CARE HOMES FOR OLDER PEOPLE
Park House Tyringham Nr Newport Pagnell Bucks MK16 9ES
Lead Inspector Caroline Roberts Unannounced 9th August 2005 12:10pm 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Park House Address Park House, Tyringham, Nr Newport Pagnell, Bucks, MK16 9ES 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) 01908 613386 Mr Edward Nigel Broadway Mrs Gillian Elaine Broadway Mrs Alyson Laslett Care Home 24 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (24) of places Park House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd March 2005 Brief Description of the Service: Park House is situated in the country estate of Tyringham; it is 3 miles from the town of Newport Pagnell which provides a range of shops and community facilities. Park House has 24 single bedrooms of which 19 have en-suite facilities, accomodation is provided over two floors. A shaft lift is available to assist residents with access to the upper floor. The home has lovely grounds including two courtyard gardens. Park House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the summary of the unannounced inspection carried out at Park House Care Home on the 9th of August 2005, commencing at 12.10pm. The lead inspector was Mrs Caroline Roberts The inspection consisted of meeting with Residents and staff, viewing records and documents pertaining to the provision of care and the running of the home. The inspector toured the building, gaining permission from a number of residents to enter their bedrooms and viewing a further number from the doorway. The homes registered manager, Mrs Alyson Laslett was present throughout the inspection. The inspector discussed the inspection findings with Mrs Laslett and Mrs Broadway (provider) prior to leaving the home. Throughout the course of the inspection staff were polite, helpful and welcoming towards the inspector. The inspector would like to thank staff for their assistance and co-operation throughout the inspection, and would like to thank the residents for allowing them into their home. What the service does well: What has improved since the last inspection?
The manager and staff team have spent considerable time improving the care planning system, although further work is still required to complete this task. Park House Version 1.10 Page 6 Staffing levels are being maintained and the manager’s hours are now supernumery. Both of the courtyard gardens have had considerable time and energy spent on them, now creating two lovely outside seating areas. New outdoor furniture has been ordered and was due to arrive in the week of the inspection. A coded lock has been fitted on to the kitchen corridor door (this lock has been approved by the fire officer and has an override which is connected to the fire alarms). On going bedroom decoration and re-carpeting. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Park House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Park House Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The admissions procedure is not followed consistently; therefore residents may be inappropriately admitted to the home. EVIDENCE: The home has an admissions procedure, which includes meeting potential residents prior to admission. The records for the four most recent admissions were viewed. Information is obtained from social services prior to the assessment-taking place in the form of a care service order. The assessments viewed were not consistent in the level of detail they contained. Park House Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9, The home has a care planning system in place, however, those care plans viewed were inconsistent in the level of information recorded; therefore residents needs are not clear or up to date and do not enable staff to provide the most appropriate care. Medication at this home is well managed promoting good health. EVIDENCE: Three care plans were viewed, it was evident that a lot of time has been spent updating the care plans since the last inspection. Individual needs of residents have been identified, further detail is required as to what action is to be taken by staff to meet these needs. Moving and Handling assessments and individual risk assessments were noted as completed fully with evidence of review. One care plan identified that the District nurse was involved with tissue viability care, it was disappointing that no tissue viability risk assessment had been completed to detail the care being provided by the home. The present tissue viability tool used by the home, had been devised by the manager this does not relate to any approved tissue viability assessment, and does not provide evidence of how the risk rating has been achieved. It is
Park House Version 1.10 Page 10 recommended that the manager base this assessment on an approved tool such as waterlow. Another care plan identified specific health issues, (diabetes and epilepsy) however no specific care plans were in place to meet these needs. Upon discussion with staff it became apparent that their knowledge around these specific medical conditions was inadequate to allow them to fully meet this individuals needs. Daily reports were noted as well completed with appropriate information. Evidence of residents involvement in the care plans was not available in the care plans viewed. The home has policies and procedures in place for the administration of medications; these are regularly reviewed by the manager. All staff receive accredited training into the administration of medications. Storage of medication was discussed with the manager; routine medications are appropriately stored in a locked cupboard. Medications requiring refrigeration are currently stored in the homes main fridge; it is recommended that a small lockable fridge be purchased for the storage of these items. Park House Version 1.10 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Not assessed during this inspection. Park House Version 1.10 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There was evidence to suggest that the home was not following its own complaints procedures thereby failing to ensure that residents views, or other complaints were responded to appropriately. EVIDENCE: The home has a clear complaints procedure and policies. Two complaints had been made since the last inspection; neither of these had been recorded in the complaints log. The homes policies state that complaints will be investigated and responded to within 28 days, from the details of one of the complaints it was noted that this complaint was dated the 4th July 2005, yet the response from the provider was dated the 6th August 2005 this was not responded to within the 28 days. The content of the response letter was discussed with the provider due to a reference to contact with the inspection team, which had not taken place. The need for all complaints to be logged was discussed with the manager. Park House Version 1.10 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 The standard of the environment within this home is satisfactory providing residents with a clean, attractive and homely place to live. EVIDENCE: The home is bright and cheerful; the home has two enclosed courtyard gardens, which offer a quiet and safe place to be able to sit outside. The front garden has a small patio area but mainly laid to lawn. The handyman carries out routine maintenance, with records maintained. Redecoration in the home is ongoing; evidence of this was seen during this visit. On the day of the inspection the home was clean and odour free. There is a policy in place for infection control. The laundry and kitchen was appropriately equipped. Hand washing facilities are available throughout the home. Park House Version 1.10 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 Staffing numbers are appropriate to the assessed needs of residents, the size, layout and purpose of the home, ensuring that assessed needs of residents are met. Residents are not always supported and protected by the home’s recruitment practices. EVIDENCE: Staffing levels were discussed with the manager, who confirmed that all of her hours are supernumery. Staffing has improved since the last inspection The personal files for two recently appointed members of staff were viewed, completed applications and two references were on file, however no evidence of a POVA check was seen and commencement of employment dates were prior to the CRB date. The manager is reminded of her responsibility to ensure residents are supported and protected by the homes recruitment policies and practices. Park House Version 1.10 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Not assessed during this inspection. Park House Version 1.10 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x x x x x x x x x Park House Version 1.10 Page 17 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 7 Regulation 15(1) Requirement Timescale for action 1.10.2005 2. 16 17(2) Schedule 4(11) 19 Schedule 2 3. 29 Careplans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet residents health and welfare needs. Residents care plans must be kept under regular review. A record of all complaints is to 1.10.2005 be maintained in the home. The provider and manager are to review the complaints procedure and ensure that they follow this. The manager and provider must 9.8.2005 ensure that staff are employed in line with Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, and as per the homes policies and procedures. 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 9 Good Practice Recommendations A lockable fridge is purchased for the storage of medication. Park House Version 1.10 Page 18 Commission for Social Care Inspection Cambridge House, Smeaton Close 8 Bell Business Park, Aylesbury Buckinghamshire HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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