Inspection on 12/06/08 for Parkcare Homes (No 2) Ltd (Alexandra Road)

This inspection was carried out on 12th June 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Parkcare Homes (No 2) Ltd... 03/06/09

Parkcare Homes (No 2) Ltd... 10/05/07

Parkcare Homes (No 2) Ltd... 30/10/06

Parkcare Homes (No 2) Ltd... 03/02/06

Parkcare Homes (No 2) Ltd... 21/10/04

Parkcare Homes (No 2) Ltd... 21/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Parkcare Homes (No 2) Ltd (Alexandra Road) 17 Alexandra Road Enfield Middlesex EN3 7DD Lead Inspector Wendy Heal Unannounced Inspection 12th June 2008 12:00 Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 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 Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.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 Adults 18-65. 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. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkcare Homes (No 2) Ltd (Alexandra Road) Address 17 Alexandra Road Enfield Middlesex EN3 7DD 020 8443 5240 020 8804 6518 alexander.road@craegmoor.co.uk 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) Parkcare Homes (No2) Ltd Mr Arthur Snelson Care Home 10 Category(ies) of Learning disability (0) registration, with number of places Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 10 10th May 2007 Date of last inspection Brief Description of the Service: Alexandra Road is managed by Craegmoor Healthcare services. It is a home, which is registered to provide a service to ten younger adults with a learning disability. Alexandra Road is located in Ponders End. The home is purpose built and first opened in 1994. It is an attractive detached house. The accommodation is over two floors. On the ground floor there is a large lounge and dining room and a kitchen. The lounge leads out to a smallenclosed garden with chairs. Also on the ground floor there is a small second lounge, which offers an alternative quiet seating area. In a separate building accessed through the garden there is a laundry. On the ground floor there are bedrooms and an assisted bathroom for disabled people and two toilets, one of which is wheelchair accessible. On the first floor there are the remaining bedrooms, a bathroom, a shower room and the office. The house does not have a lift. The stated aim of the service is to treat the service users as individuals and to promote independence and ensure that privacy and dignity is maintained. The service promotes a holistic approach to care where physical, social and psychological needs are given equal importance and appropriate care plans and interventions are put into place. The purpose and function document and last inspection report are available to Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 5 be viewed at the entrance of the home and in the staff office. The fees range from £700.00 - £1200.00 per week. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The rating for this service is adequate (1 star) this means the people who use the service receive adequate outcomes. This was an unannounced inspection and took place as part of the inspection process. Compliance was checked against key standards and took approximately 9 hours. The inspection started at 12:00 noon and finished at 9:15 pm. We undertook a tour of the building spoke with the people who live in the home and members of the staff team. We gained further information from the Annual Quality Assessment form and an inspection of the documents kept in the home. This included care plans and health and safety documentation. The manager offered his assistance throughout the period of the inspection. We would like to thank the people who use the service and the manager and staff team for their openness and participation. What the service does well: The service has a service user guide, which takes into account the needs of the people living in the home. The document is very user friendly and in pictorial form. This means it is accessible to the people who need to use it. People benefit from varied balanced meals of their choice. This ensures their wishes are respected. Medication had been appropriately signed for on the medication administration records, which ensures good practice is being followed. The home has adult protection procedures including the procedures in relation to people’s placing authorities available within the home. This ensures that staff have the necessary information to protect people from potential abuse. The complaints procedure was found to be in order, which means people’s complaints are being taken seriously. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Care plans need to be fully detailed and signed by the person the care plan is about and their advocate, relatives and other appropriate professionals. This will ensure they are fully informed about the process. Risk assessments need to be developed for those people who fail to respond or leave the home in the event of fire. This ensures that the risks to the people living and working in the home are minimised. There must be a clear record of the visits made by people’s friends or family. This will ensure that people are being supported to maintain contact with their family and visits can be monitored. There must be a clear record of people’s health care appointments with outcomes. This will ensure that their health care needs are being met. People’s weight charts must be kept up –to-date. This will ensure that people’s weight monitoring programme is being effectively monitored and recorded. People’s health action plans must be kept up-to-date and available for inspection. This will ensure that accurate health information is available to those people who need it. The curtains and blinds in the lounge must be replaced as the curtains are old and the blinds are broken. This will ensure that people’s privacy is respected. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 8 The boiler and under-floor heating must be operating effectively together to ensure that the temperature of the water in the home is maintained. This will safeguard the health and wellbeing of the people living in the home. There must be an adequate number of staff on shift at all times to ensure people’s individual needs can be met and they are safe. Staff must undertake training in relation to manual handling, fire safety, violence and aggression, epilepsy and the administration of rectal diazepam. This will ensure that staff are adequately trained to meet people’s individual needs. Staff must be offered supervision at least six times per year to ensure they can provide consistent care to the people living in the home. A clear record of the activities that people are undertaking must be maintained. This will ensure that the activities people have the opportunity to be involved in are effectively recorded. 