Inspection on 07/10/09 for Park House

This inspection was carried out on 7th October 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Park House 16/10/08

Park House 30/10/06

Park House 28/02/06

Park House 13/06/05

Park House 14/09/04

Park House 17/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Park House The Parade St Marys Isles of Scilly TR21 0LP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Melanie Hutton     Date: 2 1 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Park House The Parade St Marys Isles of Scilly TR21 0LP 01720422699 01720422699 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Council of the Isles of Scilly care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 14. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following caegories: Old age, not falling within any other category - Code OP - maximum 14 places Physical disability Code PD - maximum 2 places Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 31 Over 65 14 0 0 2 1 7 1 0 2 0 0 8 Brief description of the care home and the setting has a flexible approach to visiting arrangements. Day Care and shortterm residential care are also available if the resources permit. The bedrooms are for single occupancy and the home is comfortably furnished. There is limited outdoor space for people who use the service, however there is a park immediately opposite the home and a beach close by. People who use the service are offered a financial assessment by the Isles of Scilly Social Services to determine their contribution. Fees are based at 465.42 pounds per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Park House which took place on the 6 and 21 October 2009 by one inspector. We (the Care Quality Commission - CQC) sent out surveys prior to the inspection, to people who use the service, staff and external professionals. We received 4 completed staff surveys, 5 completed surveys from external professionals, 4 completed surveys from people who use the service and 2 from relatives of people who use the service. At this inspection we met and talked with people who use the service, relatives / representatives, the registered manager, care staff, visiting professionals and the responsible individual. We looked at records, care documentation, policies and procedures and inspected the environment. Case tracking and direct observation were used. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: We asked the service users what they thought the service could do better and were informed some staff not as caring as others, keep morale and staff motivated and listen to residents. We discussed these comments with the registered manager during the inspection. The staff told us that if they could improve something it would be more outside input i.e. clubs to come in and communication, sometimes when you have been off for a few days staff forget to tell you what has happened in that time. The staff were observed to have a hand over at the beginning of the afternoon shift and we were told that this also takes place at the morning shift and the night shift. The statement of purpose and service users guide must be reviewed and developed to Care Homes for Older People Page 7 of 31 provide full and detailed information for service users and their representatives. The training programme for staff should be reviewed and developed to ensure that all staff are provided with initial and update training to ensure they are competent to provide care to the service users. The staffing levels within the home should be regularly reviewed to ensure that staff are on duty in sufficient numbers to meet peoples assessed care needs. Staff supervision should take place regularly and a written record be held of the content of the formal supervision. Robust recruitment procedures must be followed and employment checks e.g. references be held on staff personnel files. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not provided with sufficient information to enable them to make an informed choice about the care home. Each service user is assessed to make sure the provider is able to meet their needs, preferences and choices. Each service user has been provided with a contract detailing the agreement reached between them and the registered person. Evidence: The certificate of registration is displayed clearly within the hallway of the home and references the recent change in responsible individual. A service users guide and statement of purpose is given to residents. People we spoke with, including residents and a visitor to the home, were aware of these documents. Further information must be included within this document to ensure that people are aware all of the information in Schedule 1 of the National Minimum Standards (NMS) e.g. name and address, qualifications and experience of the registered provider and manager, the Care Homes for Older People Page 10 of 31 Evidence: organisational structure of the home, the number and qualifications of staff working at the home, the range of needs to the care home is to meet etc. Each person is issued with a contract when moving into the home. This has been updated since the last inspection. Some contracts were not evident on the service users personal file - these were people who had recently moved into the home. We were told that these were waiting to be signed by the service user with the assistance of their relatives. Prior to moving into the care home, the registered manager obtains a summary of the persons care needs from the referring agency e.g. health or social services. The registered manager or her deputy, also undertake their own care needs assessment to ensure that peoples care needs, choices and preferences can be met. A written record is kept of this detailed assessment, which then forms the basis of the care plan. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided with information within the individual plans of care that tells them of the action they must take to meet peoples assessed care needs. The privacy and dignity of people who use the service is respected and promoted. Service users are generally protected by the homes systems and procedures in place regarding medication. Evidence: Care plans are in place for each person who uses the service, that detail their needs, preferences and choices. The care plans that we inspected are reviewed on a 3 monthly basis and updated following a routine review or as care needs change. It is recommended that care plans are reviewed and updated every month or more frequently if the service users care needs have changed. The care plans are stored in the service users bedroom and people we spoke with told us they were aware of their care plan, although one person said they had never read it or looked at it. The care plans are in sufficient detail to inform and direct staff of the action they must take to meet peoples assessed care needs and individual risk assessments including moving and handling are undertaken and incorporated into the care plan. Care Homes for Older People Page 12 of 31 Evidence: Good arrangements are in place to meet residents health needs and medical services are accessed when required. During the inspection visit we observed Community nurses and General Practitioners visiting the home to see their patients. We saw written records that demonstrate that people who use the service are supported to access appointments at the local hospital. People who use the service that we spoke with or received a completed survey from appeared satisfied with the care they receive. We were told they look after me very well and I am very happy here, the staff look after the basic needs of the residents and the staff are caring and attentive. We spoke with relatives visiting the home and were told The staff have helped my relative to accept living in a care home, they are kind and caring. We received completed surveys from health professionals prior to the inspection and also spoke by telephone to 2 people who completed these surveys. We were told they look after the people very well, all aspects of care are provided very well and clients appear to be well nourished and generally fairly well looked after One health professional made a comment, within a survey, about the incidence of pressure sores. On the day of inspection records did not evidence that any service user had a pressure sore and discussion with the registered manager and other staff confirmed this. We were told that previously, service users have been admitted to the home with a pressure sore, but this has been healed with the support of the community nurses. The privacy and dignity of people who use the service is respected. Staff are provided with information in the care plans relating to individuals wishes. The preferred name of people who use the service is recorded and we observed this being used both in conversations and within written records. People who use the service have access to a telephone either within their own room or they can use the telephone privately in the office. The staff assist the service users with their medication. Medication Administration Records (MAR) identify the individuals prescribed medication, which is supplied in original containers from the pharmacy. The MAR sheet is written by the registered manager and / or her deputies based on information gathered from the service users prescription. Each MAR sheet is then signed by the general practitioner as an accurate drugs administration record. The registered manager and her deputies administer the medication throughout the home from the individual containers direct to the person using the service. One service user currently residing at the home uses oxygen. It is recommended that where the oxygen is stored or used, a sign clearly identifies this. A policy and procedure is available to staff regarding medication. It is recommended that information is included regarding the disposal of medication and the action to take should an error be made. It is possible to to audit the medication received in and Care Homes for Older People Page 13 of 31 Evidence: taken out of the home. Staff have received medication training within their NVQ training and in house from the registered manager who is a trained nurse. The registered manager informed us that it is planned to discuss the provision of medication training for staff from the Islands community pharmacist. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service told us that the home meets their social / recreational needs, that they are free to determine their daily lives and that there is no restriction on receiving visitors. A wholesome diet is provided and people who use the service told us that the standard of food is very good. Evidence: We were informed (within surveys and during conversations) by people who use the service, relatives and / or representatives, visitors and visiting professionals that there are activities provided at Park House. We were told about a weekly coffee morning that is held both for people living at the home and from the local community. Religious services are held on a weekly basis. The staff and people who use the service told us about visiting entertainers e.g. singers who visit the home periodically. Staff were observed chatting with service users. One service user told us how they enjoyed playing board games with another resident. There are planned arts / craft based activities planned for the autumn that will be facilitated by an external group called Arts for Health and the local secondary school. One representative of a service user commented within a survey that they thought it would be beneficial to have more activities to stimulate the service users. Staff are due to receive training to enable Care Homes for Older People Page 15 of 31 Evidence: them to lead singing sessions. Some staff have received training regarding armchair exercising, although the registered manager said that service users were not keen to participate in this activity. A Nintendo Wii video game console has been purchased for Park House and it is hoped that some service users will enjoy using this equipment. Limited information was evidenced regarding peoples interests and participation within activities. We were not sure how people know what