CARE HOMES FOR OLDER PEOPLE
Parkfield House Thwaites Brow Road Keighley West Yorkshire BD21 4SW Lead Inspector
Gillian Sangster Unannounced Inspection 7th October 2005 10.25 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 DS0000019885.V253423.R01.S.doc Version 5.0 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 DS0000019885.V253423.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Parkfield House Address Thwaites Brow Road Keighley West Yorkshire BD21 4SW 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) 01535 609195 01535 609195 Mr Michael John Flynn Mrs Pauline Hodge Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th June 2005 Brief Description of the Service: Parkfield House is in Keighley and access to the home is via a steep cobbled road. There are tiered gardens and a patio area overlooking the gardens. Parking is on the road outside the home and there is a bus stop nearby. The home provides nursing care for people aged over 65 years. The accommodation is on two floors with a passenger lift linking the two. There are seventeen bedrooms comprising of eight doubles and nine singles. Two bedrooms have en suite facilities. There are two communal lounges leading into one another, as well as a large conservatory that is used as both a lounge and dining area. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector between 10.25am and 4pm. The purpose of the visit was to check compliance with the standards and outcomes for residents. Issues raised by a complaint, which related to care practices were also looked at. This complaint was partly upheld. The registered manager was present and was given feedback at the end. Time was spent looking round the home, observing practices, talking to residents and visitors, examining records and discussions with the manager. Records inspected included care plans, accident reports, medication records and duty rotas. The last inspection was announced and showed an improvement in the standards checked. It was therefore disappointing at this visit to find that none of the requirements from the last inspection have been addressed. A number of shortfalls in the standards were also identified. What the service does well: What has improved since the last inspection?
The home has made contractual arrangements for the disposal of medicines. Staff have received a training update in fire safety procedures. Two staff are booked on a palliative care course. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 6 What they could do better:
Care plans should be drawn up with the resident and/or their representative and must show clearly how the residents’ health care needs are being met, particularly in relation to nutrition and pressure ulcer management. The management and treatment of pressure ulcers must follow up-to-date, evidence-based practice. Policy guidance and staff training must reflect this best practice. Care plans must record how the pressure ulcer is treated, the outcome of the treatment and provide evidence of regular review and reassessment. Dressings, creams, gels and ointments used to treat wounds must be prescribed for the named resident and recorded on the medication administration chart. The care plans must clearly show what action has been taken by staff to make sure that nutritional needs are met and to prevent serious consequences to the resident’s health. Information regarding the personal care needs of the residents should not be displayed publicly as this compromises the resident’s privacy and dignity. Residents should have easy access to a telephone which they can use in private and this should be separate from the home’s business line. Sufficient staff must be provided to offer residents a choice of daily activities both in-house and in the local community. Residents should be consulted about their social interests and programmes devised to meet their needs. A number or residents described having to wait to be taken to the toilet. Routines should be reviewed to look at a more individualised approach so that individual needs can be met. The maintenance works identified in the report must be completed and the home should have a system in place so that maintenance works are identified and dealt with promptly. Residents should be given the option of having a carpet in their bedroom. Staffing levels must be increased to make sure that all the residents’ needs can be met fully. New permanent staff must be recruited to strengthen the staff team. The home must implement a system to monitor and review the quality of care provided in the home. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 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. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 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 DS0000019885.V253423.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this visit. EVIDENCE: Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Care planning is satisfactory although more detailed information is required to show how specific health care needs are met. The assessment and treatment of pressure ulcers is poor and must be improved to make sure that residents receive clinical care based on best practice. Medication administration records need to improve and must show why medication has not been administered as prescribed. EVIDENCE: Case tracking was done for two residents which involved looking at their care records and medication charts. The care plans provided some good information about how care needs were met and showed evidence of regular review. However there were some areas where improvements could be made in relation to health care needs. The records showed that one resident had lost weight and was not eating much. The nutritional risk assessment identified a very high risk and advised referral to a dietician. The care plan said “not doing too well food intake needs observing”. Yet there were no records to show that this resident’s food intake was being monitored. The manager confirmed that no referral had been made
Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 11 to a dietician. The care records should clearly show what action has been taken by staff to make sure this resident’s nutritional needs are met and to prevent serious consequences to her health. Nursing assessments are recorded for the risk of developing pressure ulcers. The records showed that both residents were very high risk and had pressure damage. Both had pressure-relieving mattresses on their beds. For one resident, although a pressure ulcer had been identified on 29 August 2005, there was no treatment plan, and only one entry made subsequently in the daily records, which showed that the pressure ulcer is still present. The other resident had pressure ulcers to both heels. The care plan gave details of the dressings to be used yet the daily records showed that different dressings had been applied. The medication charts showed that neither of the dressings used were prescribed for the resident. The manager was advised to seek specialist advice from a tissue viability nurse with regard to the treatment of these pressure ulcers and to provide training for staff. Medication ordering and administration systems were looked at. Detailed records show the medication ordered and received for each resident. Administration charts are generally well completed, yet the residents who were case tracked had not received some of their prescribed medication for several days and there was no explanation given for these omissions. The homely remedies policy also needs reviewing and updating with the residents’ GPs as it was written in 2001. The manager said that the disposal of medicines is now contracted out as part of the clinical waste collection. Residents said that they were well looked after and described the staff as “lovely” and “very good”. One resident who is nursed in bed said that staff were quick to respond if she needed help. There are some issues around privacy and dignity for the residents. A number of lists were displayed in the home, which gave details about the type of incontinence pad residents wore. Residents do not have easy access to a telephone that they can use in private. The only phone available is the office phone which limits the times that residents can make and receive calls. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 and 14. The range and frequency of activities provided is poor and there is little opportunity for residents to go out. This restricts the residents’ quality of life. Residents have some choices but little control over some areas of their lives. EVIDENCE: The home does not employ an activity co-ordinator and activities are limited to what can be provided by the care staff. Staffing levels are low and there is little opportunity for residents to go out either independently or on organised trips. One resident said how much she’d like to go shopping. Several residents are able to entertain themselves watching television, reading, doing crosswords or chatting with one another. For those residents that are less able there is not much going on to stimulate or engage them. Several of the residents when asked how they spent their day said “just sitting here – nothing else to do”. Staff were said to be kind and friendly but some residents said that staff didn’t have the time to sit and talk with them. Activity records for the two residents who were case tracked showed one had done “armchair exercises” in June and the other had watched a video in August. Apart from these entries the records were blank. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 13 Several residents said that they were given choices such as what time they got up and went to bed, what they had for their meals and what clothes they wanted to wear. A number of residents described having to wait to be taken to the toilet and said that there often weren’t enough staff to take them when they wanted to go. The manager described regular toileting rounds, but residents would benefit from a more individualised approach where staff accommodate the residents’ needs rather than the residents having to conform to staff routines. This is another indicator to suggest that staffing levels are too low. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16. Complaints are listened to and acted upon. EVIDENCE: The home has a complaints procedure, which is displayed in the entrance hall. All complaints are recorded. The manager advised that no complaints have been received since the last inspection. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. General maintenance needs to improve so that any works are identified and dealt with promptly. The home is clean and free from malodours. EVIDENCE: All areas of the home were inspected and a number of maintenance works were identified as detailed below. No lockable facilities in rooms 4 and 15. The door locks were broken in toilet 19 and rooms 3 and 13. There was no door lock provided on toilet 18. The lift sensor has been broken for several months and presents a potential hazard to the residents. The doors into bedrooms 11 and 12 slam shut and need adjusting. The radiator in the corridor at the top of the stairs has been leaking for some time and needs replacing. The carpet by the external fire door near this radiator is threadbare and needs attention. The window in the bathroom on the first floor is broken and needs replacing.
Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 16 The majority of bedrooms do not have bedside lights that are accessible to the residents. The carpet in the lounge is taped in places and the manager advised that a new carpet has been ordered. A wash hand basin, dispensed soap and paper towels are still required in the sluice room. There are ongoing problems with the heating and hot water. The manager described the heating as “temperamental” but confirmed that it is serviced regularly. It was noted that many of the bedrooms felt cold and the radiators were turned off or lukewarm. One resident nursed in bed said she felt cold and the radiator in her room was turned off. In contrast the communal areas were warm and comfortable. The manager said that there is no hot water in the single room near the conservatory. Some of the bedrooms have linoleum flooring and one resident said that this felt cold when she got up during the night. Residents should be given the option of having a carpet in their room. The home was clean with no malodours. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27. Staffing levels are low and must be increased so that staff can meet the residents’ social and recreational needs as well as their physical needs. EVIDENCE: Duty rotas are maintained. The staffing levels have not improved since the last inspection. On the day of the inspection there were 19 residents in the home. Staffing levels are at the minimum level for the current occupancy and dependency levels. The manager is included in these minimum levels and works most shifts as a nurse on the floor. The home continually operates with vacancies for staff and has difficulty in recruiting new permanent staff. There are current vacancies for care staff and a full-time nurse. The current staffing levels do not allow for holidays or any sickness. Some of the residents said that they thought there weren’t enough staff. This has been raised as a requirement at previous inspections and has not been addressed. The manager advised that all staff have received updates in moving and handling training and fire safety training. Two staff are booked on a palliative care training course. Some staff are also hoping to enrol on a dementia awareness course at Keighley College. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 33 and 35. Quality assurance systems are poor and incomplete. Residents’ financial interests are safeguarded. EVIDENCE: The home distributed questionnaires to residents in March 2005 to gain their views of the home. Six responses were received back and these identified that the home needed more staff, more activities and one resident requested a single room and more baths each week. There was no information to show how these areas had been addressed or how feedback is given to the residents. The manager said that the home does not look after any money for residents. One resident’s personal allowance is kept at the provider’s other home in Ilkley and the manager said that this is sent over to him each week. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 19 Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 20 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 X X X Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 17 Requirement Residents with pressure ulcers or wounds must have records which clearly show the grading of the wound, a treatment/dressing plan, reassessment of the wound at each dressing change and identify whether the wound is healing. Care plans must show what action staff has been taken by staff to make sure that the resident’s nutritional needs are met. The registered person must provide up-to-date, evidence based, policy guidance and training for nursing staff on wound and pressure ulcer management. The registered person must ensure that safe practices are in place and adhered to by staff for the storage, handling, recording, administration and disposal of medicines received into the home. The registered person must make arrangements for the residents to be able to access
DS0000019885.V253423.R01.S.doc Timescale for action 30/11/05 2 OP8 12 30/11/05 3 OP8 12 30/11/05 4 OP9 13 30/11/05 5 OP10 16 31/12/05 Parkfield House Version 5.0 Page 22 6 OP10 12 7 OP12 16 8 9 10 11 12 OP19 OP24 OP26 OP27 OP27 23 23 23 18 18 13 OP33 24 suitable telephone facilities and for them to be able to use these facilities in private. The registered person must ensure that the home is conducted in a manner which respects the privacy and dignity of service users. The registered person must provide a suitable range of activities to meet the needs of the residents and provide opportunities for the residents to go out of the home. The registered person must complete the maintenance works identified in the report. Residents must be given the option of having a carpet in their bedroom. A wash hand basin, dispensed soap and paper towels must be provided in the sluice room. The registered person must recruit more staff to strengthen the staff team. The registered person must increase the staffing levels to allow staff to meet the social and recreational needs of the residents. The registered person must put in place a system to review, monitor and improve the quality of care provided in the home. 30/11/05 31/12/05 30/11/05 30/11/05 30/11/05 31/01/06 30/11/05 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP10 Good Practice Recommendations There should be an individualise approach to toileting to
DS0000019885.V253423.R01.S.doc Version 5.0 Page 23 Parkfield House 2 OP20 ensure that the residents’ needs are met. The registered person must continue to maintain and improve the gardens. Parkfield House DS0000019885.V253423.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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