Inspection on 23/01/08 for Park House Nursing Home

This inspection was carried out on 23rd January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Park House Nursing Home 10/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Park House Nursing Home Kinlet Bewdley Worcestershire DY12 3BB Lead Inspector Janet Adams Key Unannounced Inspection 11:00 23rd January 2008 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.V342954.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 Nursing Home DS0000041214.V342954.R01.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 38 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (22) of places Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may accommodate a maximum of 38 Older Persons requiring nursing care of whom a maximum of 16 may have Dementia. There must be a registered nurse (RGN/EN or RMN) on duty at all times. During the daytime there must be a minimum ratio of 1:5 care staff to service users. During the night time there must be a minimum ratio of 1:10 care staff to service users. 5th February 2007 Date of last inspection 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 38 Older People, which may include a maximum 16 people with dementia related illness. Accommodation is provided in an older property with a more recent extension. Further extensive building work was in progress at the time of this inspection. Seven bedrooms with en suite facilities and a new lift are being added to the building. This will enhance living accommodation at the home, as it will reduce the number of 10 of bedrooms occupied by two people to 5. The Proprietor, and registered Responsible Person, Mrs Carla Gregory will be applying to us to increase the number of places from 38 to 40 as the extension work is nearer completion around April 2008. Accommodation is arranged on three floors, reached via a shaft lift or staircase, and the home sits amidst gardens and grounds, which will once again provide a safe outside environment for residents and their upon completion of current building works. 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 Homes provision. Current weekly fees were not specifically listed in the home service user guide. The reader may wish to obtain further up to date information from the care service itself. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 5 Park House Nursing Home DS0000041214.V342954.R01.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. This inspection was carried out by two inspectors on two separate occasions and lasted a total of nine 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 33 people living there. The Registered Manager was thanked for the very useful information provided before the inspection and her assistance on both inspection days. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection.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. A total of 24 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. What the service does well: The atmosphere within the home is warm and friendly and the staff group communicate well with residents. Staff appear enthusiastic in their work. Several of the people living in the home have problems communicating due to medical conditions and staff appeared to be good at understanding individual wishes and needs. The home have established a good rapport with relatives and representatives of the people living at the home. Comments received reflected they appreciated the service park house provides. One relative commented, ‘It’s a pleasure to come here’. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 7 The home goes to great lengths to make sure they can look after people thinking about moving into the home before they offer them a place at Park House. This offers assurance that when someone moves into the home it is a positive experience to the benefit of all people involved. What has improved since the last inspection? What they could do better: As a result of this inspection six additional statutory requirements have been made, totalling ten in all. In addition, eleven recommendations to improve practice have been listed for the attention of Park House management. Shortfalls seen during this inspection demonstrated a lack of on going monitoring of systems essential to keep the home living environment safe, and raise staff awareness of their duties to adhere to policies and procedures to maintain necessary recordkeeping. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 8 Park House management team need to revisit their practices at the home to ensure all aspects of the service are maintained to provide a safe comfortable individualised service for the people who live there. As a result, two Immediate Requirement notices were issued on the first inspection day. These concerns focused on hot radiators not being guarded and the use of bedrails. The home needs to complete risk assessments for individuals who are assessed as needing bed rails and ensure that staff who are responsible for selecting, fitting and checking bed rails receive appropriate training. Care records need to be further improved to reflect all of the personal and nursing care planned so that staff have the right guidance, and people can be confident that they will receive the care and support they need. Park House management need to improve their recruitment and vetting procedures to ensure the right calibre of staff are appointed to safely care and support the people living there. The home needs to continue to ensure all staff have access to an appropriate supervision process by appropriately trained individuals to ensure the team are directed and motivated to maximise the abilities of the people they care and support for, whilst keeping up to date with current professional practices expected in a nursing home. We are concerned that we have not been made aware of issues that have affected the well being of the people living at the home. Incidents such as regular lift breakdowns; an outbreak of diarrhoea and vomiting and the extent the recent building works has impacted on the accommodation of people living at the home have not been reported to us. In order for us to be assured ongoing improvements will continue at the home, an ‘Improvement Plan’ will be formulated by us for Park House. The home management will have one month to provide us with a response to this plan listing details of how they are going to continually improve the service to achieve consistent satisfactory National Minimum Standards for Older People. 