is planned to take place within the home apart from verbal communication. Visitors are welcomed and encouraged to visit the home. The visitors book shows that large numbers of visitors come to the home and we observed many visitors to the home during our inspection visits. Visitors we spoke with and who completed surveys told us that they always felt welcomed at the home. Visitors can be received within the communal areas - there are two lounge dining rooms or within private bedrooms. People who use the service told us that they make choices as to how to spend their day e.g. with regards to the time of getting up and going to bed and where they wish to sit during different parts of the day. One service user told us that they prefer to sit in one lounge in the morning and the other in the afternoon. The registered manager told us that financial affairs are managed by the person using the service and / or their representatives. The home does not manage anybodys finances for them, although money can be held for safe keeping. Support from independent advocates can be arranged if needed through the Isles of Scilly Social Services Department / Town Council. All of the service users we spoke with and who completed surveys, were positive about the meals that they are provided with. The main meal of the first day of the inspection visit was roast chicken, fresh vegetables and fresh fruit salad. On the second day the main meal was gammon ham, parsley sauce and fresh vegetables followed by sponge pudding and custard. People have a choice at the evening meal and options during the inspection visits included sandwiches, homemade soup, home made bread and cakes. People are able to choose where they eat their meal and we observed people eating in both lounge / dining areas and in their bedrooms. The dining rooms are spacious and attractively decorated with drinks, cruets and table decorations located on each table. The menu is based around a 3 week rotation but can be changed if requests are made or supplies do not arrive. There is no formal choice of meal offered but the cook told us that she is aware of people likes and dislikes and plans the menu accordingly. We discussed with the registered manager the process of offering people a formal choice of meal rather than basing the food provision on peoples likes and dislikes. We Care Homes for Older People Page 16 of 31 Evidence: also discussed the need to maintain a record of the food, including any alternative choice, that is provided to people. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to make a complaint should they need to do so. People who use the service are not fully protected by the agencies safeguarding policies, procedures or training for staff. Evidence: A complaints procedure is in place for people to refer to and this is included within the statement of purpose. We have not received any concerns regarding this service since the last inspection. The registered manager told us that the home has not received any complaints either. A compliments and complaints file is kept. It is recommended that the complaints log be kept in a hard bound book rather than a loose leaf file to ensure that any pattern of complaint can be identified and monitored. People who use the service and their representatives told us that they knew how to complain, although most people said they had no need to make a complaint. One visitor told us that any issues were dealt with by the registered manager or the deputies and they felt supported by the management of the home. Another person said within a survey that I would not dare to complain. This was an anonymous survey which means that we could not discuss this further. However, nobody implied to us during the days of inspection that they felt unable to speak with the staff about any concerns and service users appeared to have a comfortable rapport with the staff. There is an adult protection policy and procedure in place that is available to staff. It is Care Homes for Older People Page 18 of 31 Evidence: recommended that this be reviewed and developed to specify the agencies that would be involved if there were any suspected abuse and the process to follow to ensure that the appropriate agencies are involved. Staff have previously received training from external providers regarding safeguarding adults. This training should be updated and also provided to new staff. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is generally well maintained and is clean, pleasant and hygienic. Evidence: The care home is a two storey building. Access to the first floor is by means of the stairs or a stair lift. The registered manager told us that all of the current people who use the service access all parts of the building. Two service users who use a wheelchair have downstairs bedrooms. The home was observed to be comfortable and homely. Outside space accessible to people who use the service is limited, but immediately across the road is a public park which we were told that people frequently use when the weather is good. Two beaches are very close by, both of which would be accessible to people walking and also those in a wheelchair. There are 2 lounge dining rooms that are comfortably furnished and lighting is provided that is domestic in nature. A number of rooms have been redecorated and refurbished since the last inspection. Service users can access assisted bathing facilities on each floor. The bathrooms are very clinical in appearance. A number of rooms have ensuite toilets. Those that do not have an ensuite toilet, have a toilet located near to their bedroom. A sluice is installed in the home. Care Homes for Older People Page 20 of 31 Evidence: The home provides a comfortable environment for service users to live in. All rooms, with the exception of one ensuite toilet, have opening windows for ventilation. Not all windows are fitted with window restrictors which must be addressed to ensure the safety of the service users. The registered manager told us that the windows have been measured and the correct equipment ordered to address this. Radiators within the home are guarded and the