Inspection on 11/05/06 for Parkfields

This inspection was carried out on 11th May 2006.

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

Parkfields 25/10/07

Parkfields 08/01/07

Parkfields 15/12/05

Parkfields 12/05/05

Parkfields 05/10/04

Parkfields 01/06/04

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Parkfields 556 Wolverhampton Road East Parkfields Wolverhampton West Midlands WV4 5AA Lead Inspector Rosalind Dennis Key Unannounced Inspection 11th May 2006 10:00 X10029.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 Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 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 and 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. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Parkfields Address 556 Wolverhampton Road East Parkfields Wolverhampton West Midlands WV4 5AA 01902 621721 01902 339915 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) Dr Mohan Lal Passi Dr Uma Passi Miss Cheryl Fenton Care Home 49 Category(ies) of Physical disability (49), Physical disability over registration, with number 65 years of age (49), Terminally ill (3) of places Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No number division between categories except 3 (only) palliative care. Up to a maximum of 7 beds may be used for intermediate care. Date of last inspection 15th December 2005 Brief Description of the Service: Parkfields Nursing Home is a privately owned care home registered with the Commission for Social Care Inspection to provide nursing care to 49 people with physical disabilities aged over and under 65 years of age. It is also registered to provide palliative care for three people with a terminal illness. The Home is owned by Dr Mohan Lal Passi and Dr Uma Passi. Ms Cheryl Fenton is the registered manager and has day to day management responsibility for the home. Parkfields Nursing Home is two-storey, purpose built accommodation set in attractive grounds with parking at the front and gardens to the side and rear. The Home is situated close to Wolverhampton city centre, on a public transport route and with shops and local services nearby. Care and nursing is provided in modern accommodation offering well-equipped single rooms. 22 bedrooms have en-suites all other bedrooms have a hand-wash basin. The communal areas comprise of 3 lounges and a separate dining area. There is a passenger lift to access the first floor. The fees charged by the home are based on local authority rates and range from £336/week (residential) to £428/week (nursing). Additional fees may be involved for those individuals requiring palliative care. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out by two CSCI inspectors and involved observing activity within the home, speaking with residents and staff, observing documents such as residents care files and staff training records. The visit commenced at 09.30 hours and concluded at 16.30. The purpose of the inspection was to focus on the requirements of previous inspections and to monitor progress against an action plan submitted by the provider in response to those requirements. It is pleasing to note that the home has achieved or in the process of achieving requirements. All residents seen during the inspection appeared well cared for and staff attentive in meeting their needs. The manager was on duty throughout the inspection and the owner was available for discussion and feedback. Residents and staff were very welcoming and helpful throughout. What the service does well: What has improved since the last inspection? The inspection that was undertaken in December 2005 had identified numerous shortfalls, which resulted in 29 Statutory Requirements being made of the home, a visit by the CSCI pharmacist in January 2006 also identified deficits with medication practices. A meeting was held in February 2006 with the owner in which the concerns raised as a result of these inspections were discussed. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 6 It is obvious a lot of hard work and financial investment has been undertaken in the home in the five months since the last inspection. The cosmetic appearance of the home has greatly improved following the replacement of many corridor and bedroom carpets as well as redecoration of these areas. Staff spoken with on three separate occasions during the inspection all commented that the systems for looking after the residents had improved. Documentation within residents care records had also improved, as well as a more robust complaints process and staff have received training in adult protection/abuse awareness. The manager is now supernumerary, which has enabled her to attend to and develop managerial roles. What they could do better: 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. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 6. The quality outcome for this area is adequate. The home has a satisfactory admissions procedure and the assessment processes in use demonstrate that the home is able to meet the needs of people living there. EVIDENCE: It was seen that there had been improvement in the way the home collects necessary information about a person thinking about moving into Parkfields Nursing Home. When the records of four residents admitted for short and long-term care were looked at in depth, all their relevant care details had been written on an assessment form. However three of the assessment forms had not been dated, therefore it could not be established exactly when this Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 9 information had been obtained, suggested improvements to this form were discussed with the owner and manager. Staff spoken with on three separate occasions during the inspection all commented that the systems for looking after the residents had improved, and described new systems in place to make sure people are being ‘properly looked after’. One carer commented that if the home gets enough notice of an admission, the manager tries to get another staff member on duty to help settle the new resident in. A resident who had moved into the home a week before the inspection volunteered a comment:- ‘They’re all doing their job – they are looking after us well.’ The home is in the process of reviewing the service user guide and following observation of the draft copy amendments were suggested to the owner, which would assist in ensuring that individuals moving into the home were fully aware of the home’s complaints procedure. The manager was in the process of issuing contracts to two of the residents that were case tracked as part of the inspection. Although the contracts were not scrutinised in depth, they appear to contain sufficient information that would ensure that the resident and/or their representative are aware of the terms and conditions of occupancy during their stay at Parkfields. The home continues to provide a step-down facility from hospital and not the intensive rehabilitation associated with intermediate care, for this reason the home does not meet the elements of the standard regarding intermediate care; this led to a discussion with the owner regarding the home’s current registration categories. The inspection in December identified that individuals, admitted into “step-down” beds were often in the end stages of life and CSCI were concerned that this may impact on the home. The manager reports that since that inspection discussions have taken place with those involved in planning discharge from hospital settings to care homes and that the situation has now improved; observations made during this inspection confirms this improvement. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. The quality outcome for this area is adequate. Staff appear sensitive in meeting the needs of residents, however care plans and risk assessments require further amendment to ensure that staff are provided with all the information needed to meet residents needs. The process employed for the administration of medication has improved and ensures that residents receive their prescribed medication. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 11 EVIDENCE: During the inspection all residents spoken with agreed that they liked living at Parkfields, commenting that they feel well cared for and the staff respect their privacy. Individuals that were unable to communicate their views with the inspector were observed to appear content, settled and comfortable. The home relies on a variety of specialist equipment to look after people with different and complex needs. This was seen to be working properly and satisfactorily looked after. Four care plans looked at in depth, contained much more detail than had been identified at the last inspection in December. The information written down showed the home was well on the way to meeting this standard. Parkfields Nursing Home continues to use professionally presented forms to manage many needs. There are good examples of care plan records for some of the medical conditions experienced by people living at the home. Other plans seen needed additional information included to ensure that staff were aware of residents needs, for example:-. • Two of the four files looked at needed more specific moving and handling information. Records stated that a hoist needed to be used, but they did not state which one, and the home has three different types. • A resident who could not communicate verbally with the inspector, directed the inspector to look at his hand and it was ascertained that this individual had a medical condition affecting his fingernails. Although he had been referred to have them cut by the chiropodist, there was no care plan management to show how this condition was being looked into, being treated or professionally cared for. Another lady with a pressure sore on her bottom was seen to be cared for in a specialist easy chair. Although her records gave staff full guidance of how to care for her whilst in bed, there was no information about any type of special pressure relieving cushion needed when she is in a chair. Records also evidenced that the padding to protect the bed rails in place on this individuals bed occasionally become dislodged and, whilst there was good recordkeeping about this, permanent solutions need to be explored so that this equipment is in a safe condition at all times. • In balance of the above comments, the records of an individual who had recently passed away were looked at and showed this sensitive time of a person’s life had been managed well. Thank you letters and cards from recently bereaved relatives received since the last inspection confirm they also appreciated the care team efforts for this matter. Last month, one relative had written:- ‘We would like to thank you for the flowers and personal Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 12 presence at the funeral. It was wonderful what you did for Mum – God bless you all.’ The only issue needing further information is for records to show how personal effects are safely dealt with at such a time. All residents at the time of the inspection were observed to be well groomed and in nicely laundered clothing. Improvements to the laundry systems means the service is more individualised. During the inspection residents were observed attending the hairdresser and many commented how pleased they are with this service. The inspection in December 2005 and a subsequent inspection by the CSCI pharmacist inspector in January 2006 had identified deficits with medication practices at the home. Observations made during this inspection indicate that improvements have occurred. The home has changed its system of medication administration and medication sheets that were checked had been completed accurately. Medication was observed to be stored appropriately and at the correct temperature. The home has obtained written permission from residents GP’s for the administration of “homely remedies”, however the authorisation letter needs further amendment as it does not specify the type of medication that can be given. The manager was advised to seek confirmation from the CSCI pharmacist inspector that the revised medication policy is satisfactory. The manager has obtained a copy of the West Midlands Palliative Care Guidelines, which is a useful reference tool for staff as it provides guidance regarding appropriate symptom control for individuals requiring palliative care. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality outcome for this area is good. Daily routines are flexible with residents being offered a choice of varied activities. The home provides meals that offer variety and cater for different cultural and nutritional needs. EVIDENCE: It was pleasing to see residents taking advantage of the sunny weather under the shade of two gazebos erected in the garden. Residents were happy to share comments about the activities provided by the home. Two people in particular commented on how much they appreciated the support of the Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 14 activity organiser, and how patient she is with people who need help to join in the craft activities. Observations of day-to-day care being carried out showed people were involved in making choices with pastimes. Many residents who joined in a game of bingo appeared appreciative of the useful prizes such as shower gel that they had won. Other activities that are provided in-house include, exercise to music, visits by a church choir. Observation of minutes from a recent residents meeting show that the home acts on the views of residents and that if individuals do not like a particular activity then it will be reviewed and an alternative offered. Residents are supported to access events in the wider community if they so wish, such as attending church, or a local day centre. Meals were observed served in a lounge to residents who had opted not to go to the dining room. One lady was seen being fed her meal from a plate with her name written in felt pen on its rim. A more suitable way of identifying how staff know which meals are for specific residents was discussed with the manager during the inspection. Discussions with the catering team confirmed that apart from the regular menu, they currently prepare meals for several people on sugar free diets, and seven people with swallowing or chewing challenges. Menu plans seen evidence that the home provides varied diets that also meet the cultural needs of residents. It was observed that the home provides ‘mini fruit baskets’ for resident’s bedrooms, so people can help themselves to a healthy snack in between meals – a person spoken with was very pleased about this service. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality outcome for this area is adequate. The home has improved its complaints procedure to ensure that residents and/or their significant others are listened to and their concerns acted upon robustly. The arrangements for the protection of residents from abuse is satisfactory. EVIDENCE: All staff, residents and visitors spoken with during the inspection knew whom they could talk to if they needed to make a complaint. Copies of the home’s complaints procedure were observed on notice boards throughout the home. The manager stated that there have not been any recent complaints, the home has introduced a new system for recording complaints, which when needed will provide a more robust procedure. It was discussed with the manager and provider that it is good practice to also document any “minor concerns”. CSCI has not received any complaints since the last inspection. A folder seen pinned on the notice board in the entrance to the home clearly invites people to write any comments, complaints or suggestions in it. This is a fairly new idea, and had not been used by anyone as yet. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 16 Observation of training records and discussion with staff evidence that training in adult protection/abuse awareness has been provided in-house, the manager confirmed that it is also intended that staff attend training provided by the local authority. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 25 and 26. The quality outcome for this area is adequate. The standard of the environment is good providing residents with a comfortable place to live, however further consideration is needed to ensure that residents have access to sufficient and suitable bathing facilities. EVIDENCE: Upon arrival to the home, the inspectors were greeted by the maintenance person who was putting bedding plants in the flowerbeds and tubs, thus Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 18 enhancing the appearance of the home. It is obvious a lot of hard work and financial investment has been undertaken to improve the living accommodation in the home in the five months since the last inspection. The cosmetic appearance of the inside of the home has greatly improved following the replacement of many communal and bedroom carpets as well as redecoration of these areas. Discussion with the owner confirmed that other improvements to the communal lounges were also in hand. All residents spoken with said they were happy with their rooms, although one lady did comment that she would like to have an en suite when one became available so that she could keep her independence for getting herself to a toilet. Even though the tour of the home was carried out at the busiest time of the day – the middle of the morning, all parts