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. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, People who use the service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. People do have the information they need to make an informed choice about were they want to live as a service user guide is available. No new assessments have been undertaken since the previous inspection due to no new people moving into the home. EVIDENCE: I looked at the homes statement of purpose, which is up to date. This ensures that accurate information is available in relation to this document about the service for those people who need it. There is a service user guide, which is in pictorial form and is therefore accessible to all of those people who may wish to read it. Since the previous inspection there have been no new admissions to the home. Therefore there have been no new individual assessments completed. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, People who use the service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. People are not fully receiving care in a way they prefer and require. The care plans seen on the day of the inspection were being kept up to date. They do not contain enough detailed information to be fully effective. The service must further improve with regard to supporting people to take risks to develop an independent lifestyle particularly in relation to fire risk assessments. EVIDENCE: People are not always receiving care in a way they prefer and require. People have not always been provided with full support due to limited staff resources. (See staffing.) The care plans are person centred which means they are more specific to people’s individual needs. They cover areas such as personal details; there is an every day plan of what the person does, social interaction, health and keeping safe. Personal care, and behaviour. There are also specific additional care plan sections related to specific people. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 12 Care plans need to be fully completed in relation to particular areas. One person’s communication section needs to be completed to ensure the person can be fully engaged with by staff. The plan currently reads this will take place once the communication tools have been developed and this section needs to be expanded on to include the use of the communication tools and how they are to be used. Also care plans indicated that health action plans are in place but these was not available on the day of the inspection. (See health section.) The care plans need to be signed by the person the care plan is about were possible, their relative, advocate and relevant professionals. The care plans we inspected were being evaluated which means up to date information is available about the person, which, ensures their needs, can be met. Risk assessments need to be developed to ensure that the identified risks are minimised in relation to those identified people who refuse to respond to or leave the home when the fire evacuation process is carried out. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17, People who use the service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. People are part of the local community, but this is not expanded to enrich people’s lives wholly. People are assisted to maintain appropriate relationships, which assists their emotional wellbeing. However consistent recording of activities and visits by staff does not take place. People are offered a healthy diet, which promotes their good health. EVIDENCE: The manager confirmed that attempts are being made to appoint a life skills coach which will expand the opportunities for people living in the home. Five people attend day care ranging from two days per week to five days per week. There was only one summer timetable available for one person in relation to their day care activities. None of the people living in the home currently attend college courses. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 14 People’s activity records were inspected. We are aware that people undertake movement and dance sessions within the home and these sessions are carried out by a qualified person who is independent of the organisation. A musician also comes into the home and plays 60’s and 70’s music depending on the wishes of the people living in the home. Staff support people to undertake activities in the community such as shopping which increases their independence and social interaction. The manager had taken one identified person on a picnic, which he confirmed took place in a discussion with him. However Activities undertaken are not sufficiently recorded on the activity sheets and makes it very difficult to identify the actual activities being undertaken. It is difficult to ensure that people are undertaking the appropriate level of activities and therefore the effective monitoring of activities cannot take place. Staff also need to record when they have attempted to engage people in an activity but it has been refused. It took a great deal of time to try to locate the information we were looking for and the manager acknowledged this. The opportunity for people to enjoy their external activities and personal choices are not being maximised due to the fact that Alexandra Road does not have its own means of transport. We are disappointed that even though it was highlighted in the previous two inspection reports that the organisation has not given due consideration to obtaining appropriate transport. However the manager informed me that he is going to take the people living in the home on a holiday to Bognor Regis and this is expected to take place in September. A number of people living in the home have contact with their relatives, which benefits their emotional wellbeing. The recording of contact visits needs to be improved as not all of the contact undertaken is recorded. This makes it difficult to gain a clear picture of the level of contact being maintained by the people living in the home with their friends and family. People living in the home do have a key to their bedroom but due to the individual needs of the people living in the home they choose not to use their keys. Staff do knock on their bedroom doors when entering their bedrooms, which in relation to this specific area ensures people’s rights are respected. The kitchen was clean and tidy, which promotes people’s health and wellbeing. The fridge freezer was inspected and all food was within its use by date and properly labelled which ensures that people are not eating food that could be harmful to their health. The menu of food available was wholesome and nutritious which ensures that people’s dietary needs are being met. The food available was varied. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, People who use the service experience an adequate. outcome in this area. This judgement has been made using available evidence including a visit to this service. People’s physical and emotional health care needs are not always shown to be met, due to ineffective recording. The process for recording and administrating medication is effective which promotes good health. EVIDENCE: The record of people’s health care appointments for each person was inspected. We could not find documented evidence to indicate that people are being supported to receive all of their individual healthcare checks. This does not ensure that people’s health is being fully monitored. Information is not always effectively recorded on the health record but was sometimes identified on the daily log or sometimes noted in the diary. Information is not being effectively recorded on the health professional’s sheet. A consistent process with regard to the recording of information is not being used. People’s health action plans were not available on the day of the inspection. This does not ensure that the most up-to-date information is available to the people working in the home. A number of files appear to be being used at the same time for each individual person. This is causing confusion and staff do not appear to be clear with regard to their recording process, which is not an example of good practice. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 16 The records of people’s weight charts were not all up-to-date. This means that people’s weight monitoring programme is not being effectively followed. This does not benefit people’s health and wellbeing. The medication and administration records were inspected and all medication had been signed for on the medication administration record. This means that professional procedures are being followed. The medication cupboard was inspected and found to be in order. This safeguards people’s health and wellbeing. People were appropriately dressed at the time of the inspection. This improves people’s self-esteem. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23, People who use the service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. People who are living in the home can be confident that their views are listened to and acted upon since the recording and action taken in relation to complaints was found to be in order. Staff have received training and have the information available to protect people living in the home from potential abuse neglect and self-harm. , EVIDENCE: We have examined the complaints book and one complaint has been made since the previous inspection. This is currently being investigated by the organisation at the request of the inspector. (Please see the section headed staffing.) People living in the home have the pictorial complaints procedure in their bedrooms in their individual files. A copy of the complaints procedure is also available on the notice board in the hall. This ensures that the document is accessible to all of the people who may wish to view it. The organisations whistle blowing policy was seen and found to be in order. This ensures that people have the necessary information to report any concerns in relation to professional practice within the home. This will benefit the wellbeing of the people living and working in the home. There was no evidence of advocacy contacts or related information being available for the people living in the home, which would benefit them if they wanted to make a complaint. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 18 The adult protection guidelines for the organisation were available. The adult protection procedures in relation to the relevant placing authorities were also available in a marked file and made available to myself at the time of the inspection. This means staff have the information available to them to protect people from potential abuse. Staff had undertaken adult protection training. This ensures that their knowledge and skills are being kept-up-to-date and assists them to further protect people from potential abuse. People’s financial records were inspected and found to be in order which means that effective recording systems are in place to protect people from financial abuse. The home has a safe to ensure that people’s money is kept securely. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30, People who use the service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. People living in the home have benefited from recent improvements with regard to the environment. People are not living in a safe environment. EVIDENCE: Alexandra Road is located in a residential area near to local shops and public transport. We completed a tour of the home with the assistance of the registered manager. We inspected the premises and people’s bedrooms having sought their permission. The lounge has been redecorated and has been furnished with new leather sofas. This ensures people can sit in comfort in a nicer environment. The manager provided the commission with documented evidence that a request is going before the committee on the 01/07/08 for new flooring both the carpet and lino to be replaced in the dining area lounge and kitchen. This will further improve the current environment. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 20 The hall has been decorated which means the home has a lighter brighter appearance and feels more welcoming. The curtains and blinds in the lounge need to be replaced. The blinds are not functioning correctly and the curtains are old. This will ensure people’s privacy is fully protected at night when the blinds need to be closed. Having inspected people’s bedrooms it was observed that one identified person that had water damage on their ceiling has had their room redecorated. This ensures that they have a pleasant bedroom to sleep in at night. One person has had their bedroom carpet replaced, which has provided them with a nicer environment to live in. The toilet that was leaking has been repaired and is functioning correctly. This promotes people’s health and wellbeing. The shower that needed the shower doors made secure to allow the doors to open and operate fully have had the old doors replaced with new ones. This ensures the shower is safe for people to use. The kitchen was clean and tidy and all equipment being used within the kitchen was working effectively. This means that the home has the necessary equipment provided for people to use to enable them to live an ordinary life. The home has a well-kept garden. There which had a number of old furniture items that the council were going to collect the following day. The manager provided documented evidence of this. Light bulbs in one toilet and one bedroom were not