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.V342954.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 Nursing Home DS0000041214.V342954.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): 3 Quality in this outcome area is good. All people considering moving into Park House are assessed by an appropriately qualified person before being admitted to make 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: All prospective residents of Park House are fully assessed by the home manager prior to moving into the home. An in depth look at the admission records of 2 people admitted to the home since the last inspection confirmed that good standards of recordkeeping have been maintained for this matter. Details seen written down confirm as much Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 11 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 with the Registered Manager Melanie Allen confirmed that in the week before the inspection the outcome of such a procedure meant a decision was made not to accept one person they had referred to them by a local hospital, even though the home had three vacancies. This demonstrated the home had positive admission practices and ‘put people first’ to ensure every admission to Park House will be successful. The home does not offer an intermediate care service. Park House Nursing Home DS0000041214.V342954.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 adequate. Care plans are improving but are not yet sufficiently detailed to ensure that all residents’ needs are met. Staff are sensitive to the individual needs of each service user and meet these in a professional manner. Most medication is safely managed to make sure it promotes good health for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the of written comments received about the care carried out for the residents of Park House care home were complimentary. One person commented, ‘The carers are very kind’ Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 13 Information provided by the home before the inspection stated, ‘Each individual person has a written care plan which is formulated taking into account medical conditions and any issues relating to activities of daily living’ In order to check out this comment, an in depth look at the records of three people as well as ‘spot checking’ of four sets of records for individuals living at the home who have a variety of support and nursing needs, was carried out. Although the care records confirmed that the majority of health needs are accounted for, and that paperwork about people’s dietary needs had improved there was some lack of specific information about the person they were written about. Several care plans lacked detail to keep individuals safe whilst promoting personal well being and independence. • At the last inspection in February 2007, concerns were raised about resident safety with regards to bedrail safety. On the first day of this inspection we were concerned that this important issue had not been dealt with properly and the paperwork still lacked necessary details to assure us everything was being done to keep individuals who needed this equipment safe. Accident recordkeeping of a person who had a fall in November 2007 did not show the home was doing all it could to prevent it happening again. The person’s care records were signed to say they had been fully updated at the end of January 2008, however the falls paperwork did not account for the accident, they not been reviewed since October last year. Wound management records lacked detail to establish how the healing of one person’s foot had progressed. • • Furthermore, at the last inspection it was recommended that the home review the process of care plan records management by involving the person they belonged to, or where appropriate, their representative. There was no evidence to show this had been carried out. By the second inspection day the home management had already made a start on this project and six out of the 33 people living there had been consulted about their care planning. The above findings confirm there is not a care planning process in place, which can account for or fully match the needs and wishes of the people requiring care and support from the service. At the time of this inspection matters relating to the administration, recording and securing of medication appeared to be generally satisfactory. The Registered Manager has sought the advice of a local pharmacist and has set up a ‘Homely Medications’ policy. It was also reported that regular medication Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 14 audits are carried out, and the home have started to monitor and record the temperature of the medication room. However, the home needs to develop recordkeeping to account for topical creams and dressings seen prescribed on drug sheets for people, and to make sure they are only used for the person they are prescribed for. Upon visiting the room where medications are stored, it was evident that the room had not been cleaned for some time. By the second inspection day, this had been put right and the task been added to the housekeepers cleaning schedule so it would not be missed out in future. Park House currently accommodates a lot of very frail people who are completely reliant on the staff to fully support their physical and mental health needs. Throughout the inspection residents appeared content and staff were observed responding to residents requests promptly and sensitively. Park House Nursing Home DS0000041214.V342954.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 adequate. Daily routines are flexible with residents being offered a choice of varied activities. The home provides meals that do not always offer variety and cater for different nutritional needs 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. The January activity planner had details of 13 different activity sessions planned. Photographs displayed around the home show various events enjoyed by residents. Regular aromatherapy sessions have been introduced and are reported to be most popular with the very frail people living at the home. The home does not employ a designated activity coordinator, and the Registered Manager has assumed overall responsibility for this matter. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 16 It was confirmed that monthly outings are fully checked out before they are booked to make sure they are suited to cater for the needs of people with dementia related illness. Two recent outings to a local forest and a bird sanctuary were reported to have been very enjoyable for all involved. A community library visits the home every fortnight and was seen parked outside the home on the second inspection day. Copies of the ‘Kinlet News’ and ‘Highley Forum’ 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. On the first inspection day observation of mealtime service showed that it was not individualised and did not offer all people living at the home the opportunity of choice. All twelve people who have difficulty with chewing and swallowing were seen to be offered a bowl of thick brown coloured savoury puree. This looked unappetising and did not offer individuals any variety of flavour, taste or consistency to their meal. Tables were not set and condiments were not freely available for people to use with their food, even though some care records clearly stated people enjoyed using such meal accompaniments. By the second inspection day, management had taken note of our comments and reported that mealtime service and presentation had improved. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 17 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): 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 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. 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. Since the last inspection the management have developed a logbook to manage complaints and this is reviewed on a quarterly basis. Since September 2007 the home has received three formal complaints. Information seen in the complaints log confirmed that they had been dealt with appropriately. Training of staff in safeguarding is regularly arranged by the home. It is carried out by the registered manager and records confirmed that 96 of staff have attended training for this sensitive matter in the past 12 months. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 18 The home has the local area adult protection procedure freely accessible to staff in the downstairs office. However it is recommended the home obtains the 2007 version of the local authority safeguarding adults’ policy and ensure staff are fully aware of any changes in this guidance. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 19 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, 21, 24 & 26Quality in this outcome area are poor. The quality of life for some residents is being made worse by the environment they are living in due to current Building work in the home has challenged the physical design and layout of Park House, which has had an impact on the lifestyle of several people who use the service. At times the management has not recognised or responded to risks to provide a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the first inspection day we expressed major concerns about resident safety. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 20 • Several unguarded radiators were seen in the downstairs hallways and communal lounges. Two large radiators in the main corridor were especially of a major concern as they were located in areas regularly frequented by residents, at ‘handrail height’ and were very hot to touch. Inspection findings also confirmed this area of the home has been the location identified where residents have experienced falls in the past. It was seen that the home had not taken appropriate action to meet a statutory requirement made at the last inspection in February 2007 with regard to bedrail safety. At least four beds had bedrails fitted in an unsafe manner. Bedrails were not securely attached to the bed bases, and some of the actual rails came apart when checked, posing an entrapment injury risk. Inspection findings also confirmed staff responsible for checking the bedrail installation had not had not received appropriate training or followed Health and Safety Executive guidance for this matter. The home policy for bedrail safety did not clearly advise staff off their responsibilities in the safe use of this equipment. As a result of the above concerns two ‘Immediate Requirement’ notices were issued for urgent remedial action to be taken to put these matters right. By the second inspection day we were satisfied the home had acted appropriately to improve resident safety. Earlier this year we were made aware of the home’s intentions to extend the building to improve the accommodation it provides for people living in the home. However, we were not told about the potential impact this project would have on the living conditions for people at Park House. It appears little consideration has been made with regard to the well being of people, during this period of change. None of the bedrooms had been taken out of use to cope with the building work. Several people known to be ill have been subject to excessive noise from the ongoing construction work. On the first day of this inspection four residents were seen to be living in sub standard accommodation due to the ongoing building works. • There was virtually no natural light in the bedrooms of two people, and one of these bedrooms had also been subject to flood damage. - Both people had been moved to a more comfortable part of the home by the second inspection day. • In a bedroom shared by two people a large gap was seen surrounding a window exposing the individuals to draught and debris of the adjoining building works. On the second day another hole had been made in the wall of this bedroom. • Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 21 -We were assured that both people would be moved out of this room within 24 hours. A bathroom had been taken out of use as part of this project and this has resulted in the majority of people having to use a bathroom on another floor of the home which is in urgent need of a deep clean and refurbishment. In addition to the above findings it appears that management systems for the routine maintenance of the