CARE HOMES FOR OLDER PEOPLE
Park House Care Home Cinderhill Road Bulwell Nottingham NG6 8BS Lead Inspector
Lee West Key Unannounced Inspection 8th May 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Park House Care Home Address Cinderhill Road Bulwell Nottingham NG6 8BS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 9771363 0115 9771460 Eastgate Limited Eunice Browne Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47), Terminally ill (2) of places Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the total number of beds a maximum of 2 beds may be used for the category of TI 14th October 2005 Date of last inspection Brief Description of the Service: Park House is a purpose built care home with 47 places, offering residential and nursing care for 47 older people, including two beds for those who are terminally ill. Situated in the Bulwell area it has access to bus and tram routes into the City and various local community facilities. The building is on two floors with lift access to the first floor. All areas are wheelchair accessible. The garden has several seating areas with a conservatory leading onto the garden. There is ample parking in the large, well maintained front garden and car park area. The fees range from £272.58 for residential care to £476 MAY Scheme Nursing. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday 8th May 2006 and commencing at 11.30am was over a period of 5.5 hours. The Manager, Eunice Brown was present and assisted during the inspection. Case tracking was the method used, where Service users were spoken with about their experiences and expectations of living at the home, a tour of the home undertaken, and talking with members of staff to ensure that those living at the home have their needs met and their health and welfare maintained appropriately; together with analysis of available records. All the judgements made in this report have been made using all this available evidence, including the visit to the service. There have been a number of new service users admitted since the last inspection. What the service does well: What has improved since the last inspection?
Care plans have improved since the last inspection, to include how needs are met and the documentation has been improved and one style is used now. The records required under Schedule 4 are kept in the home for inspection and have been appropriately completed.
Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 6 The communal areas, bathrooms and shower rooms have been cleared and are not now being used for storage. The stairwell, under one of the staircases, is used for the storage of wheelchairs. These were kept underneath the stairs and did not clutter the area around the stairs. Routine maintenance was being carried out and rooms were being redecorated during the inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3,4,5,6, Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users have the appropriate information to make an informed choice, opportunities to visit and have their needs assessed to ensure they can be met. Service users assessed for intermediate care are assisted to maximise their independence. EVIDENCE: A number of new service users were case tracked during this inspection and they confirmed they had an opportunity to visit and assess the quality and facilities. Relatives present also said they had the opportunity to ask questions and were advised of the care the home could offer, together with the service user guide and statement of purpose, this they said gave them the information they needed to make a choice. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 9 The service users’ files contained written terms and conditions and extensive Shared Nottingham and Nottinghamshire Assessment Plan (SNAP)assessments were also seen in the files. Service users who are to return home said that they felt the staff at the home had assisted them to improve their “getting about” and they felt “helped to regain my strength.” Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans set out individual needs and service users are treated with respect. Their care needs are met, but with some omissions. There are no service users who are responsible for their own medication at present and procedures are followed to protect service users. Identification of service users’ wishes on death are recorded. EVIDENCE: Care plans case tracked identified individual service user’s needs, with information from the Special Needs Assessment Plan (SNAP) but some plans had not been reviewed since first admitted, so do not identify any changes in service user’s personal and social care needs.
Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 11 Some service user care plans do not have photographs on file and some records, were not signed and dated, which could lead to confusion as to whether an aspect of care had been carried out or not. Service users spoken with said they were satisfied with the care the staff provide. Visitors present also expressed their satisfaction at the level of care provided. Staff were observed, during the inspection, to treat the service users with respect and maintained their dignity and privacy. However, staff were observed to be moving service users, using inappropriate underarm lifting. Staff spoken with confirmed that they had received appropriate moving and handling training, but felt it was “quicker to move” using the underarms. Medication was appropriately stored and Medicines Administration Records correctly completed on the records case tracked. No service users administer their own medication at this time. Service users’ wishes on death are recorded within their care plans and staff spoken with confirm that they do follow these wishes. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are helped to make choices. They have some recreational activities organised. Family and friends are positively welcomed and meals, served in pleasant surroundings, are appetising. EVIDENCE: Service users spoken with said there were activities organised, and they enjoyed the sing-alongs and quizzes that are organised each week. During the inspection, relatives, service users and volunteers, were observed to be interacting in lively conversation in the dining room following the lunch. Service users said they did feel they had control and made choices. “I can choose when I go to bed and when I get up, what to wear and what to eat” and “I am able to go out when I want to”. Staff spoken with also said they encouraged service users to make as many choices as they can. During the inspection, staff were seen encouraging a service user in this aspect of care.
Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 13 Service users said meals are always good and served in a pleasant dining area. Cultural diets and specialist needs are met and the cook explained the menu rotation and choices to the inspector. Relatives are also encouraged to stay for meals if they wish and this was seen during the inspection. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 16,18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are aware that any complaints will be dealt with and The home’s policies and procedures aid the service users protection from abuse. EVIDENCE: No complaints were seen in the records, but service users spoken with said they would speak to the manager if they had any complaints and that they would be taken seriously. Relatives spoken with also said they would have “no problems in telling the manager if there was something wrong”. Staff spoken with are aware of their role in safeguarding adults and policies and procedures are in place in accordance with the Nottinghamshire Protection of Vulnerable Adults procedures. Service users said they “feel very secure here”. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19.20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, pleasant and hygienic, providing a safe, generally wellmaintained environment. Some areas require attention. Service user rooms meet their needs and there are sufficient toilet and washing facilities to meet needs. Specialist equipment is available and in working order. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 16 EVIDENCE: The home is clean and free from any odour. The communal areas inside and outside the home are generally well-maintained and during the inspection the gardeners were spoken with whilst they were working on the frontage of the home, pruning bushes and cutting the grass. There was redecoration being carried out in one of the empty bedrooms and generally the standard of décor within the home was observed to be well-maintained. There are sufficient toilets and bathrooms for the service users, but the bathrooms and toilets all contained bar soap at the time of inspection, increasing the risk of cross infections for the service users. One bathroom also had a bath seat, which was damaged and the damaged area had sharp edges, which could cause skin tears, but also could harbour bacteria. The visitors’ toilet door lock was missing, but there was no notice to advise where else to go. The bathrooms and toilets were all seen to be clean and hygienic. Hoists, wheelchairs and walking frames were all being used within the home and those observed were clean, well maintained and suitable for their purpose. Wheelchairs are stored under the stairwell of the front stairs. These are away from the general access areas for the service users. Service users spoken with all said they were satisfied with their rooms, they had their own possessions around them and suit their needs. During the inspection, rooms seen were clean, comfortably furnished and contained numerous personal items. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The skill mix and number of staff on duty are sufficient to meet the needs of the service users. The recruitment practices are appropriate and staff do receive training, but moving and handling requires updating. EVIDENCE: The duty rota showed an appropriate number of staff to meet the needs of the service users. Service users spoken with said there are “always staff there to help, when needed.” All staff files case tracked contained evidence of Criminal Records Bureau checks and two references. However, not all staff files contained photographic identification. Staff training records were seen and staff confirmed they do receive training to do their job. They confirmed they had previously had training in moving and handling, but some staff were observed moving service users with outdated techniques. National Vocational Qualification training to Level 2 is being undertaken by care staff within the home.
Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, with a clear sense of direction and open style of management. Service users rights are promoted. Finances are protected. Staff supervision is not taking place regularly. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 19 EVIDENCE: The service users and relatives spoken with said they were satisfied that the home is run in their best interests and that the manager was approachable, open and willing to listen if there was a problem. Visitors also said that the home “puts the residents first”. Professional visitors spoken with said the management and staff carried out any instructions and were also approachable and said the “staff are very helpful”. Relatives also said that the staff were always happy to listen to new ideas which improve things for the service users. Fee payment is dealt with by the head office, social services and families, and service users only have money for their own personal needs. No other money is kept by the home, so service users’ finances are protected. Service users spoken with said their families gave them “top ups” to meet their personal needs, which they kept securely. Appropriate indemnity insurances are in place and the home is part of a group. Staff files case tracked did not have any evidence of Supervision having taken place but staff spoken with said that this is carried out informally, but not on a regular basis. Which could lead to poor practice in some areas of care and impact on the service users. Policies and procedures are in place which safeguard the rights, interests, health safety and welfare of the service users and staff. Records under Health and Safety regulations, water temperature checks, weekly fire alarm tests, emergency lighting, equipment safety checks, including lift inspection, were inspected and found to be properly recorded and service users spoken with said that the fire alarms are tested regularly. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 N/a 18 3 2 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 3 3 Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15(2) Requirement The registered person shall keep the service user’s plan under review. The registered person shall arrange for the repair of the lock on the visitors toilet door and also the bath seat in the ground floor bathroom to avoid unnecessary risks to the health or safety of service users. The registered person shall ensure that persons working at the care home are appropriately supervised. THIS IS A REQUIREMENT FROM THE PREVIOUS INSPECTION The registered person shall consult with Environmental Health officers, and seek advice for suitable arrangements to prevent the spread of infection at the care home in relation to the use of bar, or other types of soaps in the toilet and bathroom areas. Timescale for action 08/06/06 2 OP19 23(2) 30/06/06 3. OP36 18(2) 30/06/06 4 OP38 12(3) 08/06/06 Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 22 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 2 Refer to Standard OP30 OP37 Good Practice Recommendations To ensure staff update moving and handling training to include the current good practice To ensure all service user and staff files contain photographic identification and all records are appropriately signed and dated. Park House Care Home DS0000026460.V293840.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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