Inspection on 10/09/08 for Park House Nursing Home

This inspection was carried out on 10th September 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 Nursing Home 23/01/08

Park House Nursing Home 05/02/07

Park House Nursing Home 12/01/06

Park House Nursing Home 24/05/05

Park House Nursing Home 25/10/04

Park House Nursing Home 19/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Park House Nursing Home Kinlet Bewdley Worcestershire DY12 3BB Lead Inspector Janet Adams Unannounced Inspection 12th September 2008 10:00 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 Nursing Home DS0000041214.V371413.R02.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 Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Nursing Home Address Kinlet Bewdley Worcestershire DY12 3BB 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) 01299 841262 carla.gregory@virgin.net Park House Care Ltd Mrs Melanie Allen Care Home 40 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (40) of places Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Dementia (DE) 18 the maximum number of service users to be accommodated is 40. 2. Date of last inspection 23rd January 2008 Brief Description of the Service: Park House is registered as a Care Home registered to provide both personal and nursing care for up to a maximum of 40 Older People, which may include a maximum 18 people with dementia related illness. Accommodation is provided in an older property which has been enlarged by two extensions. Extensive building work seen in progress at the last inspection in January is almost complete. Seven bedrooms with en suite facilities are now finished and the new lift is in the final installation stage. This has enhanced living accommodation at the home, as it has halved the number of bedrooms occupied by two people to 5, as well as reducing the demand for the communal bathrooms. The accommodation is arranged on three floors, reached via a shaft lift or staircase, and the home sits amidst gardens and grounds, which provides a safe outside environment for residents to enjoy. The communal areas are homely and comfortable. As the home is in a rural location, transport links are limited. The Registered Manager/Matron of the Home is Mrs Melanie Allen, who is supported by a team of well-qualified and experienced staff covering all aspects of the service the home provides. Park house Care Ltd makes the services of the home known to prospective Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 5 residents in their statement of purpose, and its brochure/service user guide. The fees charged depend on the care, support and accommodation provided. Additional charges to service users are for hairdressing, toiletries, and newspapers. The reader may wish to obtain more up to date information from the care service about this matter. Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes overall from the service they receive. This inspection was carried out by one inspector on two separate occasions and lasted a total of eleven hours. Some time before the inspection, we wrote to the home to request some up to date information to assist with this process. This meant that although Park House knew the inspection was imminent, they were not aware of the date or time the inspection would take place. The inspection included observing activity within the home, inspecting the premises, an ‘in depth look’ at records for residents and staff, as well as observing, talking and listening to over half of the 35 people living there. The aim of the visit on the first inspection day was to have a good look round the home, and to spend time observing people living in the home. Due to their medical conditions, several people living in the home are not able to communicate their opinions. The time spent observing people was helpful in confirming findings of the inspection process. The care of four people was looked at in depth, when comparisons with the observations were made with the home’s records and the knowledge of the care staff. Some of the staff on duty at the time of the inspection also shared their views about working at the care home. Discussions with people were carried out in private with people on their own, or together in groups in the lounges. Everyone was happy to share their comments, which are included in the main body of the report. As part of the inspection process CSCI circulated questionnaires and stamped addressed envelopes to people living visiting and working at the home, so their views and opinions could be included in this report. Both the Registered Provider and The Manager were thanked for the very useful information provided before the inspection and their assistance on both inspection days. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection. A total of 24 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? All 7 statutory requirements made at our last inspection have been fully met. Good practice recommendations we also made have been considered and acted upon. Completion of the new extension and extensive upgrade of other parts of the home have means Park House is a safe, welcoming, homely place to live and visit. People are most appreciative of the improvements and one person wrote to the home to comment, ‘The new extension is lovely and provides an even better environment for its residents and staff.’ Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 8 Management systems have improved to make sure there is better monitoring of the accommodation and equipment in the home to make sure everything is kept in good repair and all necessary maintenance checks are carried out on time. Good systems are in place for ensuring that the staff are fully suitable and well trained to care for the people living at the home. 