home had slipped resulting in people living in surroundings showing significant signs of wear and tear. Several panes of glass were in need of replacement and commodes were worn and not safe to use. Cleanliness of the home was variable. • As recorded earlier the drug store has not been cleaned regularly. • The laundry is in need of redecoration and baskets used for storage of clean washing were visibly soiled. • Several bedrooms had unpleasant odours, especially those of people known to have continence challenges. Findings on home tour confirmed discussions with the Registered Manager that the home does not have a, system in place to monitor the condition of bedrooms, bathrooms and lounges used by residents. It is a concern that bedrooms and parts of the home directly affected by the building works are not being closely monitored. The manager was not aware of the gap in the bedroom wall described earlier. Building changes meant outside access to a fire escape was different and a scaffolding pole was protruding at eye level. This had not been acted upon. Recordkeeping in the main kitchen showed the home has not acted appropriately in response to the last Environmental Health Officer visit, meaning the home was not adhering to food hygiene legislation. Remedial action had been taken by the time we returned for a second inspection visit. Park House Nursing Home DS0000041214.V342954.R01.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 poor. 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 not always supported and protected by the homes recruitment policy and recordkeeping practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels on the day of inspection appeared adequate to meet the needs of the people living in the home. Similar staffing arrangements were seen recorded in rotas in the fortnight leading up to the inspection however the rotas did not identify full names of people working in the home which means rotas are difficult to audit and it is not clear how much temporary staff are working in the home. Rotas lacked clarity to show the times the registered manager was in the home and this means staff cannot be sure when she is available. The files of five new recruits were looked at. They confirmed adequate vetting systems for one employee, but the records of the other four individuals lacked appropriate details to confirm the information required by the regulations and Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 23 to keep people living at the home safe had been obtained prior to commencement of employment. This matter was discussed with the manager and owner at the end of the inspection. Information provided by the home before the inspection stated that 75 of the care team have the minimum expected care qualification and that 10 of the care team are in the progress of attaining it. Analysis of four sets of staff training records show there is an inconsistency in recordkeeping for this matter. One set of records confirmed the individual had received the training necessary to work in a care home. Discussion with staff confirmed that although they had received some training, their records did not account for it. At the last inspection a recommendation was made that, ‘Staff are provided with information and training to meet the needs of individuals with dementia’. We were not able to review this, as the information was also not evident in records seen. The above findings confirm recordkeeping for staff needs to be kept up to date so the home can show the care team is properly trained to do their job and safeguard the people living at Park House. Park House Nursing Home DS0000041214.V342954.R01.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, 32, 33,35,36 & 38 Quality in this outcome area is adequate. Some systems for the health, safety and welfare for residents, staff and visitors need to be improved 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: The management team comprises of Mrs Carla Gregory, Registered Provider, who carries business/administrative responsibility, and the Registered Manager, Mrs Melanie Allen who holds responsibility for the day to day management of care provision. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 25 As part of the homes’ quality monitoring system, questionnaires were distributed to people living at the home, their relatives and representatives in July 2007.The manager reported the results of this survey were published in one of the home newsletters. This was not available for review, however, in the information the home provided us with before the inspection, they identified it to be a goal to improve how they listen and act upon the comments of residents and their representatives. The management reported they have already reviewed their staffing arrangements in response to this survey. Whenever possible people living at the home or their family are encouraged to manage their own finances. Records were seen of two individuals who have support from the home with this aspect of their lifestyle, and there are in progress of being further improved to safeguard all parties for this matter. Inspection findings confirm that the registered persons need to revisit their day to day as well as periodic management practices at the home to ensure all aspects of the service are maintained to maximise the safety and well being of the people who live there. Although the home hold regular staff meetings and minutes seen show that a variety of topics are covered to promote better practices in the home, there is a lack of clarity of recordkeeping for staff supervision sessions. Staff records do not confirm supervision sessions cover all aspects of practice, philosophy of care in the home, and individual career development needs. The manager confirmed that she has not received any formal training for this matter herself. Current management practices have resulted in the home not being able to demonstrate all the regular servicing and checks necessary to comply with health and safety law have been carried out. • Lack of effective monitoring systems meant that a hoist seen in daily use located in a residents bedroom missed two six monthly checks from the service engineer. • On the first inspection day up to date records for hot water testing could not be located. • Bedrail safety issues as recorded earlier were seen to have improved by the second inspection day – although newly introduced forms need to identify when and who carried out the checks. • The management of accident records seen on the first inspection day were not robust. Furthermore, observations during this inspection show other safe working systems are not being adhered to. For example clinical waste storage was not secure and bags seen burst in the external store were indicated they had been overfilled. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 26 In addition to the above issues, we remain concerned that we have not received information about the home, which has affected the safety and well being of the people living at Park House. • There has been no communication from the home to inform us of the frequent challenges the home has had to deal with due to the lift breaking down. • We were not made aware of a recent diarrhoea and vomiting outbreak, which affected residents and staff. • We were not made fully aware of the impact the current building work would have on the people living in the home. Inspection findings indicate although there had been some information shared about the building work, and that plans were on display in the hallway, there has been a lack of information shared with people living at and visiting the home about this matter. This has been a cause for concern for some relatives. Although the home has effectively responded to all shortfalls identified on the first inspection day, we remain concerned that the lack of competency demonstrated by the home that has allowed changes in the standards provided at Park House. Appropriate steps will need to be taken to assure us that effective changes will be implemented to raise standards at the home. It will be necessary for Park House to provide us with an action plan to confirm how it is going to permanently improve the service and support it provides. Park House Nursing Home DS0000041214.V342954.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 2 X 1 Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP8 Regulation 13 (4)(c) Requirement Risk assessments based on guidelines produced by HSE and MHRA to support the safe use of bed rails must be developed and regularly reviewed. (Previous timescales of 19/03/07 not met. Immediate requirement issued 23/01/08 Timescale for action 25/01/08 2 OP19 13 (4)) 6) 25/01/08 All parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety Any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and risks to the health and safety of service users are identified and as far as possible eliminated. The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse from hot radiators. Immediate Requirement issued 23/01/08.) DS0000041214.V342954.R01.S.doc Version 5.2 Page 29 Park House Nursing Home 3 OP19 23 (2) The registered persons must implement systems to confirm the environment provided for people living in the home is being kept clean, comfortable safe and in good repair. Staff must not be employed at the home until all checks are received and confirm that they are fit to work with service users. The registered person must ensure that persons working at the care home are appropriately supervised. (Previous timescales of 01/04/07 not met.) The home management team must ensure unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Staff who are responsible for selecting, fitting and checking bed rails must receive appropriate training and bed rail assemblies should be included in a planned preventative maintenance schedule. (Previous timescales of 01/04/07 not met. Immediate Requirement issued 23/04/08.) The registered persons must ensure Unnecessary risks to health and safety of people are identified and as far as possible eliminated during ongoing building works. Safe working systems must be instigated to monitor all changes to the environment DS0000041214.V342954.R01.S.doc 06/04/08 4 OP29 19 12/02/08 5 OP36 18 (2) 06/04/08 6 OP38 13 (4)(c) 25/01/08 7 OP38 13 (4) 01/05/08 Park House Nursing Home Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 Good Practice Recommendations It is recommended care plan recordkeeping is improved in line with professional nursing recordkeeping guidelines to clearly account for all care being carried out. Systems for the safe administration of medications should be developed to account for all topical lotions and creams prescribed, and used, especially those containing steroid preparations. To maximise resident welfare and wellbeing at Park House, It is recommended that the home obtain the most recent version of the local authority safeguarding adults policy and ensure staff are fully aware of any changes to this information. That the replacement of baths be included in the refurbishment programme. This recommendation remains from the inspection on the 24/05/05. It is recommended the home provide evidence to confirm that it has complied with all actions recommended by the environmental health officer. It is recommended audit systems are implemented to ensure bedrooms are kept free form any hazards especially those involved in the home refurbishment. It is recommended the home review its infection control practices in order to make sure safe working practices in high-risk areas such as the laundry and kitchen are adhered to. It is recommended that rotas clearly identify the full names and responsibilities and hours worked for all employees in the home. It is recommended that the manager maintain a record of any informal training sessions to demonstrate that staff are provided with information and training to meet the needs of individuals with dementia. It is recommended the home develop a recordkeeping system to monitor staff training needs and development to DS0000041214.V342954.R01.S.doc Version 5.2 Page 31 OP9 3 OP18 4 OP19 5 6 7 OP19 OP24 OP26 8 9 OP27 OP30 10 OP30 Park House Nursing Home 11 OP38 confirm exactly what training staff have received. It is recommended the home follow the CSCI good practice guidance on reporting incidents which affect people’s well being as required for Care Homes Regulation 37. Park House Nursing Home DS0000041214.V342954.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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.V342954.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!