temperature can be controlled in the service users own room. We were concerned that a number of the hot water outlets deliver very hot water. The registered manager has arranged for the plumber to attend to this and stated this will be dealt with urgently. The home has had a new water and heating system installed in the last year. No legionella test has been conducted. The registered manager said this was due to the system not having water stored. It is recommended that the registered provider seek further advice regarding this to ensure that it is not advisable to test the water stored, for example in shower heads. The home is clean, hygienic and free from odours. Laundry facilities are located towards the rear of the home and provide industrial washing machines and tumble driers. Hand washing facilities are located in this area. The service users clothes looked well cared for and we were told by several people they were satisfied with the laundry service. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment and training systems in place do not fully protect service suers. Evidence: The duty rota shows that generally there are 4 carers, 1 of which is the deputy manager, on duty in the morning, supported by the cook and 2 domestic staff. The registered manager usually works Monday to Friday during the day times. It is recommended that the registered managers rostered hours be recorded on the duty rota. During the afternoon, 2 carers plus the deputy manager provide care until 22.00 hours. During the night there is 1 waking carer on duty with support if needed from a sleeping in member of staff. The deputy manager works the afternoon, sleeps in during the night and then works the next day. This should be regularly reviewed to ensure that this is an adequate level of staffing overnight to meet peoples assessed care needs. Staff that we spoke with or who completed a survey told us that they generally think there are enough staff on duty. In times of holiday or sickness cover is obtained through an agency based on the mainland. Due to the traveling issues, agency staff are usually booked for more than one shift and are accommodated on the island. The same agency staff usually come which helps with continuity and stability of the staff team. New staff are required to complete an induction training. We were not able to see the induction training records for the newest members of staff. The registered manager confirmed that induction training had taken place and that the records were probably with the staff member. Staff told us within surveys that they Care Homes for Older People Page 22 of 31 Evidence: had received induction training that covered everything they needed to know to do the job when they started. Staff confirmed within surveys and during discussion, that they are provided with training that is relevant to their role, helps them to understand and meet the individual needs of people, and keeps them up to date about different ways of working. The registered manager was able to evidence that a programme of training is in place with future dates being booked e.g for first aid and fire safety. A number of staff files did not evidence that they had received any training. We compared this with the training matrix for all staff and this showed that there are gaps in training that need to be addressed e.g. health and safety, dementia care, first aid and safe guarding adults. We inspected the personnel files of 6 members of staff. These have historically been held by the personnel department of the council but have recently transferred to be held in the care home. All of the 6 members of staff had a CRB check held on file. 1 staff record only had 1 reference and 1 person did not have any references on file - it is thought these are still with the remaining information held at the Town Hall. The registered manager is going to address this as a priority. An interview record is maintained for each member of staff that identifies the questions asked and the response from the member of staff. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users views are listened to regarding the running of the care home. The supervision and training for staff does not fully protect the service users. Service users are able to access their money at all times, whilst reassured that it is held securely. Evidence: Comments from people who use the service and the staff in respect of the registered manager were positive. All felt that they could approach her with any concerns or issues and that they would be dealt with appropriately. Staff told us within surveys or in conversations that this is a nice place to work as it is a very friendly happy home, the home has a lovely feel to it, a feeling of safety and security and we are supported very well here, Lesley and the officers are always there to help us if needed. The registered manager has been in post for several years and is a registered nurse (although nursing care is not provided at the care home). The registered manager has the NVQ level 4 in management. We were able to see completed quality assurance survey forms on peoples individual files. The registered manager told us Care Homes for Older People Page 24 of 31 Evidence: that everybody plus their relatives are given a survey to complete. The registered manager may wish to include external professionals within this quality survey. These should be audited once all are returned and the results published to all interested parties - including CQC. The registered manager will assist people who use the service to manage their personal allowances if they do not have relatives / representatives to do this. This money is held securely with written records that detail all transactions. Receipts are held to support the transactions. We audited the records and money for a number of people who use the service and found these to be accurate and up to date. People can request their money at any time as the senior member of staff always holds the key to access it. Each service user has lockable storage facilities in their rooms if they wish to hold their own money. Staff told us that they