Inspection on 05/02/07 for Park House Nursing Home

This inspection was carried out on 5th February 2007.

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 10/09/08

Park House Nursing Home 23/01/08

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 Rosalind Dennis Key Unannounced Inspection 5th February 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Park House Nursing Home DS0000041214.V297386.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.V297386.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.V297386.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. 12th January 2006 Date of last inspection Brief Description of the Service: Park House is registered as a Care Home with places for 38 older people requiring nursing care. A maximum of 16 Residents, designated elderly mentally infirm, may be accommodated. Park House comprises the original house, plus a more recent extension, and is furnished and decorated to a high standard. Accommodation is arranged on three floors, reached via a shaft lift or staircase, and the Home sits amidst well-maintained gardens and grounds, which provide a safe outside environment for Residents and their Visitors. Residents also benefit from arranged trips and entertainment visits. The Proprietor, and registered Responsible Person, is Mrs Carla Gregory and 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. Care Staff receive regular training, and more than 50 of Care Staff have attained Level 2 NVQ Award. Weekly fees charged by the home range from £339.50 (residential) to £580. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 10.15 and was conducted by one inspector over a period of around 7 hours. Time was spent observing staff working, looking at documentation, speaking with staff and areas within the home that are accessible to residents were observed. The frail nature of the people living at the home meant that the inspector was unable to obtain direct feedback from many of the residents although a discussion with two residents confirmed that staff treat then well. Observations confirmed that residents appeared well cared for and staff were seen to be attentive and responding competently to residents needs. What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure robust risk assessments are completed 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 Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 6 training. The home also needs to improve staff access to the supervision and appraisal process. 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.V297386.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. The home has a satisfactory admissions procedure and the assessment processes in use demonstrate that the home is able to meet the needs of people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation of four residents care files show that staff from Park House assess the needs of individuals prior to and on admission to the home. These assessments take into account individual care needs including the level of staff assistance required by each resident for ‘activities of daily living’, the equipment needed to move people safely and any special dietary requirements. Detailed information is available regarding the social history of each resident, which provides staff with an insight into the individual before their illness, enabling staff to provide individualised care. Care plans are Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 9 drawn up from the information obtained during the assessment process and these were found to be individually relevant to each resident. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. Care plans and risk assessments are generally well written and provide staff with information to meet resident’s needs, however to ensure that residents safety is not compromised risk assessments regarding the use of bed rails must be completed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information contained within residents care files shows that staff are competent in assessing and planning care to meet the needs of residents. Risk assessments for moving and handling, pressure sore risk and nutrition were complete and had been reviewed regularly. Evidence within daily records demonstrates that the home seeks prompt advice from medical and specialist healthcare professionals as required; a GP was seen to visit during the inspection and the manager responded promptly to a resident who appeared in discomfort. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 11 The home has a good range of moving and handling equipment and pressurerelieving mattresses, which were seen in use throughout the home. Although care plans provide good descriptions of residents care needs it was discussed with the manager that the current process used to review care plans is not sufficient to demonstrate that care plans are reviewed at least on a monthly basis. During a tour of the home a large proportion of residents were seen to have bed rails in place, although care plans made reference to the use of bed rails, risk assessments were not in place or evidence to show that the use of the bed rails had been discussed with the resident and/or their representative and permission for their use obtained. Observation of a selection of medication administration sheets showed that generally medication administration was satisfactory. Two MAR charts were found to have gaps where staff should have signed to indicate administration/non-administration of medication, therefore it could not be established whether the residents received their medication at those times. A document readily available within the medication room and drawn up by the home provides staff with clear instructions on the recording of medication and abbreviations to use when medication is not given, therefore staff had not followed this guidance. The home records the temperature range of the drugs fridge and documents the action taken if the fridge exceeds the range. The home does not record the temperature of the medication room or the room where a medication trolley is stored and it is recommended that the home starts to monitor the temperature of these rooms. Throughout the inspection residents appeared content and staff were observed responding to residents requests promptly and sensitively. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Daily routines are flexible with residents being offered a choice of varied activities. The home provides meals that 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 and each month transport is provided to enable residents to access a community activity. Photographs displayed around the home show various events enjoyed by residents. A hairdresser visits the home every week and a purpose built salon is available for this facility and a community library visits the home every fortnight. The home’s recent quality questionnaire identified that further efforts to increase access to activities would be welcomed and the provider spoke of the home’s intentions Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 13 to offer aromatherapy and reflexology sessions to residents, which will enhance the range of activities offered. Observation of menus shows that a variety of food is offered, including snacks between meal times. Food that was served during the visit was wellpresented, including soft and pureed food. Two residents who were spoken with commented positively about the food offered, stating that alternatives to the menu are offered if particular foods are disliked. Staff were observed to be attentive at meals, offering sensitive assistance as and when needed by residents. Observation of a selection of bedrooms show that residents can personalise their bedrooms with photographs and pictures and the manager confirmed that items of furniture may be brought in if an individual wishes. The home encourages visits by relatives and significant others, one individual who visits the home on a regular basis spoke of how the staff group are friendly and take time to provide reassurance regarding any changes with the health of their relative. