V318233.R01.S.doc Timescale for action 30/06/07 2. OP18 30/04/07 3. OP21 13(4)(a) (c) 13(4)(a) (c) 18(1)(c) (i) 13(4)a-c 30/12/06 4. OP22 30/04/07 5. OP30 30/01/07 6. OP38 30/01/07 10. OP38 23(4)c-e 30/12/06 Park House Version 5.2 Page 25 standards. (Previous timescale of 30 April 2006 not met). 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 OP22 Good Practice Recommendations The width of doors should be increased to maximise access for wheelchair users. Park House DS0000035370.V318233.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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
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