CARE HOME ADULTS 18-65
Park House 157 Park Lane Hornchurch Essex RM11 1EH Lead Inspector
Rhona Crosse Unannounced Inspection 23 June 2005 14:00 & 6 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Park House Address 157 Park Lane, Hornchurch, Essex RM11 1EH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01708 707370 Mr Michael Joseph Prior Mrs Harjinder Kaur Prior Mrs Harjinder Kaur Prior CRH Care Home 5 Category(ies) of LD Learning disability (5) registration, with number of places Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 10 March 2005 Brief Description of the Service: Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced so the home did not know the inspector was coming. The inspector arrived and shortly afterwards the manager/proprietor came to the home. Although this is an unannounced inspection statutory records required by legislation must be available for inspection. No access was available to staff employment records, staff training records or staff supervision records. There was no copy of the staff rota held in the home. Health and safety records were also not available. At the previous unannounced inspection in March 2005 staffing employment records, staff training records and staff supervision records were not available. At this unannounced inspection these records were not available for inspection Mrs Prior the manager/proprietor stated that Mr Prior was responsible for these areas and was on holiday. However, there must be systems in place to enable these records to be available for inspection at any time. A date and time to return to the home to gain access to these records was arranged. The return visit was arranged for the 6 July 2005 at 10.30. At this visit there were no copies of past staff rotas available for inspection. These are statutory records and must be available for inspection. The service sheets for the fire alarms and emergency lighting could not be found (although it was said that these had been serviced this year (2005) the home could not produce the evidence of this. A small book identifying a visit on the 3/7/04 was the only information available. Any further failure by the home to ensure that statutory records are available for inspection will result in formal action being taken by the Commission. What the service does well:
Each new service user has an assessment carried out by the home. From this assessment a care plan and risk assessment are drawn up. This details the needs, likes and dislikes of the service user along with any potential risks being identified. Ongoing care plans and risk assessments are being updated as needs change. Health care needs are being attended to. The medication records inspected and the storage of medication was good. In discussion with service user’s they appeared confident that Park House is ‘their home’ and that they can choose what they do when they are at home.
Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 6 Service user’s spoken with said ‘I like living at this home, I feel safe here, there are no men’ (all the service user’s are female). Another comment made was ‘I like going to college we have a laugh there and you do interesting things.’ When service user’s were asked if they were worried or unhappy about anything who would they speak to? Two service user’s said ‘Jinder (the manager/proprietor) I would speak to Jinder she would sort it out’, ‘I would wait for Jinder she would help me, she’s very busy but she would sort it out’. A third service user said ‘I would tell the carer’s they would help me, I would tell any of them if I was not happy’. All service users said they liked the food, one stated ‘I don’t like swede or parsnips I leave them.’ Service users said ‘the carer’s are nice they look after us, they help us’. Service user’s rooms were filled with personal possessions on display. All bedrooms were very individual, comfortable and homely. What has improved since the last inspection? What they could do better:
Although the home identify in the care plans the skills that service users have, skill maintenance and goal setting is not being recorded therefore the home cannot show if service user’s are reaching their potential or are aiming for higher achievements. The National Minimum Standards state that the home should be able to show a year on year improvement of the skills of service user’s. Service user’s files were overflowing with old documents, some of which were loose. Information was not readily or easily available. These files should be thinned out with old information archived and the remaining information held securely in each folder. The premises were inspected. Two beds were found to be poorly made. The staff member on duty said that one of the service users had gone back to bed to rest during the morning. However, the second bed found by the inspector to be poorly made had 2 coat hangers in the bed under the duvet and a screwed up sheet in the centre of the bed. The manager should monitor the bed making carried out by staff. The downstairs bathroom requires the vanity unit replacing. The upstairs shower required cleaning (although this is said not to be used by service users). All other areas of the home were clean and free from odours.
Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 7 The practice of wedging fire doors open was seen at this inspection. This was raised with the manager as a risk to health and safety. On the inspectors return visit, notices had been placed on all fire doors stating these should be kept closed. The manager/proprietor must look at ways of allowing air into bedrooms without placing service user’s at risk when they are asleep in bed. There are systems that can be used (portable door closures that react to the fire alarm and release the door when the fire alarm sounds closing the door automatically). Statutory records must be available for inspection at any time. The manager/proprietor should consider creating an ‘Inspection folder’ that would hold all relevant information required. This would assist all staff who are left in charge of the home to provide the appropriate information for inspection purposes. 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. Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 These standards are well managed with information being readily available for inspection. EVIDENCE: The manager /proprietor stated that the Statement of Purpose and the Service User’s Guide are being updated and will provide a new copy to the Commission. These documents detail the service the home is able to provide. The majority of service user’s would need their relatives, social worker or the home to tell them about the home as they would not understand the documents. Consideration should be given to providing a picture form of these documents. There are currently no vacancies at the home. From the inspection of a recent admission it was observed that an assessment is provided by the local authority placing the service user and that the home also carryout their own assessment. Any prospective service user is able to make visits to the home prior to admission. The most recent service user visited for short periods then moved in relatively quickly as this was seen as more beneficial. However the length of the visits would vary depending on the needs of the prospective service user and could start with short hourly visits, staying for a meal and progress to over night stays or a short stay prior to moving in, to enable the person to see
Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 10 if they like the home and if they would ‘fit in’ with the other service users living there. Copies of contracts or terms and conditions were seen on service users files. Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 The home is not evidencing that they are working towards improving the potential of service user’s that live at the home. Therefore this area is not well managed. Other standards within this section were well managed. EVIDENCE: A random selection of care plans were inspected, care plans and risk assessments are being updated. However. Skill maintenance and goal setting is not recorded. The home must be able to evidence a year on year improvement in the abilities of service users, or alternatively if no skills/goals are able to be set then this should be recorded. It was observed that service users are given choices about how they spend their time when at home, with service users able to go to their rooms when they choose. Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 17 There are appropriate activities being provided for all service users. Service users were seen to be given a choice of how they spend their leisure time. EVIDENCE: Activities take place and these are recorded. Each service user has an opportunity plan that identifies each month the activities that they have taken part in. There is a summer trip planned for a day out to Clacton. This has been arranged by one of the clubs that the service users attend. A disco was arranged for Saturday with the Mencap club. At the Queen’s theatre in Hornchurch there is a ‘party in the park’ this takes place on 9/7/05 and service users will be going to this event. There is another outing to Aylesford Priory booked for the 10/7/05. A Barbeque was taking place at a local farm on the afternoon of the inspection and some of the service users had shown an interest and were going to go to this event. Other activities take place such as the Church service, specifically designed for people with a leaning disability. Trips out to the local shops in Romford or Hornchurch also take place. In house activities depend on the likes and dislikes of service users. There are lots of
Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 13 board games and videos available. Some of the service users go out to college and various day centres. One service user attends the Ardleigh Green college to learn computer skills once a week. In discussion with the service users she stated ‘I like going there, you can have a laugh and you learn things’. The same service user goes to an assisted work project twice a week an receives a nominal payment for the work she does. Another service users attends art therapy once a week and visits Nason Water’s, another day centre two days a week where they carryout activities. A further service user goes to a work project called Melville Court and also goes to the Club House on Thursdays and the Broxhill centre on Fridays where they carryout activities. One service user has a ‘befriender’ who visits regularly to support the service user. Menu’s were inspected and it was observed that meals are varied and choice is provided to service users. In discussion with one service user she said ‘I like the food, but I don’t like parsnips, I leave them if they give me them’. Another service users said ‘I like the food and they give me plenty to eat, you can have what you like’. Links with family and friends are encouraged and there are no set visiting times that relatives have to keep to. Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Medication procedures are well managed. Staff assistance or supervision with personal care was also well managed. Health care needs were well documented and service users are well supported with medical needs. EVIDENCE: An audit of the medication held by the home was made. The medication was appropriately locked away for safekeeping. The medication administration sheets were appropriately signed when medication was administered. Personal care is provided by female staff for any of the service users who require assistance with this. Health care needs were observed to be well documented with appropriate contacts being made with health professionals as necessary. Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards will be inspected at further inspections. EVIDENCE: Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 30. Standard 29 relates to specialist equipment, this stndard does not relate to any of the service users accommodated. Attention is required to some maintenance work. This standard could be managed more appropriately. EVIDENCE: The home was inspected. The bedrooms, lounge, dining room and kitchen were clean and tidy. The downstairs bathroom requires the vanity unit replacing around the sink. The upstairs shower room requires the shower cleaning as this was dirty (this shower was said not to be used by service users). The bedding on two beds were checked. One bed was poorly made, the staff member said that the service user had gone back to bed for a rest that morning. However when another bed was checked it too was poorly made and had 2 coat hangers and a screwed up sheet in the middle of the bed. The manager must monitor the bed making carried out by staff. Service user’s bedrooms were decorated and were very individual with personal possessions on display. Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35, 36 The training of staff must be improved with statutory training taking place on an annual basis. Although staff have a training profile these are not up to date. As information was missing from the employment records of staff the home is not protecting vulnerable service user’s. Formal supervision sessions are taking place for all staff, this standard is well managed. EVIDENCE: Although staff are aware of their roles and responsibilities staff training must be increased to include al the statutory training required (manual handling, food hygiene and basic first aid). 6 staff are currently enrolled to take the NVQ level 2 training. Newly recruited staff have come to the home with training already achieved, such as NVQ level 2, food hygiene, basic first aid lifting and handling and diet and nutrition. The four most recently employed staff files were inspected. All had CRB disclosures on file. One staff member had no copy of a passport (if any) or a current photo identification. For another staff members reference was hand delivered. The reference stated ‘To whom it may concern’. All references must
Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 18 be sent to the referee and not given to the staff member to hand to the referee. This is poor practice. Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 42 Due to the fact that a return visit had to be made to the home to access these records this standard is not well managed. There must be systems in palace to ensure that all information is available for inspection at any time. One of the core standards to be inspected is Standard 39. However due to the abilities of the current service user’s accommodated this standard cannot be tested as they cannot understand what this standard relates to. EVIDENCE: The manager is a qualified Social Worker and is currently undertaking the Registered Managers Award training. Staff rotas were not available at the last unannounced inspection and again at this unannounced inspection. The manager stated that these were with the accountant. The home must be able to evidence the hours worked by staff and copies of past and current rotas, which are statutory documents must available for inspection at any time. This is poor management.
Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 20 Fire drills are taking place and a record of these was seen. The last fire drill took place on the 9/3/05. The fire alarm call points are being tested weekly and a record is kept of this. The fire alarm service and emergency lighting was last tested on 3/7/04. There was no recent documentation to show this had been serviced in 2005 although the proprietor said that a visit had taken place this year. The fire extinguishers are due for their annual check this month (July 2005). The annual Gas safety certificate was dated 10/3/05. Fridge and freezer temperatures are being taken on a daily basis and a record is kept of this. There is also a record of the ‘core’ temperature of joints of meat/poultry recorded, (this was on the instructions of the last environmental health officers visit in September 2004). The 5 year electrical safety certificate is due this year. The home must make arrangements for this work to be carried out by a qualified electrician. The portable electrical appliances received their annual safety check, this was dated 7/6/05. The homes insurance certificate is current, the date for renewal is December 2005. The Legionella test on the water system must be carried out. The manager must arrange for this work to be undertaken and inform the Commission of the agreed date. Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 2 3 2 3 N/A 2 Standard No 11 12 13 14 15 16 17 x 3 x 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 x x 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Park House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x N/A x x 2 x G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 22 No 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 YA25 Regulation 23(4)(c) (i) Requirement Fire doors must not be wedged open at any time.This is an unmet requirment from the last unannounced insepction. Beds must be appropriately made. The manager should monitor this. Replace the vanity unit in the downstairs bathroom. Clean the upstairs shower and keep clean at all times. All statutory employment checks must be undertaken prior to any new staff member commencing work.(2 satisfactory references, photocopy of passport, photo ID) Timescale for action 23/6/05an d ongoing action. See recommen dation number 2 30/7/05 30/9/05 30/7/05 23/6/05 and ongoing action as new staff employed. 30/9/05 2. 3. 4. 5. YA25 YA27 YA27 YA34 16(2)(c) 23(2)(c) 23(2)(d) 19 1-8 6. YA35 7. YA35 8. YA37 & 42 13(2)(c) & Statutory training must be 18(1)(c) provided for all staff (basic food hygiene, basic first aid, lifting and handling 18(1)(c) The staff training profiles should be current and document all training undertaken identifying the dates of training achieved. 17(2)sche All statutory records must be dule (4)& available for inspection at any 23(4)(v) time. (staff rotas, health and & safety documentation including
G55_S0000027870_Park House_V234355_230605_Stage 4.doc 30/9/05 23/6/05 and ongoing action.
Page 23 Park House Version 1.30 23(4)(e) 9. YA42 23(4)(iv) 10. YA42 13(3)(c) 11. YA6 15(1) fire alarm servicing and fire drills) This is an unmet requirement from the last unannounced inspection. Provide evidence that the fire 30/7/05 alarm service has been undertaken for the year 2005. Or have this work carried out Provide evidence that the 30/8/05 Legionella test of the water system hads been carried out for 2005. Provide documentation to 30/8/05 support the skills maintenence and goals set for service users to reach their potential. Or if no new skills/goals can be set record this in the care plan. 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 YA41 Good Practice Recommendations Information held in service users files should be peared down to keep only relevent inforamtion relating to current needs in these files. All other inforamton should be archieved. Consideration should be given to the use of individual door closures that come into operation when the fire alarm is sounded. 2. YA42 Park House G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 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 G55_S0000027870_Park House_V234355_230605_Stage 4.doc Version 1.30 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