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 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 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-it was reported that there had not been any recent complaints, although some negative responses to a recent quality questionnaire had been received. The provider spoke of her intention to create a complaints log and review this on a monthly basis even if there are no complaints; it was discussed that this is good practice as this can then be used as an audit tool to show how the home is performing. CSCI have not received any recent complaints in respect of the home. The manager confirmed that the home works within the framework of the local area adult protection procedure and a copy of this guidance was observed to be readily available within the home. Training in the protection of vulnerable Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 15 adults is provided and staff that were spoken with during the inspection confirmed their attendance and demonstrated good awareness of relevant procedures. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is good. The standard of the environment is good providing residents with a comfortable and clean place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are several lounge/sitting and dining areas within the home, which provide residents with a choice as to where to relax and eat. Bedrooms are personalised with photographs and pictures and in shared rooms, adequate screening is provided for privacy. The home has recently submitted an application for consideration by CSCI to reduce the number of shared bedrooms and increase the number of single bedrooms and it is considered this will improve the choice for individuals who would prefer not to share a Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 17 bedroom. All parts of the home on the day of inspection were observed to be clean and with good décor. Processes are in place to ensure staff adhere to good infection control practices such as the provision of staff hand washing facilities in all residents bedrooms. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is good. Training opportunities within the home ensure that staff are appropriately skilled and competent to carry out the duties for which they are employed. Staffing levels are sufficient to meet the needs of the current residents and the home has a robust recruitment procedure, which protects residents from the employment of inappropriate staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random selection of two staff files found that the information required by the regulations and to keep service users safe was available and had been obtained prior to commencement of employment. Comprehensive induction training is provided and care staff are supported to attain NVQ Level 2. The numbers of staff with NVQ Level 2 exceeds the required level, 2 staff have attained Level 3 and another member of care staff has attained NVQ Level 4. The home’s positive approach to skills development is also seen in the opportunity afforded to ancillary staff to undertake NVQ Level 1. Staffing levels on the day of inspection appeared adequate to meet the needs of service users, and although a lift breakdown early in the day meant that Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 19 some residents were unable to come downstairs until late morning staff were seen closely supervising these residents. Two residents who spoke with the inspector commented that staffing levels were usually sufficient to meet their needs and three members of care staff felt that the staffing levels are sufficient to provide the care required by the current residents. The manager and two other members of staff have recently attended training in dementia care and although the manager spoke of how this information is cascaded to staff through discussion, it is recommended that a record is made of these discussions to show that staff are provided with information and training to meet the needs of individuals with dementia. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 20 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 and 38. Quality in this outcome area is adequate. The home monitors and reviews processes to ensure that residents receive a range of quality services. The home has systems in place to protect residents from harm however by not adhering to current guidance regarding the safe use of bed rails the health, safety and welfare of residents is not fully promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 21 The management team comprises Mrs Carla Gregory, Registered Provider, who carries business/administrative responsibility and the Registered Manager, Mrs Melanie Allen holds responsibility for the day to day management of care provision; discussions with both individuals demonstrates that the management approach is resident focussed with a commitment to improving services within the home. As part of the homes’ quality monitoring system questionnaires were distributed to service users and their significant others towards the end of 2006 to obtain feedback on the services provided by the home. Copies of the questionnaires show that a variety of questions were asked and these triggered a range of responses, from very positive to some quite negative responses. The provider collated the responses and an action plan shows how the home intends to improve areas that were not viewed as satisfactory. Discussions with the provider confirmed that action has already been taken to address some concerns –such as reviewing break times for staff to ensure that there is adequate supervision of residents in lounge areas. The financial arrangements for two service users was examined and found to be satisfactory, with clear records in place to show all transactions and spending accounted for. During a tour of residents bedrooms a number of bed rails were found fitted with an excessive gap at the head end of the bed and one bed fitted with a pressure- relieving mattress did not have extra height bed rails in place. The manager immediately undertook to check the fitting of bed rails in use, a sample of which were re-assessed at the end of the inspection and were found to be fitted correctly. It is disappointing that the home had not followed relevant guidance despite a poster being displayed in the office documenting the risks associated with bed rails and the need for vigilance. Observation of the accident book demonstrates that it complies with current legislation and scrutiny of accidents/incidents by the provider ensures appropriate follow up action is taken. Staff have received training in fire safety and other safe working practice topics and the home has developed a fire risk assessment, which although not signed or dated was comprehensive. Staff supervision records indicate that not all staff have had access to regular formal supervision and although discussions with the manager suggest that informal sessions have occurred the manager needs to evidence that these have taken place. Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 22 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 3 8 2 9 3 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 3 X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 2 Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 23 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 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. The registered person must ensure that persons working at the care home are appropriately supervised 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. Timescale for action 19/03/07 2 OP36 18 (2) 01/04/07 3 OP38 13 (4)(c) 01/04/07 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 OP7 Good Practice Recommendations The registered person is advised to review the process of DS0000041214.V297386.R01.S.doc Version 5.2 Page 24 Park House Nursing Home 2 3 OP9 OP19 reviewing care plans involving the service user and or their representative as appropriate. It is recommended that the home monitors and records the temperature of the medication storage areas to ensure the temperature does not exceed 25°C. 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 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. 4 OP30 Park House Nursing Home DS0000041214.V297386.R01.S.doc Version 5.2 Page 25 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.V297386.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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