Inspection on 10/04/07 for Parkfield House

This inspection was carried out on 10th April 2007.

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

Parkfield House 29/10/07

Parkfield House 11/04/06

Parkfield House 12/09/05

Parkfield House 12/04/05

Parkfield House 16/11/04

Parkfield House 14/06/04

Parkfield House 15/12/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Parkfield House Charville Lane West Hillingdon Uxbridge Middlesex UB10 0BY Lead Inspector Mrs Rekha Bhardwa Key Unannounced Inspection 10th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Parkfield House DS0000010935.V333698.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. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkfield House Address Charville Lane West Hillingdon Uxbridge Middlesex UB10 0BY 01895 811 199 01895 811 131 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) HALTON SERVICES LIMITED Mrs Gurbachan Kaur Sandhu Care Home 44 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (36) of places Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 36 BED NURSING UNIT Day Shift: 33-36 service users, Two Registered One additional carer for a half day. 31-32 service users, Two Registered 29-31 service users, Two Registered 23-27 service users, Two Registered Assistants. Nocte Shift: 33-36 service 31-32 service 29-31 service 23-27 service users, users, users, users, One One One One Registered Registered Registered Registered Nurses and Five Care Assistants. Nurses and Five Care Assistants. Nurses and Four Care Assistants. Nurses and Three Care Nurse Nurse Nurse Nurse and and and and Two Two Two One Care Care Care Care Assistants. Assistants. Assistants. Assistants. 8 BED DEMENTIA UNIT Staffing levels in the Dementia Unit must at all times be maintained at 1 RMN (or RN with appropriate post qualification training in dementia care) and 1 Care Assistant unless negotiated and agreed with the Commission For Social Care Inspection in advance of any change being made. Date of last inspection 11th April 2006 Brief Description of the Service: Parkfield House Nursing Home is a Georgian building, situated in a residential area in Hillingdon. The building has 3 storeys. It is registered to accommodate 44 people, 8 of whom are accommodated in a dementia care unit. The building is a listed building, and is a converted mansion. There are 36 single bedrooms (spread over the ground, first and second floor) and four double bedrooms (all situated on the first floor). All bedrooms are en-suite. There are 2 sitting areas on the ground floor and one sitting area on the second floor. There is a dining room on both the ground and first floors. The Home is near the local high street, public transport and local amenities. The fees range from £500 to £850 per week. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 21 hours was spent on the inspection process. A tour of the home was carried out, and service user plans, management records, training records, staff employment records, administration records, maintenance and servicing records were viewed. The pre-inspection questionnaire and comment cards from people living at the home and representatives/visitors have also been used to inform this report. The CSCI pharmacist Inspector carried out a medication inspection on 10/04/07 and a separate report is available. The requirements and recommendations from the pharmacist inspection have been incorporated in this report. 16 people living at the home, 9 visitors and 12 staff were spoken with as part of the inspection process. On the morning of inspection the Registered Person, Registered Manager and Deputy Manager were not present. The administrator and registered nurses assisted the Inspectors. The Registered Manager did attend the home from 1.30pm. The term ‘service user’ refers to a person living at the home. What the service does well: People wishing to be accommodated at the home are comprehensively assessed prior to admission to the home to ensure the home is able to meet their needs. Staff care for the people living at the home in a gentle and professional manner, respecting their privacy and dignity. Some comments received from people living at the home and visitors include: ‘I find the home and staff first class and can find nothing to complain about’, ‘ the home is very friendly and service users and relatives are treated as if it were their own home’, ‘they are very good to me and helpful’, ‘the home provides a good quality of care in a homely and friendly way’. The home has a Registered Manager and comment was received from people living at the home, staff and visitors regarding how supportive the Registered Manager is. The wishes of the people living at the home and their representatives in relation to health deterioration and end of life care are recorded so that these can be respected. The home has an open visiting policy and visiting is encouraged. The home has a new activities co-ordinator who is very aware of the importance of finding out individual interests and planning activities to meet these interests. The cook works hard to provide a variety of meals for people living at the home. Visitors spoken with said that they are made welcome at the home. The Registered Manager has information regarding advocacy services and recognises the importance of advocacy for service users who do not have representatives. Procedures for the management of complaints and adult protection issues are in place and