Inspection on 18/12/08 for Park House Rest Home

This inspection was carried out on 18th December 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Rest Home 04/02/08

Park House Rest Home 14/09/06

Park House Rest Home 16/02/06

Park House Rest Home 09/08/05

Park House Rest Home 04/11/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Park House Rest Home 220 Havant Road Hayling Island Hampshire PO11 0LN Lead Inspector Jan Everitt Unannounced Inspection 18th December 2008 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 Rest Home DS0000062008.V373626.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 Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Rest Home Address 220 Havant Road Hayling Island Hampshire PO11 0LN 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) 02392 465274 02392 765274 Ms Sally-Jayne Hoke Mr Lee John Gosling To be confirmed Care Home 16 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (16), Mental disorder, excluding learning of places disability or dementia (3), Old age, not falling within any other category (16) Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the DE and MD category may only be admitted over 55 years of age. 23rd April 2008 Date of last inspection Brief Description of the Service: Park House is a detached residential care home situated within its own grounds, in a quiet residential area of Hayling Island. The home is registered with the Commission for Social Care Inspection (CSCI) to accommodate up to a maximum of 16 service users. The home benefits from a large rear garden and the front of the property is gravelled, with hanging baskets and flowers in the borders and provides parking for approximately 8 vehicles. The home is on a local bus route and the seafront at Hayling Island is within easy reach. The home meets the individual accommodation space requirements set out in the National Minimum Standards (NMS) 3rd edition for existing providers. The current fees are stated to be between £415 and £460 per week. These fees do not include toiletries, hairdressing, chiropody and other personal items. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the evaluation of the quality of the service provided at Park House and takes into account the accumulated evidence of the activity at the home since the last inspection, which took place in February 2008. This unannounced visit to the home took place on the 18th December 2008. For this visit the inspector was assisted for part of the inspection by the care assistants and cook who were on duty at the time. The registered person Ms Hoke attended the home later in the day. An Annual Quality Assurance (AQAA) had been completed by the home and the information from this and the last inspection report was used to inform this report. Evidence for this report was obtained from reading and inspecting records, touring the home and from observing the interaction between staff and service users. During this visit we spoke to most of the service users and a staff. In order to prepare for the visit, surveys were sent to the people living in the home, staff and other professionals involved with the home. Three service users, seven staff and four health professionals surveys were returned with comments that indicated a high level of satisfaction for the care they receive. The home is registered to provide support for 16 residents and at the time of the inspection there were 13 people in residence, all of whom were female. The registered manager is no longer employed at the home and the registered person, Ms. S. Hoke is managing the home in the interim and is in the process of applying to CSCI to register as the manager What the service does well: The home welcomes potential service users and their families to visit the home and look at the facilities of the home. The registered person, where necessary, seeks information from external healthcare professionals as part of the preadmission assessment, to ensure the home is able to meet assessed needs. Staff treat service users with respect; they share their companionship and give support sensitively. Comments from service users and a relative said: My mother receives excellent care. I enjoy the food and the staff are very kind. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 6 I am happy here the staff are very good. A comprehensive and appropriate training programme is available to all staff, who commented when spoken to and on surveys returned by them that: All induction training was given and I am waiting to commence NVQ level 2 training. Training is updated on a regular basis and I am invited to attend any training sessions appertaining to the care of the service users. We received appropriate training to enable us to do the job and are made aware of any new regulations. Training is available if needed. I can always approach the manager/proprietor who will give me advise and is a good support. Health care is promoted through the home having developed good working relationships with healthcare specialists. Daily routines in the home are flexible and service users being encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. Service users made positive comments about the food and the meals the home provides and were generally pleased with the activities in which they could participate. What has improved since the last inspection? What they could do better: The lack of care plans for service users would not ensure that staff know how to meets their assessed needs and their changing needs. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 7 The medication policies and procedures should be made more specific to the procedures practiced at the home. Medicine prescribed on a ‘when required’ basis would benefit from guidelines in the care plan which give criteria as to when to administer this medicine. This would ensure a common approach in the use of this. Medication administration record (MAR) sheets must be recorded appropriately and a code be documented indicating the reason that the medication has not been administered or taken by the service user. Staff would benefit from further training in the medication policies and procedures specific to the home. Service users would benefit from a record and monitoring of their weight when they first go to the home to live, which may identify any nutritional risks to their well being. Staff should be reminded to cover commode buckets when transporting them through the communal areas and also be aware of infection control principles when transporting such equipment. The registered persons should review staffing levels at the weekends to ensure that sufficient care staff are on duty to meet all service users needs in a timely way. The registered persons must plan a programme of supervision for all staff to take place at regular intervals throughout the year. The registered persons should have in place a quality assurance system that identifies regular auditing and outcomes of service user satisfaction surveys, care practices, care plans and medication records along with the safety and cleanliness of the environment. 