Inspection on 11/03/08 for Park House, Little Knowle

This inspection was carried out on 11th March 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Park House, Little Knowle 04/03/10

Park House, Little Knowle 19/05/06

Park House, Little Knowle 13/12/05

Park House, Little Knowle 12/05/05

Park House, Little Knowle 23/11/04

Park House, Little Knowle 27/07/04

Similar services:

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Park House, Little Knowle 11 Park Lane Little Knowle Budleigh Salterton Devon EX9 6QT Lead Inspector Dee McEvoy Unannounced Inspection 10:00 11 March 2008 th 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, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House, Little Knowle Address 11 Park Lane Little Knowle Budleigh Salterton Devon EX9 6QT 01395 443303 01395 443303 perry_pilkingtonparkhouse@hotmail.com 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) Mrs Mabel Eileen Lily Perry Mrs Suzanne Lily Mary Pilkington Mrs Mabel Eileen Lily Perry Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (27), Old age, not falling within any other category (27), Physical disability over 65 years of age (27) Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th May 2006 Brief Description of the Service: Park House is a large detached property situated in a large garden approximately half a mile from Budleigh Salterton town centre. Bedroom accommodation is provided on the ground and first floors. The first floor bedrooms can be reached by a chair lift. The home provides personal care for up to 27 older people who may have physical needs or dementia. A comprehensive statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is made available to all potential residents before they make a decision about living at Park House. A copy of the most recent inspection report is also freely available. Information received from the home indicates that the current fees are £475 weekly. Services not included in this fee are chiropody, hairdressing and newspapers. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home and their relatives, and to staff and outside professionals. Completed surveys were received from 4 people living at the home; 15 relatives and 7 staff and 7 health and social care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. An unannounced inspection visit was carried out over a period of nine and a half hours. To help us understand the experiences of people living at this home, we used the services of an ‘expert by experience’. These people have experience of using services, and they join some inspectors to help us get a good picture of the service from the viewpoint of the people who use it. Experts by experience can provide a unique contribution to the assessment of quality. On this occasion the expert by experience spoke with several people about the social activities and food at the home, he also had lunch in the dining room with several people, looked around the home and looked at some records. His observations and findings are contained within this report. During our visit we looked closely at the care planned and delivered to three people. The home provides care for people with a dementia related illness and some people do not have the capacity to communicate fully or understand the inspection process. We spent considerable time observing the care and attention given to these people by staff. We also spoke with several people and spent time speaking with members of staff, including the manager and assistant manager. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. The outcome of the inspection was discussed manager/owner and the assistant manager. with the registered Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 6 What the service does well: We asked people living at the home, their relatives and outside professionals what it does well. Comments from people living at the home included, “Matron and her staff are very kind and helpful always”, “The food at Park House is excellent & varied. Every effort is made at Park House to make me feel at home”, “The staff are very friendly and it is a comfortable place to be” and “They look after me very well”. Relative’s comments included, “Welcoming, homely, supportive, kind. Feels comfortable, food is good, residents treated with respect”. “Kindness and cheerfulness to care for the varying conditions of needs and behaviour patterns of their patients”. “Makes the patient feel comfortable and relaxed”. “Excellent all round services”. “They provide maximum individual attention and care”. “The caring staff seem to work very well on a one-to-one basis”. “Gives my father a better quality of life with all the support he may need on hand…” “Extremely impressed with everything. They welcome unannounced visits, which says it all”. Health and social care professionals comments included, “Provides a homely atmosphere for the residents…” “Compassionate and caring” “Good supportive environment – friendly helpful staff” “Kind & concerned” “Warm, homely, environment that is absolutely right for some people. Feels welcoming when you walk in. Staff appear to be friendly, helpful, smiley”. Good information is available to people to help them decide if the home will suit their needs. Admissions to the home are well managed, ensuring that people’s needs are assessed and that people are made to feel welcome during the settling in period. All people spoken with or contacted were satisfied with the care provided at the home, many were more than satisfied. Comprehensive care plans ensure that people’s health and personal care needs are well met. The home works well with other health professionals to ensure people have access to good health services. People told us that their dignity and privacy was respected and that they were supported to be as independent as possible. People enjoy a flexible routine, which suites their needs and most people enjoy the social life and activities at the home. Families and friends are encouraged to visit regularly. People told us they enjoyed the food, comments included, “It’s excellent”, “The food is always good” and “I am never hungry!” Dietary needs, and individual likes and dislikes are catered for and the kitchen team will ensure that everyone has food they enjoy. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 7 People told us they felt confident that they could raise any concerns or complaints with the management and these would be dealt with satisfactorily. People living at the home are protected from abuse by well trained staff who have appropriate attitudes towards them; systems are in place to ensure that people’s financial affairs are protected. The home is generally well maintained. Communal areas are decorated and furnished to a good standard. People living at the home were very happy with the environment. Bedrooms have been personalised and people have been encouraged to bring furniture and personal effects in order to make their rooms feel homely. All areas of the home were clean and fresh, people told us it was “usually” like this. Staffing levels are good and people told us their needs were “always” met. Staff feel well supported and receive a good level of training, including regular updates in all health and safety related topics. New staff receive good induction training to ensure they can do their job safely. The management of the home is open and inclusive, led by the manager and deputy manager. Good systems are in place to ensure that people living at the home “have their say” and can influence the service provided. On the whole the health and safety of people living and working at the home is promoted, with systems in place to ensure good practice. What has improved since the last inspection? What they could do better: People spoken with during this visit could not think of any improvements, one told us, “I can’t think of anything” another said “I am content as it is”. No requirements have been made as a result of this inspection. Three recommendations have been made. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 8 The home has been asked to ensure that the management of medication is improved by ensuring recording is accurate. This will ensure that practices remain safe and peoples’ wellbeing is protected. The lifestyle of the home suits most people but the home has been asked to improve the social activities and opportunities for some people to ensure that their social needs are met. The home has been asked to ensure that the call bell system is easily available to people in communal areas and their bedrooms so that they can summon help when required. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 9 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, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good information to people, which enable them to make a choice about whether the home will suit their needs. Good systems are in place to ensure that people’s needs are assessed and can be met prior to moving into the home. EVIDENCE: There is a guide to the home, the Statement of Purpose, which gives people an idea of what to expect of the home. A copy of this and the most recent inspection report is available in the hallway. People returning CSCI surveys told us they had received enough information about this home before they moved in, helping to ensure it was the right place for them. Relatives also told us they were given enough information to help make a decision about the home. One told us, “The matron Mrs Perry is available and readily forthcoming with information and assistance”. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 11 Three of the four people returning CSCI surveys said they had been given a contract, which helps to make sure people are clear about the terms of their stay, their rights and responsibilities. (One person did not answer this question). Individual contracts were seen, which contained information about the cost of care, which room was to be occupied and other terms and conditions. The individual or their relative/representative had signed contracts. People spoken with during this visit told us they were happy living at the home, one said, “It’s fine here, it suits me well. I couldn’t find better”, another person told us “So far so good” and a third said, “This is now my home and they look after me”. One person wrote in their survey, “Every effort is made at Park House to make me feel at home”. Our expert by experience spoke with people about their experience of the home, he told us, “One resident described the home as being “cheerful, good tempered and well worth visiting”. Another said, “This place is run quite well as a combination of a Home and Hotel”. Yet another commented “nice well run home with a very kind Matron and staff” “. Surveys from relatives show that the home “always” or “usually” give people the support expected and agreed. Relatives’ comments were generally very positive, for example, “I am generally very well pleased with the care & consideration given to my mother”, “The home cares for my uncle very well and he seems very happy there” and “Very caring, welcoming staff. I have never had any reason to challenge or complain in four years”. The home uses an ‘assessment for good care planning’ as a way of getting information about people’s needs and preferences before they move to the home. This helps to ensure that individual needs can be met. We looked at three assessments, all gave good information about people’s’ abilities, needs, usual routines and preferences to enable staff to plan and deliver care appropriately. Social care professionals told us that assessment arrangements ensure that accurate information is gathered and that the right service is planned and given. One wrote, “They appeared to have an admission routine that the carers knew what was required of them”. The home does not provide intermediate care. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good care planning system, which provides the staff team with the information needed to enable them to support people in a way they prefer. People’s health needs are well met and the management of medication is generally satisfactory. People feel they are treated with respect and that their privacy is upheld by caring staff. EVIDENCE: All people responding to CSCI surveys told us they “always” received the care and support needed. One wrote, “Matron & her staff are very kind and helpful always”. During our visit people told us they were happy with the care they received, comments included, “They (staff) come quickly when I need them”, “Staff are kind and nothing is too much trouble for them” and “I am well taken care of here. No complaints at all”. The expert by experience observed, “The carers and management were seen to demonstrate genuine care, attention, respect and affection for the residents”. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 13 Each person has a plan of care, which details his or her individual care needs, wishes and preferences. Personal profiles have been completed which give a sense of the individual and their close relationships with others. Staff were aware of people’s needs and could describe the care delivered, which reflected what was written in individual care plans. Risk assessments were in place and generally reflected behaviour or situations, which may cause harm to people, for example poor mobility, falls, aggression and the use of equipment. Where people’s behaviour may challenge the service a good system is in place to monitor behaviour and described events or circumstances, which may affect that individual. There are good instructions for staff to follow when dealing with difficult situations, which helps to provide a consistent approach. Moving and handling assessments and plans, skin care and continence assessments were in place and generally provided staff with the instructions needed to deliver care. Staff were observed to assist people with manual handling needs in a competent and sensitive manner, using the correct equipment and giving gentle instructions and reassurance to people as needed. Staff were given information at shift handovers about some peoples’ particular needs – any changes to their needs, who was to be offered a bath, or needed encouragement with drinks or food. Staff surveys showed they were “always” given up to date information about people’s needs, one wrote, “We have a very good and informative care plan system”, and another told us, “The care plans are organised and easy to see information” a third wrote, “I feel the handover highlights any area that needs special attention, like someone who is poorly so that we can read the care plan for more information. I think information is shared well with staff & matron”. People’s personal care was well attended to; people were smartly dressed, and well groomed. Our expert by experience noted, “All residents appeared clean, well dressed and well cared for. All spoke highly of the laundry service and the speed with which their clothes were returned. People said that baths and/or showers were frequent and also “available on demand”. The Day Book records that service users were offered baths/showers at least twice a week and also indicated when hair was to be washed. This book also records medical appointments and birthdays and is an excellent aide memoir for staff”. One relative wrote, “We feel, my mum is well looked after in all aspects. Particularly when my daughter got married – the carers made extra effort in making sure she had her hair done and her nails painted and dressed in her wedding outfit. We appreciated how much time and effort they put in”. People told us their medical needs were “always” met; one person said their medical needs were “usually” met. Health professionals responding with CSCI Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 14 surveys told us the home “always” sought advice and acted on advice. Health professionals felt that people’s health care needs were “always” (3) or “usually” (2) met. Their comments included; “Often manage patients who have complex mental & physical needs”, “Skilled at managing patients with mental health problems. Make appropriate use of the GP service. Make helpful suggestions & useful advice for treatment of patients” and “The home contacts the district nursing service promptly”. A care manager told us, anxiety and panic displayed by one person was handled with “patience and skill” by Mrs Perry and her staff. One relative told us, “The level of care is very good”, another wrote, “my mother (and other residents) are always clean, respectable and well