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. The summary of this inspection report can be made available in other formats on request. Park House Nursing Home DS0000041214.V371413.R02.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 Nursing Home DS0000041214.V371413.R02.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 & 3. Quality in this outcome area is good. An appropriately qualified person assesses all people considering moving into Park House before being admitted. This makes sure the home is suited to meet the person’s needs and wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Providers for the service produce a corporate style welcome information folder for prospective residents, which contains the home’s Statement of Purpose and Service User Guide. This is the information we require them to have by law. Copies of this information was requested and examined after our inspection visit. Although the information has been improved to reflect the additional numbers of people the home is registered for, it is considered that more information should be included to make it very clear to potential residents/representatives that almost half of the people living at the home have dementia related conditions, and they are not Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 11 accommodated in a separate unit, but share the same living and communal accommodation with the rest of the people living there. As a result some parts of the home have restricted access to make sure people are kept safe. This has caused some concern with people lately and a recent comment we received indicated a lack of awareness of the service the home provides. All prospective residents of Park House are fully assessed by the home manager prior to moving into the home. When we asked people about the home admission process everyone agreed it had been handled well and they received enough information about Park House. One person wrote, ‘After viewing different homes and reading through their CSCI report we were in no doubt that Park House was the right choice for Dad.’ An in depth look at the admission records of two people admitted to the home since the last inspection confirmed that the good standards of recordkeeping seen for this matter at the January inspection have continued. As much information as is necessary is collected for the home to decide whether they can meet the person’s personal and health care needs before they move in. Discussion about the admission process with Melanie Allen, the Registered Manager for the home confirmed she was most knowledgeable about the needs of the people who currently have their names on the home waiting list. Information shared showed the home continues to have sensitive and thoughtful admission practices, which ‘put people first’ to ensure every admission to Park House will be successful. Not only are the physical and psychological needs of the person taken into account, careful consideration is given to the type of accommodation that is offered to any individual to make sure the individual is happy with the facilities, layout and location of their bedroom. One person awaiting admission who was not deemed to be suited to living in one part of the home was in the process of being offered the opportunity to move into another room which would promote personal wellbeing and independence. Park House Nursing Home DS0000041214.V371413.R02.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 adequate. The support and personal care provided at Park House does not always promote good health for all of the people who live there. Medication management systems do not offer assurance people have received medication as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A lot of people who live at the home are bedfast and completely reliant on the staff to meet all of their daily needs. Therefore it was positive to receive a lot of complimentary comments about the care carried out for the residents of Park House. People wrote, ‘The care and support is excellent’ ‘We cannot praise and thank them enough for the way they care for Dad.’ ‘We have always been fully informed. If doctors are required we are informed Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 13 in advance.’ Due to their medical conditions, several people living in the home are not able to communicate their opinions. On both inspection days a total of over 4 hours was spent in the company of residents in two communal lounge areas. Care practices observed were generally satisfactory and the majority of staff were seen to be attending the needs of residents in a respectful, caring manner and were very knowledgeable about the individual needs and preferences of the people they were caring for. However, there were some inconsistent care practices and more attention needs to be given to ensure people’s safety dignity and comfort is maintained, especially when they are being assisted to move from one place to another. Observation of three people being hoisted in the lounge areas showed that on two out of three occasions people were transferred from armchairs in an unsatisfactory manner. • On one occasion the three staff members involved did not check a person’s feet were safely positioned before transferring the individual. This meant the person could not balance properly during the manoeuvre. • Two staff members did not attach a sling securely to another person and it moved out of place when the hoist was operated resulting in the person not being supported properly and the individual’s under clothing being exposed. The staff involved had to readjust the equipment before they could continue to move the person with the hoist. Care plans sampled did not cover some peoples needs and did not offer staff guidance and support to keep