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 Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 8 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 Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed prior to their moving into the home to ensure their needs can be met. EVIDENCE: We received the AQAA for the home, which stated: As registered providers we personally carry out an individual needs assessment prior to clients moving to the home. A thorough assessment form is used to obtain as much information as possible from clients, family, representatives, social workers and hospital staff. On admission to the home the manager and head of care make a further assessment usually for a further 2-3 weeks, during the “settling in period”. We are further assisted by social services that also carry out a needs assessment for their client. These are held at the home on client’s care files. Admission Assessments are always carried out very promptly to avoid unnecessary delays, with decisions and feedback given usually the same day. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 10 We consult and involve all parties in these assessments and value any input, concerns and information received. Perspective clients are further invited with their families to come for trial days, lunches or activities before deciding to come to the home. A sample of three was viewed. These supported what the AQAA told us and demonstrated a thorough assessment that covered most aspects of care before a decision was made about the person coming to the home to live. It was observed in one file that social services had sent a care needs assessment and other information had been gained from others who had been involved in caring and supporting the individual including family members and health professionals. Surveys returned by service users indicated that they had received sufficient information about the home to support their decision to move there. A service user spoken with told us that she had been visited by the manager in hospital and had been given information about the home. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of care plans for service users would not enable staff to have the information they need to meet that persons needs. The health needs of service users are met with evidence of health professionals attending the home for consultation. The current medication procedures are not specific to the home and staffs lack of training could result in practices that could potentially put service users at risk. Staffs working practices help to ensure that the privacy and dignity of residents is promoted EVIDENCE: The home was accommodating thirteen service users at the time of this visit. A sample of four service user care plans, who were the most recently admitted people, was viewed. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 12 Three of the care plan folders contained an admission assessment along with a social profile; risk assessments for moving and handling and for one person a mood chart was being maintained. There was also information in the form of a care plan, on how to meet the service users personal needs. It was seen that the home signed to say care plans had been reviewed monthly. Social profiles are recorded which detail a social history and family information. It was noted that in one service users records, who had been the most recently admitted person, there was no admission form or care plans completed with just a social profile recorded. The home keeps separate files with daily records for each person. Also stored in this file were sleep pattern charts that were being maintained for service users. It was noted that these records are headed up with Christian names only, or preferred names with no surnames documented. Service users full names should be recorded on all care documentation. There was information on a daily record for a service user, which stated that their diet had been changed. The care plan had not been reviewed appropriately to record this or describe why the diet had been changed and what the changes were. When the cook was spoken to she was aware of this and had recorded in the kitchen records that one service user now needed a special diet, but told us she was not sure why. Staff exchange information to one another at handover meetings when handover notes document the overall happenings in the home but care plans do not always reflect current information or changes. It was noted in the care plans that physical health needs are also identified. There was information in the notes from other health professionals and this had been incorporated into the care plan for that person. The district nurse visited the home at the time of this visit to attend to a residents wound. This was done in the privacy of the persons own bedroom. We were informed that the home has access to the community psychiatric nurse who will visit the home to assist and give advise in caring for the needs of those individuals with dementia. Service users can be attended by a number of GP practices. Service users surveys returned say they receive the medical support they need. One relative said that my mother is regularly checked by the local doctor and nurse. At the time of this visit a GP was attending the home to undertake a preliminary assessment of a service user who had recently been admitted to the home. Three health professionals returned surveys to CSCI and comments were generally very positive, they said, within the limited time they spend in the home. The comments received said service users are well cared for and staff always act promptly if a medical concern is identified. Another commented that the staff are polite and appear caring towards their residents. A visiting Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 13 health professional commented on a returned survey, that