groomedclothes, hair, make-up, nails. Etc”. Records show that people have access to a variety of health professionals including GP, district nurses, optician and other specialists and out patient clinics. A dentist made a routine visit during this inspection. We looked at the way the home stores and administers medicines. On the whole medicines at the home are managed safely. Medicines are stored and disposed of safely. The fridge used to store medicines is lockable, and we were told it was “occasionally used”. At present temperatures of the fridge are not kept, which would ensure it is kept at the correct level. Other storage was satisfactory, including the arrangements for storing of controlled medicines. Lockable medicine cabinets are fitted in all bedrooms and people’s medication is stored there. Medication is kept in individual cassettes, which are filled by the local pharmacy. There are clear instructions on each cassette regarding the dose, time to be given and effect of medication. Medicine administration record charts (MAR) are produced on the computer by the deputy manager, she follows the instructions on each cassette, however the accuracy of the transcribing is not verified by another competent person, which would be good practice and ensure a robust system was in place. MAR charts looked at had been completed to show when medicines had been given or had be omitted or refused. Since the last inspection procedures have been put in place to inform staff of the time people need medicines, and is available to all staff, as a checklist. Only staff trained to do so administer medication. During our visit staff were seen and heard to be polite and friendly when delivering care or assisting people with their daily activities. Staff were heard to address people in a respectful manner and their approach was pleasant and caring. People told us that staff were respectful towards them. One person said, “They (staff) knock on my door and they are pleasant”, another said, “I am treated very well”. Health professionals told us people’s privacy and dignity was “always” or “usually” respected. One relative told us, “Staff always try to respect my fathers dignity, which is paramount now he is so vulnerable”. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible and people are supported to exercise control over their daily lives. Social activities meet some peoples’ expectations and preferences and people benefit from contact with their family and friends, which is encouraged and supported by the home. Meals at the home are enjoyed and provide a nutritious variety. EVIDENCE: People told us routines at the home were flexible. One person said, “You can do as you want really”, another said, “You do what you’ve usually done”, and another told us, “I can get up and go to bed when I want. I can go to my room when I like”. The expert by experience notes, “All of the seven residents spoken with seemed content with their routine. Most people said they had a choice of when to rise and retire. One person always rises early to exercise their pet dog, which they were allowed to bring to the home.” A relative told us, “They have social activities, a lovely garden, and appear content with their routine”. Relatives told us people were “always” or “usually” supported to live the life they choose. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 16 Care plans contain good information about people’s preferred routine, such as bedtime and morning preferences. One person likes a ‘tot a whisky’ at night, this is recorded and the person told us staff would offer this before bedtime. One person told us how they had settled well at the home and how they had made “new friends”. Staff were aware of particular friendships and ensured that people could sit together to chat. Surveys returned to CSCI show that two people felt there was “always” activities available to take part in, one person felt this was true “usually” and a fourth said activities were “sometimes” appropriate. Care plans gave some information about people’s interests and hobbies but this was limited in places and more relevant information could assist staff to plan activities, which could be enjoyed by individuals rather than in a group. Two people told us they were not “keen on group activities”. One care manager told us that Park House provides daily activity and entertainment but that this did not always suit everyone’s needs. Another care manager wrote that their client “needs social stimulation & activity. Park House has limited provision but Mrs Perry said she would explore the possibility of someone playing scrabble with my client”. One relative felt more could be achieved in this area, they wrote, “Any mental stimulation would be of great benefit to him. And I would like and expect that this would be part of his overall care”. Records looked at show that activities tend to be undertaken in groups and involve music and singing. The expert by experience told us, “None of the residents spoken with could recall any activities but it became apparent that indoor activities took place most days at no extra cost to those participating. There was no current provision for outings due to cost and staffing limitations. In good weather the more able people are able to go into the large and attractive garden”. During the afternoon of our visit two people enjoyed an art and crafts session with the help of a visiting ‘artist’. These sessions happen fortnightly and the two people involved during our visit appeared to really enjoy themselves. Later that afternoon a visiting singer arrived and several people enjoyed a sing-a-long. People were singing and tapping their feet. Records show that an aromatherapist visits regularly and spends time with individuals. Regular music and movement and yoga sessions are also available for people to attend. Books are changed regularly at the home by the “travelling library”, which visited during our inspection. The hairdresser visits twice a week. The expert by experience told us, “ The “Day Book” recorded that the local Vicar visited on the first Wednesday of each month for a Service of Holy Communion with at least 6 residents. A resident confirmed this event”. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 17 The home’s cats were a good source of conversation between people, many of whom enjoyed petting and chatting to them. One person has been supported to look after a their small dog since being admitted to the home, which was very important to them. Visitors are welcome at any time and the home has established good relationships with the relatives responding to the CSCI survey. Relatives confirmed that they were always welcome at the home and that they were always informed and consulted with regards to their relative; one wrote, “always informed of GP visits and outcomes” another told us, “I and my family are always made very welcome on a regular basis…” Family members also told us that people were assisted to use the phone to help them keep in touch with friends and relatives. One person living at the home said their visitors could “come and go when they like”. The home makes a real effort to help people keep in touch with family members. One visitor is collected by staff and driven to the home for lunch at least two or three times a week in order to spend time with their loved one. The home provides a relaxing, comfortable and supportive environment for people to live in. The staff were observed to support people in a sensitive and discreet way that promoted dignity, choice and independence. One relative told us, the home… “Helps him to maintain as much independence as possible”. Some people were seen to move freely around the home, spending time in their chosen place and seeking the company and activity they preferred such as reading or knitting. We saw that when people became restless staff were at hand to talk to them or walk with them if they preferred. People were offered choices about what they would like to drink or where they wanted to sit. Surveys returned to CSCI showed that people “always” or “usually” liked the food. The expert by experience was asked to look specifically at meals and mealtimes and he told us, “Although there is no set alternative menu, the staff have good knowledge of, and meet, people’s preferences. People generally spoke highly of the quality of the food using the words “food lovely, really super, excellent cook”. One person classed the food as “alright”. On the day of the visit the main meal was roast pork with boiled potatoes, broccoli and diced swede with gravy to taste. The dessert was apple pie with custard or cream (with an alternative of ice cream). Tea or coffee followed the meal. All the food was tasty, hot and well presented. About 17 people ate in the dining room with the remainder taking their meals either in their rooms or in the lounge where carers could give individual attention as necessary. The carers in the dining room took time to gently encourage reluctant diners and checked before removing uncleared plates”. The expert also noted, “People were encouraged to partake of mid morning coffee or tea and biscuits. Many people also took advantage of the water dispenser in a corridor and it was noted that drinks were always freely available. People were encouraged to drink water”. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 18 The menu for the day is displayed on a whiteboard in the dining room but not in the lounge. Mrs Perry told us she was considering using the wipe board in the lounge to display the daily menu. The tables in the dining room have bright primary colour tablecloths and napkins or aprons were supplied as appropriate. After lunch there was no undue delay in assisting diners back to one of the two lounges or elsewhere. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that their complaints will be listened to and staff understand the principles of adult protection, which helps to protect people from abuse. EVIDENCE: All people responding with CSCI surveys knew how to make a complaint and knew who to speak with should they have any concerns. People felt Mrs Perry and the staff were approachable and would listen to them and “always” act on what they say. Relatives were also aware of how to make a complaint and told us that concerns were responded to. Outside professionals were confident that complaints or concerns were responded to appropriately. Records show that the home has received two complaints since the last CSCI inspection. These were dealt with in a professional way. The Commission has received no complaints or concerns about this service. A copy of the complaints procedure is posted in the hallway and is also available in the Statement of Purpose. Training records showed that staff receive adult protection training to ensure they are aware of the issues and know who to raise any concerns with. Staff spoken with said they had attended training and had a good understanding of adult protection matters and understood their personal responsibility to report incidents of concern. People spoken with confirmed that they were happy living at the home and all said they felt safe at the home, one person told us, “I feel Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 20 safe and happy here”, another said, “I am as safe as I could be”. All relatives felt that people were well cared for at the home. The AQAA tells us that the home are accessing training and information regarding the Mental Capacity Act to establish if they need to change any aspects of the care planning and admission process, and to make sure that they are doing everything they can to act in the best interests of the people living here. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy a good standard of accommodation that is attractive, clean, homely and generally well maintained. EVIDENCE: The expert by experience gave his impression of the home, “Security at the main entrance was good and visitors are asked to sign-in and use the antiseptic gel on entry. The immediate impression is of a welcoming home with no unpleasant odours. Many of the carpets have been replaced recently to make them more amenable to people with dementia. The light, airy dining room has recently been re-decorated and has large windows overlooking the garden. For people with dementia who have difficulty in identifying their bedrooms it may be helpful if their photograph was on the door”. Park House is genaerlly well maintained, with homely and comfortable accommodation including two lounges and a dining room. Decoration and Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 22 refurbishment is ongoing and since the last inspection new carpets have been laid and several areas, including bedrooms have been redecorated. Mrs Perry told us that people had been involved in choosing the decoration of their bedrooms where possible. People told us they liked their private bedrooms and had been able to personalise this space with items of furniture and mementos brought from home. Since the last inspection the home has been awarded a grant to improve the environment for people with dementia. This grant has been used to build a new wet shower room, which has improved the overall bathing facilities at the home. It was noted at the last inspection that people did not have easy access to the call bell system in communal areas. During our visit we also noted this. People spending time in communal areas told us that staff were always walking through the sitting rooms and their attention could easily be attracted if needed. It was accepted that some people were unable to use a call bell and Mrs Perry had identified other ways of ensuring that people in communal areas or bedrooms were checked frequently. Mrs Perry told us one person who chooses to spend a lot of time in their room is to have a new call bell fitted to suit his needs. In order to reduce the risk of scalds and burns to people, hot water temperatures are controlled and radiators seen in bedrooms were covered. It was noted that records kept of bath temperatures showed that some people were being bathed in water of 32oC and 34oC, which is rather chilly. This was reported to Mrs Perry. The home was clean and free from offensive odours throughout. People responding with surveys said the home was “always” or “usually” clean and fresh. The laundry was clean and well organised with the necessary equipment in place. Staff receive training in infection control and hand sterilising gel is in all rooms and also at the main entrance for visitors to use to minimise infection. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Staffing levels are sufficient to ensure that peoples’ needs are met in a timely way and experienced and friendly staff support people well. People are protected by the robust recruitment practice followed at the home. EVIDENCE: People living at the home spoke highly of the staff. Their comments included, “Staff are very helpful and friendly”, “They (staff) are pleasant people and are there when you need them” and “They (staff) are pretty good – I get on with all of them”. Some relatives also spoke highly of the staff’s approach and attitude. Relatives responding with surveys felt that the home gave the support required and could meet the different needs of people living there. The majority of people responding with CSCI surveys told us staff were “always” available when needed. The majority of staff returning surveys told us there was “always” enough staff to met people’s needs. During our visit people’s needs were attended to in a timely and unhurried way. Mrs Perry aims to have 6 care staff on duty during the morning and 4 on the afternoon shift. We looked at the staff rota for two weeks in March – three staff were on leave and one was on sick leave. The rota showed that there were generally 5 care staff plus the deputy and Mrs Perry to deliver care in the morning. Care staff are not involved in domestic tasks such as cleaning or preparing meals and therefore have time to provide the care needed. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 24 We looked at the recruitment practice within the home to ensure people are protected. All staff returning surveys told us that employment checks such as Criminal Record Bureau (CRB) check and references had been undertaken. We looked at three staff recruitment files. All the required checks had been obtained before staff started working at the home. Staff told us they had good training opportunities and good support from the management. All staff responding with surveys said they had received induction training, which helps them to understand how to work safely and respectfully with people. The home has adopted the Skills for Care induction programme, a nationally recognised programme to ensure good standards. The AQAA shows that 25 of care staff have achieved a nationally recognised care qualification (NVQ 2 or above), which helps to ensure that staff are competent to meet peoples’ general care needs. This is below the expected level and the home needs to continue to work towards the expected 50 of care staff with NVQ 2 or above. Following the inspection information received from the home confirmed that the target of 50 of staff with or working towards NVQ2 had been achieved. Other training, including mandatory training is well addressed. One staff member told us, “I think that we have a lot of training in a range of job related topics and the management obviously put a lot of resources into providing well trained staff for the residents”. Records showed that staff had undertaken training such as adult protection, medication, dementia, and eye care. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 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 good systems in place to ensure that people’s views are sought and acted upon. Health and safety within the home is promoted meaning people live in a safe environment. EVIDENCE: The registered manager (Mrs Perry) is professional and carries out her duties and responsibilities effectively. Mrs Perry has many years of experience running a registered care home. A competent and enthusiastic deputy supports her and together they provide clear leadership for the staff group. One member of staff told us, “Our employer talks to us and explains how she likes us to work, if we don’t understand anything or have any problems we are always able to talk to Mrs Perry…” Outside professionals and relatives appear confident in the management of the home, one relative wrote, “I think the Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 26 home is very well run and overseen” and another told us, “Mrs Perry and her staff run Park House with great care and kindness in a most professional way”. One care manager told us, “Mrs Perry and her team are always approachable, she will always try to help…” The home has established quality assurance systems, which ensure that the service is managed and developed in the best interests of the people living there. Annual surveys are sent to residents, relatives and outside professionals. The management team take the necessary action within agreed timescales to implement requirements identified in CSCI inspection reports. The home does not look after any people’s money. Those who might choose to look after their own money would be encouraged and supported to do so. A record is kept of any bills paid on behalf of people, such as hairdressing or chiropody, and a monthly account is sent to whoever deals with their finances. Staff told us they received regular supervision and support to help them do their jobs well. One staff member told us, “Management give a lot of time & support to us. We have lots of information available & training”. Overall, health and safety at the home is managed well. The records we looked at showed that staff have received training and regular updates on all health and safety related topics. Records showed that staff had undertaken fire safety, first aid, manual handling, food hygiene, infection control, and health and safety training to ensure people work safely. During a tour of the building it was noted that two bedroom doors did not close properly, which could increase people’s risk if there was a fire at the home. This was a result of the new carpets being fitted. This was dealt with immediately and by the end of the inspection these doors were closing, as they should. Restrictors were in place in first floor bedrooms where windows were checked at random. This reduces the risk of falls from windows. The kitchen was organised and generally well equipped, the chef said he had the necessary equipment. The home has implemented “Safe food, better business”, a nationally recognised benchmark for food hygiene and safety. Fridge and freezer temperatures are recorded regular to ensure that food is stored safely. The fridges in the kitchen were clean and food stored had been labelled and dated. The AQAA showed that maintenance of equipment and systems, such as water, gas and electrical systems were up-to-date. Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 27 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 X 18 3 3 X X 2 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations It is recommended that printed MAR charts be checked by two people and that hand written MAR charts be signed and dated by two people to ensure accuracy and accountability. It is recommended that the correct temperatures (the range of temperatures) of the medicines Fridge be kept to ensure that medicines are kept according to manufactures instructions. It is recommended that particular consideration be given to stimulating and meaningful activities for all people living at the home, which meet with their preferences and capabilities. Call systems with an accessible alarm facility should be provided in every room. 2. OP12 3. OP22 Park House, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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, Little Knowle DS0000022001.V350486.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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