are followed. Bedrooms are personalised and provide a homely environment. Staffing levels are appropriate to meet the needs of the people living at the home. Recruitment Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 6 procedures are robust and protect people living at the home. Monies for people living at the home are being appropriately and securely managed. What has improved since the last inspection? What they could do better: The majority of shortfalls identified at this inspection were in relation to documentation. Shortfalls were identified in the formulation, review and updating of the service user plans. This included care plans, continence assessments, moving & handling assessments, wound care documentation, use of bedrails, diet and fluid intake records and the overall recording and updating of information. A record showing marked weight loss had not been questioned or reviewed. Since the last visit from CSCI Pharmacist Inspector there had been an improvement in the management of medications, however shortfalls identified could place service users at risk. Care plans were not in place to identify service users individual social and leisure interests. Although the majority of people living at the home spoken with said they are offered a choice of meals, others said they are not. A document to record peoples’ meal preferences plus offering all people alternatives prior to the meal was discussed with the cook and Registered Manager. Whilst the overall standard of the environment is fair, some shortfalls in furnishings and décor were identified in areas to include en suite, bedroom, corridor, plus bath and shower facilities. Lack of storage is also an issue. An environmental audit must be carried out from which the redecoration and refurbishment plan can be updated with timescales for completion. Personal toiletries were found in some bathrooms. Paper towels were not available in the en suites, so there was no provision for staff and visitors to dry their hands. The home still only has 6 care staff with an NVQ level 2 in care or equivalent qualification, whereas the expectation is for a minimum of 50 of all care staff to have this qualification. Shortfalls in other areas of training were also identified to include care planning, topics relevant to the diagnoses and needs of the people living at the home, and some health & safety training. Management cover for the home to include contingency arrangements in case of emergency were not in place on the morning of inspection. The majority of policy and procedure documents had not been reviewed within the last year, and in some cases, for several years. It is important to review such documentation in line with changes in legislation, guidance and good practice. Some concerning health & safety shortfalls were identified to include fire and moving & handling training issues and lack of updates of risk assessments. Action must be taken to address all the shortfalls identified in this report and systems put in place to maintain all aspects to a good standard thereafter. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 7 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. Parkfield House DS0000010935.V333698.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 Parkfield House DS0000010935.V333698.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): 3. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wishing to live at the home are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. EVIDENCE: The Inspectors viewed pre-admission assessments on each unit. These were comprehensive and provided a good picture of the needs of the person wishing to live at the home. In some instances the healthcare professionals involved with the persons hospital care had provided additional information. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the service user plan documentation was inadequately completed, thus placing service users at risk of not having their needs fully identified and met. Overall the medications are being managed, however shortfalls identified could place people living at the home at risk. Staff care for people in a courteous and professional manner, thus respecting their privacy and dignity. Procedures are in place for end of life care to ensure the wishes of people living at the home are respected. EVIDENCE: 4 service user plans plus some additional records were viewed as part of the inspection process. Although the pre-admission assessments were comprehensive, the information had not always been used to inform the service user plan. The home uses pre-printed care plans, and it was noted that in most cases the information was very general and the document had not been personalised to the individual. Care plans had been put in place for the majority of identified needs, however some needs did not have a care plan. For Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 11 one person who had been mobile, a care plan entitled ‘Immobility (non weightbearing)’ had been put in place 18 months ago. This was not relevant to the person and staff had not recognised this and had continued to review the care plan monthly. Care plans had not always been formulated for newly identified needs, for example, for a person who had been identified as being in pain, no care plan was in place to reflect this. There was no evidence of input from the people living at the home and/or their representatives in the formulation and