feel very well supported by the registered manager and the deputy managers. One person said we can talk to them at any time and they are always really helpful. There were no written records to demonstrate that supervision is taking place and the content of the supervision. The registered manager told us that she meets with the staff regularly but this has not been recorded. A range of measures are in place to promote safe working practices and this includes a number of policies and procedures. Risk assessments have been developed to positively manage risks that people who use the service may experience living at Park House e.g. fire and environmental risk assessments. We were able to see certificates demonstrating that equipment and services at the home are regularly serviced and maintained. The fire officers were visiting the home on the 2nd day of the inspection to test the fire alarm systems. The local fire brigade carry out a full fire drill twice a year involving staff and people who use the service. Further training should be provided to the night staff during the year. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 It is required that the 16/01/2009 statement of purpose contain all of the information detailed in Regulation 4 and Schedule 1. This is to ensure that people are provided with information to enable them to make an informed choice about the home that they live in. 2 1 1 It is required that the service 16/01/2009 users guide be reviewed and developed to provide the information as detailed within Regulation 5 and standard 1. This will enable people to make an informed decision about the home they live in. 3 38 23(4)c-e Fire training and drills must 30/12/2006 be undertaken on a regular basis that reflects good practise standards. (Previous timescale of 30 April 2006 not met). Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered person shall compile in relation to the care home a written statement, known as the statement of purpose. This will provide current and prospect service users with information about the care home to enable them to make an informed choice on whether to live there. 07/12/2009 2 18 13 The registered provider shall 07/12/2009 make arrangements, by training staff or by other measures,to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. All staff should be provided with training to ensure that they are confident of the action they must take should they observe any suspected abuse. Care Homes for Older People Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 25 13 It is required that the 07/12/2009 registered person shall ensure that all parts of the home that the service users have access to are so far as reasonably practicable free from hazards to their safety. Hot water outlets must be fitted with thermostatically controlled valves that restrict the temperature of the water delivered to 43 degrees centigrade to prevent the risk of scalding. 4 25 13 It is required that the 07/12/2009 registered person shall ensure that all parts of the home that the service users have access to are so far as reasonably practicable free from hazards to their safety. Window restrictors must be fitted to ensure the safety of the service users. 5 29 19 A robust recruitment procedure must be followed prior to appointing new members of staff. This will protect the service users. 07/12/2009 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 30 18 The registered provider 07/12/2009 shall, ensure that at all times suitably qualified and competent person are working at the care home. All staff must have induction training and a record maintained of this training. Further training must be provided to all staff to ensure that they are trained and competent in order to meet the needs of service users. 7 36 18 The registered person shall 07/12/2009 ensure that persons working at the care home are appropriately supervised. Written records must be kept to evidence that formal supervision is taking place for all staff. 8 38 23 The registered provider must make arrangements for person working at the care home to receive suitable training in fire prevention. This requires day staff to receive training every six months and night staff every three months. 07/12/2009 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that the care plans are reviewed and updated on a monthly basis. It is recommended evidence e.g. a signature, is in place to show that the service user and / or their representative have been involved in the development of the plan and agree with the care planned. It is recommended that clear signing is in place where oxygen is in use or stored within the home. It is recommended that the medication policy and procedure be reviewed and developed to include guidance on the action to take regarding errors with medication and disposal of medication. 2 9 3 12 It is recommended that written records are maintained of activities that take place within the home and the service users participation and enjoyment of the activities. It is recommended that written information is gathered of service users interests and hobbies. It is recommmended that the record maintained detailing the food provided within the home, be developed to identify choices made by individual service users. It is recommended that the complaints log be maintained within a hard bound book. It is recommended that attention be given to the bathrooms to make them more homely and welcoming in appearance. It is recommended that the registered person seek further advice regarding the testing of the water for legionella. It is recommended that the registered managers hours be rostered on the duty rota. It is recommended that the night time care needs of the service users be reviewed to ensure that they are fully met by 1 waking member of night staff. It is recommended that the quality survey forms are audited and the results published to all interested parties. The environmental risk assessments should be reviewed and developed where necessary. 4 15 5 6 16 21 7 8 25 27 9 10 33 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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