at times, staff do struggle with managing residents who have challenging behaviours and that staff would benefit from training in this area. The service users have access to a chiropodist, optician and dentist and the home ensures that service users have access to all NHS entitlements as needed. The care plans documented all visits from visiting medical professionals with any action outcomes from their visits. The AQAA states that the administration and storage of medication has improved in accordance with the requirements and recommendations from the last inspection visit and the visit from the pharmacy inspector. Steps had been taken to comply with the requirements issued at the last inspection with regards to medicine management. The policies and procedures that guide the management of service users medication were viewed. These policies are in a folder and cover all aspects of medication management but they have not been adapted to the homes own practices and procedures. This was discussed with the (registered person) that these should be adapted to be more specific to the home. Medication is supplied to the home in a monitored dosage system (MDS) from the community pharmacist, who does visit the home to give advice. A medication storage trolley has been purchased which is housed in the dining room and is attached to the wall. There is a controlled drug (CD) cupboard fitted to the wall above the trolley. The CD register was stored in this cupboard and was noted to being recorded appropriately by two care staff and the balance of drugs recorded matched that of the stock of tablets being stored. The carer told us that there were no other place in the home that stored medication and what was in the trolley was all the prescribed medication as well any as required medication (PRN). It was observed that the medicine trolley was untidy and shelves were sticky and in need of cleaning. We observed medication being administered. The medication was dispensed from the MDS into a pot. The medication administration sheet (MAR) chart was signed and then medication was taken directly to the resident. This procedure was discussed with the registered person (Ms. Hoke) who said the supplying pharmacist had advised the staff to take this procedure and sign the MAR chart as each tablet is popped out of the MDS into the pot. If a service user refuses or drops the medication then the MAR chart would be altered. Advice was sought from the CSCI pharmacy inspector following this. She advised that the Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 14 best practice is to dot and pot. The carer puts a dot in the signing square of the MAR chart as each dose is prepared, so they can keep a check that they have dispensed from the box all medications to be administered at that time. The medications are then given and witnessed as being taken. The chart is then signed and the dot disappears as the chart is signed. A sample of MAR charts was audited for residents being case tracked. It was evidenced that for one resident that the prescribed medication had been signed for on the MAR chart but the tablets remained in the MDS system for that specific day and time. Another MAR chart had medication prescribed for mid-day but no tablet was in the MDS system to be dispensed. We observed that for another resident a medication had been prescribed by the GP on an as required basis (PRN), but the tablet was being stored in the MDS system and being given regularly three times a day. The carer assisting us could not explain the reasons and there were no guidelines in a care plan to describe the criteria for when this medication should be given. The registered person should take advice from the GP and pharmacist as to how this medication should be given whether it be on a regular basis or as needed and the MAR chart reflect this. Medicine prescribed on a ‘when required’ basis would benefit from guidelines in the care plan which give criteria as to when to administer this medicine. This would ensure a common approach in the use of this medicine There were some gaps in the MAR chart recording and no evidence that they are audited at regular intervals to identify these errors. A visiting district nurse was attending the home to administer an injection and this had been prescribed by the doctor to be given weekly for three weeks but the D/N had given this on three consecutive days. When this was questioned, the home was told that the regime for the administration of this drug had changed, but this had not been reflected on the MAR chart instructions. There were no residents choosing to manage their own medication and the home was not administering any medication covertly. The previous manager undertook medication training for staff and the registered person has identified that staff do need a refresher course and newly appointed staff also need training before they can administer medications. This has been planned for January 2009. We were able to observe the interaction between the staff and people who use the service and were also able to speak with some individuals and two relatives on the day. The two relatives spoken with were happy with the care provided to their relative at the home; one commented that their parent was well cared for and happy in their surroundings. One individual living at the home commented that staff were kind and gentle, and they could come and go as they wished. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 15 Staff were observed speaking and assisting the residents with dignity and respect. A staff member commented on the survey returned that all personal care is carried out taking into consideration the dignity of the client. It was observed that on care plans, the preferred choice of name had been recorded and staff were heard to speak to residents by the name they wished. Park House Rest Home DS0000062008.V373626.R01.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. The residents are supported to exercise choice within their daily lives. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. EVIDENCE: The AQAA stated that the home has made great efforts to improve the daily and social activities for the residents. The registered persons has taken on board what the service users say and have developed an activities folder containing quizzes, games, craft activities particularly suited to those who are mentally infirm. The manager told us that she would like to employ a dedicated activities organiser but the budgetary restraints of the home will not allow this at this time, but the home tries to arrange a programme of activities so that there is always something for the residents to look forward to. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 17 Service user surveys returned to CSCI and service users spoken with at the time of this visit indicated that there are usually activities arranged for them to take part in and one relative commented that mother enjoys the activities that take place. We evidenced that the home had a full Christmas entertainment programme in place. On the day of this visit they were preparing for the Christmas party and there was an atmosphere of excitement in the home. Residents were observed being involved with the preparations. A resident spoken to said she was staying at the home on Christmas day and that she would like to go to church but did not like to ask her family or the home to take her as she understood they were busy. The local clergy do visit the home to offer communion and talk to individual residents. Outside entertainers attend the home for music, singing, and music for health and visiting pets. Residents told us that they had enjoyed Christmas carol singing from the children of the local school the previous week. A record of these visits, who attends, and the level of their participation is documented. They home have open visiting and relatives are welcome to come to the home for meals and special parties. On the day of this visit the home was expecting a large number of visitors for the Christmas party later that day, with a full entertainment programme throughout the evening. Two relatives visited the home during this visit and said they were made welcome to the home when they did come and had been invited to the party that evening which they were looking forward to. The home provides a four weekly menu cycle. The cook was spoken with. She has been at the home for a considerable number of years and told us that she is very familiar with the service users likes and dislikes. She has recently changed the menus with the help of the registered person to introduce a number of new dishes, but says; in general the residents like the old fashion meals. She told us that residents have an alternative meal if they did not want what was stated on the menu. This was confirmed when speaking to a carer who said all dietary needs are carried out with substitute meals made available to suit the clients personal tastes. Residents told us at this visit and on the CSCI surveys returned, that the food is good and that the meals provided are very appetising and varied. The lunchtime meal was observed, which was fish and chips. The service users told us that it was most enjoyable. The cook said that residents could have snacks and drinks at any time they request. They are able to take their meals in their rooms or in the dinning area of the lounge where there are round tables seating four people and this Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 18 promotes communication between clients and gives them choices as to where and with whom they wish to sit. The home provides for a vegetarian diet for one resident and another has been prescribed a gluten-free diet that the cook said she has knowledge of. This was not documented in the care plans as to reasons why this was prescribed. Nutritional assessments are not undertaken routinely and weights are not recorded in care plans. It was observed that residents were asking for cold drinks and these were supplied quite promptly as these were made up and kept in the kitchen hatchway for staff to dispense when they were requested. There was evidence that service users have choices. The care plans document their preferred names and their likes and dislikes with regards to food. Residents spoken to said they have choices within their daily lives. One resident told us that she can stay in bed for a while but the carers call her to get up for breakfast, but she does not mind. She said she goes to bed when she wishes. Service users were observed to be moving around the home as they wish with some restrictions on certain residents on their going up to the first floor, owing to the large building project that is underway. The risks to service users have been identified and this can restrict their movements during the day whilst this work is in progress. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are protected through the open complaints process and the staff’s knowledge and understanding of safeguarding and protection issues. EVIDENCE: The home provides a policy for dealing with complaints and this is held in the home and is accessible to all. The policy includes contact details for the CSCI. Staff receive training on induction about the complaints policy and whistle blowing policies. They are further trained on these subjects during dementia care training. A copy of the Hampshire Adult Protection procedure is held at the home for all to access. The AQAA states that the home has received 3 complaints in the past year. One of these complaints has gone to Safeguarding and is being investigated by Social Service who has taken the lead in the investigation, together with multi-agency involvement. The Commission has received two complaints one of which was around the issues currently being investigated; the other has been resolved by the home. All procedures have been followed accordingly. Staff spoken with told us that they would know what to do if they witnessed or Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 20 suspected abuse. With the recent issues in the home, some staff have used the whistle blowing procedures to inform social services and the registered persons, of issues in the home. Staff spoken with and surveys returned to CSCI told us that they feel more confident in their role in this and would not hesitate to report any concerns. Surveys returned to CSCI from staff reiterate that they know who to speak to if they have any concerns about the home. The AQAA states that in the forthcoming year the registered persons will be reviewing and improving operational management structure within the home to safeguard and ensure procedures are followed. The home undertakes thorough recruitment practices and all appropriate checks from the criminal record bureau (CRB) protection of vulnerable adults (POVA) are obtained before commencement of employment along with two written references. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home in general provides service users with a safe, clean and homely environment. However, currently the home is undergoing extensive alterations in various parts of the home for which risk assessments are in place. EVIDENCE: The home is in the process of undergoing extensive building works and refurbishment works. The building works have involved walls being removed and bedrooms and toilets being altered. This has resulted in a great deal of dust and noise being created. The registered person is trying to keep this to a minimum but with such a big project there is inevitably disruption to the home. The registered person has undertaken a full risk assessment for all the working areas and actions have been recorded to ensure the safety of service users and staff whilst this work is being done. We spoke to the builders who described Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 22 how they ensure that the building is safe and affords privacy to service users at the end of each day. Some service users have moved rooms to enable the alterations to take place and this has been done with consultation with them and families. The laundry is in the outside extension, which is under construction and houses the new machines that have been purchased and are fit for purpose. All bedrooms were viewed. Some have been decorated and those viewed have been made personal with individual pieces of furniture and personal belongings. There are some rooms that are in need of redecoration and refurbishment but this is in the planned refurbishment programme for the home. There is a resident who has to go through another residents room to access her own. This is being addressed in the alterations and these rooms will become separate en-suite rooms after the alterations. The proprietor/manager told us that within the next year this would be completed. The main building works are due to be completed by March/April 2009. In the last year the home has redecorated the lounge /diner which has been divided up using some of the lounge chairs giving the effect of two rooms. There are four dining tables enabling 20 people to be sat for meals. The lounge and dining furniture was observed to be in good condition and of a good standard. Currently the home has only the use of one assisted bathroom whilst the other is in the process of being altered to a shower room. Two new stair lifts have been installed and more hoist aids purchased. It was observed that some rooms are cluttered with bags of clothes and continence aids but this will be resolved once the home has completed the refurbishment and more storage space has been created. The kitchen was visited and was clean and well organised with evidence of appropriate records being maintained of cleaning schedules and the monitoring of equipment. The AQAA states that all staff have received training in the prevention and control of infection. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers, alcohol gel sanitizers and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons. The home manages all the laundry, which is done by the care staff. There were no offensive odours in the home. A member of staff was observed, during the afternoon, to carry a commode bucket through the lounge area, without gloves being worn, to a bedroom and whilst this may well be the only route to that room the transporting of the Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 23 commode bucket should have been done more discreetly and at least been covered. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their needs met by staff that are trained, supportive and sufficient in numbers. However, the staffing levels at weekends are not adequate to support staff to meet service users needs. The recruitment practices are robust and protect the service users. EVIDENCE: The staffing rota was viewed. This showed that two carers are on duty throughout the day and one waking and one sleeping staff at night. The registered persons attend the home five days a week. A cook is employed Monday to Friday and a housekeeper Monday to Friday. At the time of this visit there was two carers and the cook on duty. The cleaner came in to do her duties later in the day to support the afternoon staff whilst the registered person was shopping for the Christmas party that evening. As with the previous manager the cooking duties were undertaken by one of the carers at weekends, leaving one carer to care for the service users. There are also the laundry duties and any cleaning duties to undertake. The staff spoken to at the time of this visit said that at weekends it had been difficult in recent past to manage with only one carer to undertake various duties and that there was a need for a for a specific week-end cook to be employed. The Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 25 provider has told us that since the previous manager has left her employ she has now taken over this role at the week-end, leaving the two carers to care and she will continue to do this until she can employ a week-end cook. The AQAA states that the home has recruited more part time staff to ensure a larger pool of staff is available. A new staff member was spoken to at the time of this visit and she told us that she was enjoying the job and learning something new every day. The previous report identified short falls in the recruitment practices of the home. A sample of three recently recruited staff files was viewed. The files demonstrated that all the appropriate Criminal Record Bureau, (CRB) Protection of Vulnerable Adults (POVA) checks along with two written references had been received by the home before the person commenced employment. There was evidence in staff files that staff have access to various training and have received training in all mandatory areas such as food hygiene, first aid and manual handling, health and safety, vulnerable adults, infection control, continence management, challenging behaviour and dementia. Staff receive at least three days training a year and are enabled to access courses either at the home or externally. The AQAA states that eight of the ten staff employed has completed induction. Two of the three files viewed had evidence of the induction programme all newly recruited staff undertake. The other file evidenced only the general induction had been completed, as the carer had only just commenced employment. Surveys returned to CSCI by two new staff confirm that they have received induction training and are waiting for information on NVQ training. The AQAA stated that four of the ten care staff have NVQ level 2 and above. The proprietor/manager told us that five staff are about to start NVQ level 3 with two starting level 4. Four care staff were spoken to and they told us that they receive appropriate training and that all their recruitment checks were taken up before they commenced working at the home. The surveys returned from staff also confirm that training is updated on a regular basis and we are invited to attend any sessions that appertain to the client base. A programme of supervision is not yet in progress but the registered person has told us that she has plans to put a programme in place in the coming year. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The registered persons have a good understanding of the areas in which the home needs to improve but residents would benefit from improvements in management practices by quality monitoring the service. Service users financial interests are safeguarded. The health and safety of service users and staff are promoted and protected EVIDENCE: The current registered manager is no longer managing the home. The registered person, Ms.Hoke, has undertaken that role and is in the process of undertaking her RMA after which she will apply to the CSCI for registered manager. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 27 She stated in the AQAA that the home is restructuring and will be introducing a senior carer position, which will undertake specific roles in the home and will support junior staff. Two care staff are undertaking the NVQ level 4 to enable them to take on this role. The registered persons have an action plan in place which sets out how the improvements for the home are going to be resourced and managed. The registered persons wish to get staff more involved in the decision making of the home and provide more input into the running of the home. The home has gone through a period of unrest and staff surveys, and staff spoken to, told us that the home is much better now and that they enjoy coming to work and consider that the registered person (Ms Hoke) is very approachable and available to speak to about any suggestions or issues that concern them. The AQAA received from the home stated that: As owners we speak directly to clients and their families to ascertain how the home is meeting its aims and their needs. The management has distributed satisfaction survey questionnaires to service user and relatives. There are no results to date of these as they have not all been returned for analysis. There was no written evidence of a quality assurance system being available on the day of the visit. The registered person said that the home had undergone a health and safety audit recently that had been undertaken by an outside organisation employed to do so, but other audits to monitor the quality in the home and residents satisfaction surveys, have not been completed. Ms Hoke told us that she and the other registered person are aware of the shortfalls and are working towards putting together a comprehensive monitoring system to cover all aspects of quality. The home keeps pocket monies for service users needs such as newspapers, hairdressing etc. The records of any transactions are recorded with receipts kept in individual records. A sample of two accounts was checked and evidenced that the monies held balanced with the records. All monies are stored in individual containers. The proprietor has undertaken a full risk assessment of the home for the environment whilst the building works are in progress and these are reviewed as the work progresses. These were seen by us. The home has a fire risk assessment dated April 2008 and the proprietor told us that the home is in contact with the fire and rescue service with regards to the fire safety within the home and the changes in the new layout of the home. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 28 The fire log was examined. This showed that fire alarm tests had not been recorded for three weeks. This was discussed with the registered person who said she would look into this but felt sure is was a recording error and fire alarms had been tested. Fire training for staff evidenced that this takes place twice a year. There is no programme of staff supervision. This was discussed with the registered person who told us said she has plans to commence this in the coming months. A sample of servicing certificates for equipment and systems were viewed and found to be current. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. It was noted that a service user sustained a fall and was recorded as an accident but was not documented in the daily notes. There was evidence in the staff files that all mandatory training appertaining to health and safety had been undertaken. Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 29 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 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 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 3 Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1) Requirement Timescale for action 31/01/09 2. OP7 15 (2)(b) The registered person must ensure that all service users admitted to the home have care plans recorded promptly to guide staff on how their needs are to be met. The registered person must 31/01/09 ensure that care plans reflect the changing needs of the service users and record changes, as they occur. The registered person must ensure that all medication including ‘as required(PRN) medication which has been prescribed by the GP is administered as prescribed and reasons for non-compliance documented on the MAR chart. The registered person must ensure that the medication procedures are specific to the home and the care staff receive updated training on the homes policies and procedures for the safe management of service users medication. The registered person must put DS0000062008.V373626.R01.S.doc 3. OP9 13(2) 31/01/09 4. OP9 18(1)(c)(i ) 31/03/09 5. OP36 18(2) 31/03/09 Page 31 Park House Rest Home Version 5.2 in place a supervision programme for all staff to receive supervision at least 6 times a year. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Park House Rest Home DS0000062008.V373626.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Rest Home DS0000062008.V373626.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. 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