people safe to promote their good health. When the records of five people were examined it was seen that: • The recordkeeping to safely account for manual handling procedures, required to support people as part of their day to day lifestyle, were not adequate. It is of further concern that the daily records of a person stated the very frail individual had ‘banged side of forehead whilst transferring on hoist’. The person’s records did not offer staff appropriate advice to safely transfer the individual. Furthermore, this issue had not been recorded in the home’s accident book. This matter was discussed with the home management who were not aware of some of the handling issues discussed. It is recommended the home review residents’ manual handling paperwork to confirm people’s needs are properly assessed and they have detailed plans of care so staff know how to safely transfer people especially when equipment is used. It was positive to be told that staff moving and handling training was already planned to take place within the next fortnight. This provides an ideal opportunity to fully improve this issue. • An incident, which resulted in a person needing dressings for a skin tear on an elbow, had not been reported appropriately. The home DS0000041214.V371413.R02.S.doc Version 5.2 Page 14 Park House Nursing Home • management were not aware of this issue when this matter was discussed. Accident management was an issue we raised in our last inspection report. The care plans for people who have behaviours challenging to others did not provide guidance for staff as to how this should be managed effectively. However observation of such individuals confirmed staff are able to act in a person centred way and are able to give a verbal update of people’s needs. Since our inspection in February 2007 we have expressed concerns about resident safety with regards to bedrail safety, and improvements seen at our January inspection this year offered us assurance that this issue had been fully addressed. During the tour of the home, many beds were seen to have this equipment installed as required, except for the bed of a person recently admitted for short term care. Staff who admitted the person had not noticed the rails were not secure on the person’s bed. Although the bed was replaced immediately after we noticed this, the person’s records did not reflect what checks had been made when the equipment was started to be used, that the installation had been unsafe nor did they account for a different bed being provided. Although care plans have been reviewed on a monthly basis, the layout and presentation of the care records meant that any changes to care records cannot be made easily and there is not enough room for staff to add any more details at a later time. This matter was discussed with the manager, and it is advised that this system is reviewed with staff to ensure the format enables easier review and update of care plans. With the assistance of a trained nurse the home medication management systems were reviewed. Satisfactory standards seen at previous inspections have not been maintained. Although Controlled Drugs were adequately accounted for, there was no clear system to show the home’s safe compliance with the administration, safekeeping and disposal of other types of drugs. Examination of the records of five people confirmed medication records were not up to date; gaps were apparent in medication administration records which meant they were not a reliable record to confirm people were getting the medicines they were prescribed at the right times. • One of these individuals was seen demonstrating challenging behaviours to others and had been prescribed specially prepared medication by the doctor to help promote the person’s wellbeing. However, it was not being stored or used effectively. Two bottles of this liquid medication was seen stored in the drug fridge were in contact with ice at the back of the fridge. The medicine bottles were clearly labelled ‘do not freeze.’ The nurse was advised to obtain fresh DS0000041214.V371413.R02.S.doc Version 5.2 Page 15 Park House Nursing Home • • • supplies. Discussion about this matter with our pharmacy inspector confirmed this practice makes the chemical content unstable. Furthermore, two bottles of the same medication were seen to be in use for the person at the same time and a third opened bottle of the same medication was seen to have expired a month earlier. This had not been taken out of use. The nurse could not confirm whether the person was receiving medication which had expired or not. Care records confirmed the person continued to demonstrate periods of challenging behaviour. There were no medication administration records for a person admitted for short term care although staff were applying prescribed ointment to the person. There was excessive stock of medications not accounted for. Records seen could not fully account for all medications received into and going out of the home. Several bottles of medication seen opened in the home’s two drug trolley did not have the dates they were opened on them. The above unsafe practices puts people who use the service at risk of not getting the prescribed medicines they require to enable symptom control of their medical conditions. The above findings are of particular concern as the home was fully aware this aspect of the service would be inspected. This indicates a lack of awareness of their obligations to manage medications safely. Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 16 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. The daily life and social activities arranged for people living at Park House takes into account the differing expectations, preferences, lifestyle and capacities of each individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides activities for residents to take part in if they choose, such as arts and crafts, music and movement. Photographs displayed around the home show various events enjoyed by residents this summer. The September activity planner had details of 12 different activity sessions listed. Feedback from all of the residents who took part in our survey confirmed there are always activities planned that they can take part in. Everyone commented they especially enjoyed going on the outings the home arranged, so it was good to be told that two trips out were being organised in addition to pastimes listed on the monthly activity plan. Since the last inspection a carer has undertaken the role to assist in coordinating activities in the home. The person was very enthusiastic about her Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 17 new responsibility and commented that people particularly enjoyed recent art and craft sessions. She also commented that the regular hand massage sessions provided by a visiting therapist are most popular and are enjoyed by 12 of the very frail people living at the home. A community library continues to visit the home every fortnight to provide a regular supply of books with appropriate print for people living at the home. Copies of the ‘Kinlet News’ ‘Cleobury Bulletin’ and ‘Highley Forum’ and the newsletter of the local Alzheimers Society group were available for people to read to keep in touch with ‘ local goings on.’ The home’s open visiting policy ensures families and visitors are made welcome – some relatives also accompany their family members on the Park House trips out. All residents who made comments about the meal provision were in agreement that the food at Park House was good. One relative said her father enjoyed his food and sometimes had second helpings. Several people commented there was plenty of variety and choice. Observation of meals being served in both dining areas confirmed this. On both inspection days people were offered drinks, fruit and snacks in between meals on a regular basis. Although a lot of people rely on staff to be assisted with their meals, discussions with staff on duty confirmed they were knowledgeable about people’s dietary needs, and the best way to serve their residents’ food so they can dine independently. The home catering staff continue to use their “Safer food, better business” paperwork recommended by the local environmental health officer. This means they have a good permanent record that all food hygiene practices continue to be followed. Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 18 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. The interests of residents are protected through the home’s complaints procedure and staff are fully aware of their role in protecting residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and provider are available within the home on a daily basis and are therefore on hand to deal with concerns as they arise. The home has a complaints procedure that is up to date, easy to understand and a copy of the procedure by the entrance door ensures that it is readily accessible. It is also included in the welcome pack given to anyone who moves into the home. Information the home provided us with before our inspection told us there has been three complaints dealt with by the home in the past 12 months. These are all clearly accounted for in the home complaints logbook, which continues to be reviewed on a quarterly basis. Management improvements have continued to make sure people feel comfortable to raise any concerns they are unhappy about. Up to date information is kept available in the office for the staff team to refer to if the Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 19 need arises. The home also wrote to us and informed us, ‘Staff are putting into practice the knowledge learned at previous vulnerable adult training.’ They also stated that in the next year they have plans in place to make sure 100 of staff will have received up to date safeguarding adults training. All comments received from staff that took part in our survey confirmed they knew what to do if someone had concerns about the home. One person wrote, ‘With all the training sessions which covers these situations and the support of the matron and the proprietor, I would never have any concerns about dealing with such issues.’ Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 20 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): 19,24 &26. Quality in this outcome area is good. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All individuals who made comments to us about the home were in agreement that the home always smelled fresh and had a welcoming, clean and tidy appearance. One person who wrote to us commented, ‘The home has never had an unpleasant smell looked dirty or untidy.’ Since our last inspection there has been good progress with the upgrade of the home. Before the inspection the home provided us with a wealth of details to inform us of the progress that has been made. Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 21 Completion of building and refurbishment at the home has resulted in 7 additional en suite bedrooms being provided as well as 4 original bedrooms being upgraded to a good quality homely standard. • Several areas of the home have been redecorated and recarpeted. • A temporary visitors /quiet sitting room has also proved to be popular. • New nursing beds with integral bedrails have been purchased. • A bath hoist has been obtained to maximise the use of an older bathroom. • Externally, a new secure patio area has been provided so that all people living at the home can sit outside. All of the above improvements were seen as part of the tour of the home. Technical difficulties beyond the control of the home has resulted in a delay in the new large lift being operational, which has meant there has not been full access to the newly installed walk in shower yet. During the tour of the home it was positive to be informed that the bathroom refurbishment is planned for the coming year as part of the home upgrade. Spot checks of hot water temperatures in these areas were satisfactory and matched those recently recorded by the home maintenance man. The manager also informed us that the maintenance and redecoration schedule is now a working tool to make sure any necessary repairs are identified, recorded and carried out. Plans are also in place for further upgrade of the ground floor accommodation in the home A comment received from someone who recently visited the home expressed concern that some parts of the home have doors locked. We have been aware of this issue for some time, as it is part of the home environmental safety assessment to maximise safety where some people with dementia related conditions are accommodated. The manager confirmed all necessary risk assessments continue to be in place to account for this matter and they are regularly updated and reviewed. Since our last inspection the home has been inspected by the environmental health officer who confirmed the home was adhering to necessary food hygiene regulations at the time, however some uncovered food was seen stored in a fridge during our inspection. Systems to improve infection control have been introduced since our last inspection. There are improved hand washing facilities and improved cleaning systems have been introduced which are in line with current good infection control practices. The housekeeping team now have colour coded mops to use in different parts of the home. Standards of cleanliness were much improved in high risk areas like the laundry. Independent health professionals have also carried out an infection control audit recently. The home is currently awaiting this report. Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 22 • 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. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of residents. People living at the home are supported and protected by the home’s recruitment policy and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Favourable comments received from people living at the home confirmed that they receive the care and support they require. One person commented, ‘Staff are always there when I need them’. On both inspection days the home manager confirmed that one nurse and 6 carers were on duty on the early shift to care and support for the 35 people living at the home. Examination of past, present and future rotas for the month of September confirmed the home is adequately staffed and takes into account the dependency needs of people living at the home. Improvements to information recorded on the team rotas confirm a good skill mix to be on duty at all times, and clearly identify when the manager is on duty. Park House management also employs an administrator, housekeeping, catering and laundry staff to ensure smooth running of all aspects of the home. Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 23 Information provided for us by the management confirmed the home has been satisfactorily staffed in recent months. Recent use of agency staff has continued to be minimal and has not had an adverse effect on the care and support people have received. The home has recently had a successful recruitment drive and new starters due to start include two night carers and a new deputy manager. Examination of the files for two recent new starters showed that suitable recruitment procedures are in place. Each file was well-organised and contained references, criminal record bureau disclosures and confirmation of identity and qualifications. The manager demonstrated a good sound knowledge of the recruitment procedures and the importance of employing the ‘right’ person for the job. Although the home has a good induction programme, which monitors the progress of new carers when they start work at the home, this was seen to need to be introduced for the nursing staff they employ. The records of two newly recruited nurses did not have any information to confirm they had been fully introduced to the running of the home and were competent to be in charge as necessary. However, staff comments sent to us indicated that they are clear regarding their role and what is expected of them. Many aspects of staff training have continued to improve in recent months, and almost 75 of the carers have the minimum expected care qualification. Good ‘tracker systems’ have been set up by the management so they have an ‘at a glance’ picture of the training staff have had and what they need. Staff stated that there are many opportunities for training not only in the mandatory topics but also in specialist areas. The records of three staff members including the manager confirmed the team have attended training for nutrition, dementia awareness and challenging behaviour since the last inspection. Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 24 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. The management team is committed to improving the quality of the service. Improved systems for the health, safety and welfare for residents, staff and visitors need to be further developed and adjusted to make sure that they are kept up to date, to meet people’s changing needs and safeguard their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It is obvious Mrs Carla Gregory, the Registered Provider, the Registered Manager, Mrs Melanie Allen have made a lot of effort to improve management systems at Park House since the last inspection, when we asked them for an Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 25 improvement plan to confirm how they were to make permanent changes to meet care home regulations. The improvement plan they provided, alongside the details in the AQAA (Annual Quality Assurance Assessment) they sent us in July contains good information which lets us know about changes they have made and where they still need to make improvements. It clearly shows how they are going to do this. Many management systems have been reviewed and developed to make sure the staff team get the right direction, monitoring and motivation. Both registered persons have undertaken supervision training, which resulted new paperwork being introduced to fully address this issue, and staff records confirm this matter is now in hand. Staff members who responded to our survey were unanimous to confirm the manager regularly meets with them and offers them support. One person wrote, ‘The matron is always there if you need any advice, and we always sit and go over things regularly.’ Detailed recordkeeping in quality audit files confirms there is close monitoring of important issues such as equipment safety. Regular staff meetings have been held to keep people fully informed of all changes as they occur. The home management are keen to let ‘everyone have their say’ how the service can be improved and have made several changes to show they listen and act on what people say about the home. • Cooked breakfasts have been introduced. • Shower facilities have been provided for those who expressed this wish. • Staff break times have also been reorganised following comments received from a recent resident survey. Improvements to the safe working systems in the home have continued to ensure good management of monies and valuables kept in safekeeping for residents. Review of one person’s records confirms this system to be as robust as when it was looked at during our inspection in January this year, however it was confirmed that the individuals personal monies were being paid into the home bank account although Mrs Gregory has made several efforts to find an alternative solution for this matter with the placing authority for the person. This was discussed in depth at the inspection and professional third party involvement will be sought to resolve this issue. Many service and maintenance records for essential equipment used in the home were seen to be up to date and complied with necessary health and safety legislation. Good recordkeeping confirms weekly maintenance checks are carried out for equipment such as wheelchairs, hot water supply, and fire safety. Bedrail safety checks are carried out daily to ensure they are installed properly at all times although our findings show this system needs to be Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 26 reviewed so all individuals living at the home has this equipment safely installed. The home has effective recordkeeping systems for accidents, which meets all health and safety and data protection legislation. However, not all staff are following the company policies for this matter, which may result in the risk of an accident happening again. Park House Nursing Home DS0000041214.V371413.R02.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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X X 3 X 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 X 3 X 2 3 X 3 Park House Nursing Home DS0000041214.V371413.R02.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. 1. Standard OP7 Regulation 13 (4)(c) Requirement Manual handling risk assessments must be developed in care plans to make sure staff have the right detailed information to carry out these tasks for people who rely on them to safely transfer them in a dignified manner as part of their daily living needs. Timescale for action 25/11/08 2 OP9 13(2) 25/11/08 The home must develop their medication management systems so they can show the safe receipt, storage, handling administration and disposal of medications takes place. Staff who administer medication must be trained and competent and their practice must follow current written policies and procedures to ensure that residents receive their medication Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should contain information about the service as per Schedule 1 to the Regulations including accommodation arrangements for individuals with Dementia related illness. People thinking about moving into Park House must be provided with all the necessary information they need to help them to decide whether the home is right for them. It is recommended care plan recordkeeping is improved to clearly account for all individual’s care and support needs. Care plans should be kept under review in order to monitor alterations in people’s circumstances and effect changes in the care that they receive to keep them safe and well. It is recommended systems for the safe use of bedrails be further developed so that all bedrail installations are safely accounted for as part of a person’s admission to the home. It is recommended the home develop an induction programme for nursing staff they employ. This will confirm they are competent and confident to carry out nursing duties expected as per their job specification for working at Park House. It is recommend that monitoring systems are further developed to make sure staff record all accidents and incidents which result in injuries to people living at the home are acted upon appropriately to minimise the risk of any such incidents happening again. 2. OP7 3 4 OP7 OP30 5 OP38 Park House Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Nursing Home DS0000041214.V371413.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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