review of the service user plans, with the exception of bedrail consents and deteriorating health information. The majority of this information had been reviewed monthly, however for one person who had been in hospital a review had not been carried out on return to the home. Risk assessments for falls were in place and there was evidence of review following any falls. The information in one falls risk assessment did not tally with the information in the service user plans, in that the persons condition had changed markedly over a period of months and the care plans had not been re-written to reflect this. Wound care documentation was viewed. For one person with a pressure sore, the pressure sore risk assessment had not been reviewed monthly. Care plans for wounds had been formulated, although some of the information following review by the Tissue Viability Nurse had not been included. The care plan for skin care had not been updated to reflect the presence of a wound. The specific pressure relieving equipment in use for each person had not always been identified in the service user plan. Moving & handling assessments had been carried out and in most cases the specific equipment to be used had been identified. Some of the assessments were incomplete and did not give a clear picture of the persons needs for all moving & handling procedures. Continence assessments were in place, however these were more suited to community living and did not clearly identify each persons urinary continence needs. Care plans for continence care needs were in place. Nutritional assessments had been carried out. Fluid balance charts and nutritional intake charts were in some cases incomplete and therefore did not provide an accurate record of the persons’ intake. For one person a weight loss of 12 kg in one month had been recorded and no action had been taken to follow up this finding. This was discussed with the registered nurses and it was felt that this was an inaccurate reading. Staff undertook to re-weigh the person. Bedrail assessments and risk assessments had been carried out and consent for their use obtained. For one person the use of bedrails had not been reviewed following a fall from the bed, even though the bedrails had been in situ at the time of the fall. For another person who had refused to have bedrails, assessments and consents were still in place in the service user plan. For one person who did not wish to have the protective coverings on the bedrails, this had not been reflected in the assessment or consent documentation. The impression gained by the Inspectors was that bedrails are used unless there is a reason not to do so. Bedrails should only be used for people for whom they have assessed as necessary and appropriate to use to minimise the risk of accident. Where bedrails are not required, these must be removed from the bed and put into storage. A form entitled ‘Wheelchair Disclaimer’ had been signed for some Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 12 people living at the home. One viewed was not fully completed, therefore it was impossible to know if the consent was for the use or non-use of the wheelchair lap strap. There was evidence of input from the GP and other healthcare professionals recorded in the service user plans. Some care documents are completed by the registered nurses and others by the care staff. This is time consuming and leads to some duplications in work, plus the registered nurses are not always checking that documents are fully complete, for example, the fluid and nutrition intake charts. The need to review all service user plans and associated documentation and to ensure they are up to date and accurately reflect the needs of the people living at the home was discussed with the Registered Manager. Staff require training in the completion of service user plans in order to provide them with the skills and knowledge to complete them fully. (see Standard 30). CSCI Pharmacist Inspector carried out a medication inspection on 10/04/07 and a separate report is available. The requirements and recommendations resulting from that inspection have been incorporated into this report. The abbreviation ‘MAR’ stands for medication administration record. Staff were seen caring for people in a gentle, caring and professional manner, respecting their privacy and dignity. People living at the home spoken to expressed their satisfaction with the care they receive at the home, and this was also reflected in the comments received on the comment cards. Personal clothing viewed was labelled with their name and people were appropriately dressed to show individuality. People can bring in personal belongings to the home, in line with fire safety. There was a contented, homely atmosphere throughout. Information in respect of the wishes those living at the home and their representatives in the event of deterioration in health and also bereavement wishes had been recorded. In some instances letters from representatives clearly recording these wishes had also been received. Policies and procedures are in place for death and dying. This was discussed with the Registered Manager at the time of inspection. There was no evidence of staff training in ‘end of life’ care. (see Standard 30) Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an activities co-ordinator in place, and work is to take place to ascertain peoples’ individual interests in order to plan to provide activities