fitted in these rooms on the day of the inspection. We requested that the maintenance man was contacted and the light bulbs were obtained and placed in the identified areas on the day of the inspection. This ensured that there was adequate light for people to use these areas safely. The boiler has been replaced and took place after the last inspection visit as a result of the identified problems. However on the day of the inspector we noted that the temperature of the water supply throughout the home was not sufficiently hot. We requested that the appropriate company were contacted to come to the home on the day of the inspection. The manager contacted his immediate line manager and also contacted the appropriate company by telephone and email regarding the matter. As a result a representative from the company came to the home. Prior to this the water had then become too hot particularly the water supply in the kitchen. We requested the manager speak with staff and put risk assessments in place in relation to the use of the water supply. This ensured the people living and working in the home were protected from potential harm. This was actioned on the day of the inspection. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 21 The company representative informed me that the water valve in the kitchen needed to be replaced and this task was completed. The changes in temperature had been caused by an old under-floor heating system. We have since been informed having spoken with the manager that the under floor heating is being updated and placed on a separate circuit to the boiler to resolve the problem. The problem should be fully resolved by the 27/06/08. Given both the water supply and the problem with the boiler/under floor heating have now had appropriate action taken to ensure that the water temperature will function at a consistent temperature. We have rated the environment as adequate. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35,36, People who use the service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. Not all of the people living in the home are supported by qualified staff which means people’s needs cannot be fully met. People are not fully safeguarded by the homes recruitment policies and procedures. Not all the staff are receiving regular supervision so a consistent approach to work with people living in the home cannot be maintained. EVIDENCE: The staff rota was inspected and there were adequate numbers of staff on shift to meet the needs of the people living in the home on the day of the inspection. However it has been identified that this previously this has not been the case. It was requested the organisation ensure that an investigation is undertaken to ascertain the reasons for this. The organisation have started their investigation and taken appropriate action by contacting an agency and other staff within the organisation to ensure that any shifts that fall below expected staffing levels are covered. This was to ensure that the health safety and wellbeing of the people in the home is promoted and protected. The rota is not always clear and we have discussed with the manager of the service that the rota must be accurate and adequately reflect the actual number of staff on shift. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 23 We discussed with the manager the fact that the one identified person who lives in the home that has twenty-four hours one to one staffing, per day. (Which is funded by the health authority) must have the staff working with her/him clearly identified on the staff rota. This will ensure that the individual needs are met. This has now been actioned by the manager and has been confirmed that this is in place at the time of writing the report. The manager has interviewed for staff and informed me that four staff have been identified to fill vacant posts subject to adequate references being received. One member of staff is on maternity leave. Staff had undertaken a range of training such as protection of vulnerable adults, basic food hygiene, fire safety, first aid, cosHH, infection control, manual handling, violence and aggression. One staff has undertaken their NVQ level 3, which further develops staff’s skills and knowledge and promotes their personal development. This improves the quality of care provided to people living in the home. Two people need to undertake their manual handling, one person needs to undertake, fire safety. One person needs refresher training in relation to how to manage violence and aggression. Staff need up-dated training in relation to epilepsy and the use of rectal diazepam to ensure they have all the required knowledge and training to meet the needs of the people living in the home. The manager confirmed that he would request that the above training is provided to his staff. A number of training certificates were not available on the staff files. We requested the manager contact the appropriate person by telephone, which he did. He discussed the fact that all staff did not have all of their training certificates on file and the identified person confirmed to me on the telephone that he would ensure the certificates would be forwarded to the home. The manager of the home has verbally informed me that the outstanding certificates have been received. Staff recruitment policies and procedures all the relevant documentation was inspected and one identified person’s reference did not have a company stamp and was not on headed paper and dated. All other documents were found to be in order. The above issue has been brought to the attention of the homes manager and their immediate line manager who is contacting the appropriate department within the organisation regarding this matter and will inform us of the outcome. This document was a photocopy of the original and the original document may indicate the missing information therefore a requirement has not been made as the area manager has agreed to look into this matter. The supervision records of staff indicated that staff are not all receiving regular supervision, which means that staff are not being supported to work with the Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 24 people living in the home in a consistent way. We recommend that the senior support workers undertake supervision training to assist the manager to complete this task more effectively. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42, The people who use the service experience an adequate. Outcome in this area. This judgement has been made using available evidence including a visit to this service. The service is not benefiting fully as a well run home. The manager is going to continue the monitoring review and assessment process that takes place within the home. The health and safety of people living in the home is not fully promoted and protected due to outstanding environmental improvements and inadequate staffing levels. EVIDENCE: People who live in the home do not benefit fully from a well-run service. Previous evidence in relation to the reduced staffing levels and the irregular supervision of staff impacts on service provision and the consistency and quality of care provided to the people living in the home. The manager is continuing the homes quality assurance process of sending letters to all service users relatives and professionals to obtain feedback Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 26 regarding the service and then will act on the feedback received to improve the service offered. An experienced registered manager manages the service. We looked at the provider visits on the day of the inspection. We are also being sent regulation 37 notifications of incident forms. The liability insurance was seen and was found to be in order. This means that staff working in the home are legally safeguarded if an injury or incident took place causing them harm. We inspected a range of health and safety documentation. Fire drills had taken place. The weekly bell tests were complete and the fire alarm system had been inspected to ensure it was working effectively. The emergency lighting had been checked regularly. The gas, electric and water certificate was seen and found to be in order. The portable appliance-testing certificate was seen and was valid. The manager requested a copy of the full portable appliance testing record on the day of the inspection from the property department. This means that people’s health and safety is protected in relation to these areas. However the health safety and welfare of the people living in the home is not fully promoted and protected. This is due to the erratic temperature of the water system and issues regarding staffing levels. Appropriate action has been taken (See section headed environment.) regarding this and as a result the under-floor heating is in the process of being updated and placed on a separate circuit to that of the boiler which should resolve the identified problem. The staffing levels have been insufficient to meet the needs of the people living in the home and as a consequence the organisation have been requested to carry out an investigation with regard to the reasons for this, which is ongoing. (Please see section headed staffing.) The area manager has been to the home to ensure that adequate staff are on duty and agency staff/bank staff were used to cover identified shifts were this was needed to safeguard the wellbeing of the people living and working in the home. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.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 Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 3 X 3 X 3 X 1 3 X Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 28 YES Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 (1) Timescale for action The Registered Person must 15/07/08 ensure that all the specific areas of the care plans contain detailed information. All relevant parties must sign the document. This will ensure that the person’s needs are fully met and the appropriate people are fully informed throughout the process. The Registered Person must 10/07/08 ensure that risk assessments are developed in relation to those people who refuse to respond to the fire alarm when it is sounded or leave the home during the fire evacuation process. This will ensure that the risks to those people living and working in the home is minimised. Their health and safety will then be promoted. The Registered Person must 12/07/08 ensure that there is a clear record of the visits and contact between the people living in the home and their friends and family. This requirement has been restated from the previous inspection. The DS0000010588.V365207.R01.S.doc Version 5.2 Page 29 Requirement 2. YA9 15 (2) 3. YA15 41 Parkcare Homes (No 2) Ltd (Alexandra Road) 4. YA19 12 5. YA19 12 6. YA19 12 7. YA24 23 8. YA24 23 9. YA33 18 (1) previous timescale of 05/12/07 was not met. The Registered Person must ensure that all health care appointments are undertaken. All health care appointments must be effectively recorded with outcomes. This will ensure that people’s health care needs are fully met. The Registered Person must ensure that people’s weight charts are kept up-to-date. This will ensure that people’s weight is being effectively monitored and their health and wellbeing is being promoted. The Registered Person must ensure that people’s health action plans are up-to-date and available for inspection. This will ensure that up-to-date health information is available. This will ensure the persons individual needs can be met. The Registered Person must ensure that the lounge curtains and blinds are replaced. This will ensure that people’s privacy is respected. The Registered Person must ensure that the necessary work is completed in relation to the boiler and under –floor heating system. This will ensure that the water temperature remains constant and all equipment is working effectively. This will ensure people are living in a safe environment. The Registered Person must ensure that there are adequate staff on shift at all times. This will ensure that people’s individual needs are met and that the rota is completely accurate and reflects the staff working in the home. This DS0000010588.V365207.R01.S.doc 15/07/08 10/07/08 25/07/08 14/07/08 10/07/08 08/07/08 Parkcare Homes (No 2) Ltd (Alexandra Road) Version 5.2 Page 30 10. YA35 18 (1) 11. YA36 18 (2) 12. YA41 17 requirement has been restated from the previous inspection. The previous timescale of 02/12/07 was not met. The Registered Person must 01/08/08 ensure that staff undertake training in relation to manual handling fire safety, violence and aggression, epilepsy and the administration of rectal diazepam. The Registered Person must 01/08/08 ensure that all staff receive supervision at least six times per year. This will ensure that staff work effectively as a team. The Registered Person must 15/07/08 ensure that there is a clear record of activities, which are effectively recorded to show the activities that people actually undertake. This requirement has been restated from the previous inspection. The previous timescale of 05/12/07 was not met. 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. YA36 Refer to Standard Good Practice Recommendations Due consideration should be given to training senior support staff to assist the manager in completing supervision duties with staff. Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Parkcare Homes (No 2) Ltd (Alexandra Road) DS0000010588.V365207.R01.S.doc Version 5.2 Page 32 - 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!