to cater for peoples’ individual and group interests. The home has an open visiting policy, thus encouraging people to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring peoples right to independent representation is respected. The food provision in the home is good, however more work is required to ensure individual preferences are ascertained and thus provide meals that fully meet everyones dietary needs. EVIDENCE: The home has a recently appointed activities co-ordinator in place. It was clear from discussion that the activities co-ordinator is aware of the importance of finding out individual interests and of constructing an activities programme to reflect these. Outings for the spring were being arranged and there was evidence of outings having taken place, for example, to the London Eye and Ruislip Lido. Musical entertainment has been planned twice a month. The home receives visits from representatives from the Church of England and Roman Catholic churches. The Registered Manager stated that she is planning to Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 14 access training in dementia care for the activities co-ordinator in order to provide the skills for suitable activities for the dementia care unit. The activities co-ordinator has a diary for each person to list the activities they have partaken in. No care plans for social and leisure interests were seen in the service user plans. The Registered Manager said that she does ascertain peoples’ interests at the pre-admission assessment, but no action had been taken to transfer this information to the service user plan. The home has an open visiting policy and visiting is encouraged. People living at the home can choose to receive visitors in the day room or in their own rooms, whichever they wish. Visitors spoken with said that they are made welcome when visiting the home. The Registered Manager has contact details for Hillingdon Age Concern, which now works in conjunction with the Relatives of Residents in Care homes in Hillingdon Support Association. Due to the withdrawal of funding some advocacy services are being discontinued in the Hillingdon area, and the Registered Manager was aware of the importance of ensuring everyone, especially those without representation, have access to advocacy services. One Inspector viewed the kitchen. The area was clean and tidy and the kitchen records were up to date. Risk assessments for specific food hazard risks were in place and were up to date. Good supplies of foodstuffs were available and there was evidence of stock rotation. Certificates on display evidenced that the kitchen staff had undergone food hygiene training within the last 3 years. The menu is regularly reviewed, and any changes to the published menu are recorded with the reason for the change. Comment regarding the meal provision had been received, both on the comment cards and people living at the home at the time of the inspection. In most cases people expressed their satisfaction with the food and said that they are offered a choice of meals, with an alternative being provided if they do not like the options available. Some people did say they are not offered a choice at mealtimes. Drinks and snacks are provided throughout the 24 hour period. No records of individual meal choices are kept and this was discussed with the cook and the Registered Manager. The cook did not have any information regarding peoples’ individual likes and dislikes and did have some information regarding specific dietary requirements for medical reasons. This was discussed and it was clear that the cook would be interested in speaking with people to discuss their individual preferences. The Registered Manager said that she does ask people about their likes and dislikes during their pre-admission assessment, however this information does presently not get transferred to the service user plan or kitchen. Staff were seen assisting people with meals in a gentle and discreet manner, and specialist cutlery was available as needed. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear complaints procedures in place to address any concerns raised by people living at the home and their visitors. Procedures for the protection of vulnerable adults are in place, and staff are aware of the POVA procedures to be followed, thus safeguarding the people living at the home. EVIDENCE: The home has a clear complaints procedure, copies of which are on display in the home. The home had received two complaints since the last inspection and the documentation evidenced that these had been fully addressed and responded to. There had been one Protection of Vulnerable Adults (POVA) issue since the last inspection. The Hillingdon Safeguarding Adults Team had dealt with this. Staff spoken with were aware of Whistle Blowing procedures and stated that they would report any concerns. Additional training for staff in POVA has been planned. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the internal and external environment is of a fair standard, thus providing a clean, comfortable and homely environment for people to live in. Plans need to be put in place to address any shortfalls in the environment in order to maintain a good standard throughout. The bath and shower facilities are not all in good condition and could pose a risk to those living at the home. Bedrooms are personalised, providing people with a homely place to live. Infection control procedures are in place, however some shortfalls in infection control practices could place those living at the home, staff and visitors at risk. EVIDENCE: The Inspectors carried out a tour of the home. Whilst overall the home was being well maintained, areas of redecoration and refurbishment were identified. For example, the flooring in some of the en suite facilities and in one bathroom on the ground floor is very marked and must be made good. The walls in areas of the ground floor corridors and in some of the bedrooms Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 17 viewed were scuffed with wheelchair tyre marks and needed redecorating. The Registered Manager explained that the ground floor corridors had been redecorated since the last inspection and that further damage had been sustained by wheelchairs and hoists. A full environmental audit of the home must be carried out and the refurbishment and redecoration plan updated, with timescales for completion, to include all areas of the home requiring attention. The external grounds are attractive and well maintained, providing a pleasant area for people living at the home and their visitors to sit out in. The home has bath, shower and toilet facilities to meet peoples needs. Some of the toilet surrounds in the bathrooms were rusty and in need of replacement. The sides of the standard baths were marked in places, as were the walls of the bathrooms. The shower attachment was broken, the shower tray was marked and the paintwork on the boxing in of the pipe work was chipped and stained in the second floor shower room. Bathrooms were being used as storage areas for linen, cushions and some items of equipment. Adequate storage facilities need to be provided for the home. The bath, shower and toilet facilities must be included in the environmental audit. Several bedrooms were viewed and these had been personalised and were homely. Flat screen digital televisions had been recently installed in all bedrooms, providing both television and radio channels. The furnishings and fittings were suitable throughout. The beds are manually adjustable and discussion took place with the Registered Manager regarding the possible provision of profiling beds, specifically for those who are have high dependency needs and nursed in bed. The laundry room was clean and tidy. There are two tumble dryers and two washing machines. Wash programmes include those to disinfect soiled items. Clothing was being appropriately dried, to include items that cannot be tumble dried. Overall the home was clean and smelled fresh. No paper towel dispensers were seen in the en suite facilities, and therefore there was no provision for staff and visitors to dry their hands. Comment was received regarding the fact staff do not wash their hands after taking off protective gloves. Paper towel dispensers were available in the bath and shower facilities. There was standing water noticed in the Parker Bath on the first floor. Personal toiletry items were found in some of the bathrooms, to include deodorant, razors and shampoo. Surgical scrub was also found in two bathrooms, to include one on the dementia care unit. Two bedpans and a bar of soap had been left on the floor of one en suite room. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed to ensure that the needs of people living at the home can be met. Systems for vetting and recruitment practices are in place and protect people living at the home. Staff are qualified and experienced to care for people, however the lack of up to date training in some areas relevant to individuals needs must be addressed to ensure they are fully met. EVIDENCE: A staff duty roster was available and this detailed the staff on duty. In addition to this there is an information board by the lift on the ground floor and this is updated daily to reflect the staff on duty throughout the home for the whole day. This is good practice as the information is available to people living at the home and their visitors. Staff spoken with said that the staffing levels are appropriate. It is essential to keep the staffing under review in line with individual dependencies. The home was clean and fresh throughout. Appropriate numbers of kitchen, domestic and maintenance staff are employed at the home. The home still only has 6 care staff qualified to NVQ level 2 in care. The training matrix showed that 4 more current staff are undertaking this qualification. The expectation is that 50 of care staff employed at the home Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 19 are qualified to NVQ level 2 in care or the equivalent. Action must be taken to address this shortfall. One Inspector viewed 3 sets of staff employment records and these included all the information required under the Care Home Regulations 2001. The Administrator said that she does ensure that staff have any necessary visas to work at the home. She also explained that head office deal with the verifications of the registered nurse Personal Identification Numbers (PIN) to confirm their qualifications. Evidence of this verification must be in the individuals employment file and the Registered Manager said that this would be addressed. A record of each registered nurses’ actual PIN was available on the file. The home has an induction and foundation programme for all new staff. One Inspector examined the training matrix for the period of 2006 and 2007. Although there was evidence of training taking place for some staff in a few relevant topics, training for registered nurses in formulation and updating of service user plans and for some staff in medication management had not taken place. There was no evidence of training in topics such as nutrition, continence management, end of life care and medical conditions relevant to the diagnoses of people living at the home. It was noted that some staff had received training in Diabetes in 2005. Training must be ongoing and the training needs of the staff team must be identified and a training plan developed to meet these needs. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the experience and qualifications to manage the home, however shortfalls in contingency arrangements for management cover could lead to the home not being effectively managed at all times. Systems for quality assurance are in place, however shortfalls in assessment, policy & procedure review have been identified, thus people living at the home are not being provided with up to date care management. Individuals monies are well managed, thus safeguarding their interests. Shortfalls identified in the overall management of health & safety at the home could place people living at the home, visitors and staff at risk. EVIDENCE: The Registered Manager is a first level Registered Nurse. She has several years experience of working with older people and has been in post for nearly 5 Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 21 years. The Registered Manager said that she has completed the work for the Registered Managers Award and is awaiting verification of her portfolio. The training matrix does not evidence that the Registered Manager has undertaken annual health & safety training, plus training and updates in topics relevant to the needs of people living at the home. On the morning of the inspection the Registered Person was on leave, the Deputy Manager was on a day off and the Registered Manager was on sick leave. As a result, there was no management cover for the home and the registered nurses were expected to provide this cover as well as working on the floors providing nursing care. The Registered Manager did attend for the afternoon of the inspection. The staffing roster did not accurately reflect the management hours for the home. The management of the home must be effectively planned for and recorded, to include any contingency plans in case of emergency, to provide suitable management cover at all times. The home has system in place for quality assurance. This includes audits of medications, service user plans and accidents. The home obtained the CQS certified quality system for management in 2004. This covers several aspects of quality assurance. Shortfalls identified in the service user plans and the management of medications evidence that the auditing systems in place for these areas are not being implemented effectively. Meetings for people living at the home and their relatives take place 6 monthly and minutes are recorded. Minutes of the October 2006 meeting were available and viewed by one Inspector. Minutes of staff meetings were also available. The Registered Manager said that she has an open door policy for people living at the home, staff and relatives to discuss any issues, and this was verified in discussions with people living at the home, staff and visitors at the time of inspection. Policies and procedures detailed in the pre-inspection questionnaire had not been reviewed recently, and in some cases, for several years. All policies and procedures must be reviewed regularly in line with any changes in legislation, guidance and good practice. Regulation 26 unannounced visits to the home take place and a report written, a copy of which is forwarded to CSCI. Service User Surveys had taken place in January 2007, the results of which had yet to be collated and published. This was discussed with the Registered Manager at the time of inspection. One Inspector sampled the records for monies held by the home on behalf of individuals living there. These were up to date and clearly identified all income and expenditure. Receipts are kept for all expenditure. The home has safe facilities available. Maintenance and servicing records to include kitchen records were sampled. Those viewed were generally up to date. Water temperature records were viewed and up to date. The fire risk assessment had not been reviewed since 09/06/04. A table and 2 chairs had been situated in one of the first floor corridors and were causing a partial obstruction. This was identified and addressed at the time of inspection. Generic risk assessments for equipment Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 22 and safe working practices had not been reviewed since 01/07/03. The health & safety policy had not been reviewed since 2003. (see Standard 33). Fire drill records viewed did not always clearly indicate what time drills had taken place and what action had been required following the drill. One Inspector was informed that fire drills are incorporated in the fire training undertaken by an external trainer. There must be clear evidence that fire drills are being carried out to include all staff at the required intervals for day and night staff. The training matrix provided by the home did not evidence that all staff, to include the Registered Manager, had received fire safety training and moving & handling training within the last 12 months. Action must be taken to address all areas of health & safety to ensure that all records and training are up to date and maintained so thereafter. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 24 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 Requirement The service user plans must accurately reflect the needs of each individual using the service. They must be reviewed monthly and whenever the service users condition changes. Input from the person using the service and/or their representative must be sought for the formulation and review of the service user plans, unless it is impracticable to carry out such consultation. All documentation relating to wound care must be up to date and accurate. All assessments and associated documentation in respect of individuals care must be fit for purpose, completed in full and kept up to date. Where a change in a persons weight is identified appropriate action must be taken to include referral to the GP. Bedrail assessments and risk assessments must be completed in full and the outcome must clearly identify the DS0000010935.V333698.R01.S.doc Timescale for action 01/06/07 2. OP7 15 01/07/07 3. 4. OP8 OP8 17 17 01/05/07 01/05/07 5. OP8 17 20/04/07 6. OP8 13(4)&(7) 01/05/07 Parkfield House Version 5.2 Page 25 7. 8. OP9 OP9 9. OP9 10. OP9 11. OP12 12. OP12 13. OP15 14. OP19 appropriateness of the use of bedrails for the individual. The wishes of the individual must be fully taken into account. 13(2) The home’s medication policy should be updated and the section on disposal expanded 13(2) Medication must be thoroughly checked and recorded when received from hospital or for respite care. Medication must be recorded when disposed of. 13(2) Professional finger pricking devices or lancets for professional testing must be used in the home to prevent the risk of infection. 13(2) Assessments and consent for covert administration must be reviewed and updated if medication is to be crushed by staff. 12(1)(b), A review of training of staff in 18(1)(c) dementia care, and the type of (i) activities undertaken in the dementia care unit, is required. Previous timescale of 01/06/06 not met 12, 15, 16 People living at the home must be consulted about their social and leisure interests. Care plans to reflect this information must be formulated and the information used to plan activities to meet peoples needs. 12, 15 Information regarding service users food preferences must be recorded and all those involved in the provision of meals must be aware of peoples likes and dislikes. People living at the home must be offered a choice at mealtimes. 23(2) A full environmental audit must be carried out and the redecoration and refurbishment plan updated to include all shortfalls identified. DS0000010935.V333698.R01.S.doc 01/06/07 23/04/07 01/05/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 Parkfield House Version 5.2 Page 26 15. OP19 23(2)(d) 16. OP21 23(2)(l) 17. OP26 13(3) 18. 19. 20. OP26 OP26 OP28 13(3) 13(3) 18 21. OP30 18 22. OP30 18 23. 24. OP31 OP33 12 24 25. OP33 10, 12 26. OP38 23(4) The bathroom and corridors identified in the report must be redecorated. Previous timescale of 01/06/06 not met Bathrooms must not be used as storage areas. Adequate storage facilities must be available for the home. There must be suitable facilities for hand drying, for example, the provision of paper towels, in all areas where people may require to wash their hands. Action must be taken to resolve the problem of standing water in the Parker Bath on the first floor. Personal toiletries must not be left in communal areas. The home must have 50 of care staff qualified to NVQ level 2 in care or the equivalent. An action plan with timescales to address this must be forwarded to CSCI. Staff must receive training in topics relevant to the diagnoses and needs of the service users. An action plan to address this must be drawn up. The registered nurses must receive training in the formulation and review of service user plan documentation. Arrangements must be in place to ensure that the home is being managed effectively at all times. Effective systems for auditing must be in place and prompt action taken to address any shortfalls identified. All policies and procedures must be reviewed regularly in line with any changes in legislation, guidance and good practice. All risk assessments to include fire, equipment and safe working DS0000010935.V333698.R01.S.doc 01/08/07 01/06/07 01/06/07 01/05/07 13/04/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/05/07 Parkfield House Version 5.2 Page 27 27. OP38 28. OP38 practices must be reviewed and maintained up to date thereafter. 13, 18, 23 All staff must undergo health & 01/05/07 safety training and updates at the required intervals. An action plan to address this must be drawn up. 23 There must be clear evidence 01/05/07 that fire drills are being carried out at the required intervals for all staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP24 Good Practice Recommendations It is strongly recommended that a record individuals meal choice be maintained as evidence of the meal provided for each person. It is strongly recommended that profiling beds be provided for people who have high dependency needs and are nursed in bed. Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Parkfield House DS0000010935.V333698.R01.S.doc Version 5.2 Page 29 - 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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