of the home were seen to be clean and tidy, and the systems in place meant all attention to detail for checking and cleaning residents personal equipment had been carried out by early afternoon. The home looks after five people who need a special tube in their stomach to feed them. These individuals were all seen to have new supplies of oral care equipment to keep their mouth moist and fresh. Discussion with staff during the tour of the home confirmed they manage to weigh all residents on the sit on scales provided, or by the use of a hoist and observation of records showed these were now recorded monthly. Out of the six communal bathrooms in the home it was reported that four of the bathrooms in the home were only suitable to be used by people who were fully mobile as there was not the equipment in place to safely transfer residents in and out of these types of baths. It was established that all of the people currently living in the home need help, and therefore only two bathrooms could be used by people requiring assistance. This issue was discussed with the manager and owner at the end of the inspection, to ensure solutions to improve this matter can be sought without delay. On arrival at the home the shower was not working properly, however this was promptly repaired by the maintenance person. Whilst being showed round the home the head cook was happy to share information that the environmental health officer had visited Parkfields the previous day, reporting that everything was satisfactory and that the team were doing everything ‘above and beyond’ what was expected to meet Food Hygiene laws. Discussions with staff confirmed their awareness of the importance of day-today routines to promote good standards of infection control. It was reported that hand hygiene routines also included staff being supplied with personal tubes of hand rub to disinfect their hands after washing them. All were seen to use the protective equipment of gloves and aprons appropriately as and when necessary, including laundry staff. The home’s management of clinical waste has greatly improved. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome for this area is adequate. Training opportunities within the home are satisfactory which ensures that staff are appropriately skilled and competent to carry out the duties for which they are employed. Staffing levels appear sufficient to meet the needs of the current residents. The home has a recruitment procedure in place that protects residents from the employment of inappropriate staff. EVIDENCE: On the day of the inspection, two qualified nurses and 8 carers were on duty, as well as a student nurse on placement to the home. The home has not used agency staff for some time, preferring instead to utilise existing staff to cover shifts if required. Members of staff spoken with felt that staffing levels are Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 20 sufficient to meet resident’s needs and observations during the inspection showed that staff responded promptly to residents call buzzers and requests. An outstanding requirement that was identified at the last inspection related to the manager not having sufficient supernumerary time. Observation of staffing rotas and discussion with the manager confirmed that supernumerary time is now allocated, this has enabled her to attend to and develop managerial roles rather than “working on the floor” all the time. The deputy manager provides continuity in the absence of the manager. Discussions held with a number of staff on duty evidenced that they had enjoyed recent training, were knowledgeable and had a very good understanding of the individuals whom they support. Staff were observed to be accessible, good communicators and interacted appropriately with the residents during the inspection. A student nurse on duty gave positive feedback regarding the home commenting that the staff group were helpful and supportive and that the home is “a good placement to gain experience”. In addition to mandatory training, records evidence that staff have attended study sessions such as wound care, clinical updates and palliative care, although not all records for mandatory training were observed to have the correct date documented. The majority of care staff have achieved NVQ Level 2 in care and some staff have achieved NVQ Level3. The home has not appointed any new employees recently, however observation of three staff files shows that the home has audited staff files and addressed previous recruitment deficits, for example; individuals that had commenced employment without completing an application form have now completed forms on a retrospective basis. All files checked showed evidence of criminal record bureau disclosures and suitable references. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. The quality outcome for this area is adequate. The home is well maintained and the staff group appropriately skilled to ensure that the health, safety and welfare of residents is promoted. The home monitors and reviews processes to ensure that residents receive a range of quality services. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 22 EVIDENCE: The manager is a registered nurse with a range of supporting qualifications, skills and experience and is currently studying for the Registered Managers Award. Observation of training certificates confirms that the manager attends regular clinical and professional updates. All staff spoken with during the inspection, including some who have worked at the home for several years, commented that improvements had occurred in the way the home is managed on a day-to-day basis. This was also apparent during discussions with the manager and through observations that were made during the inspection. Staff have access to clinical supervision and appraisals are undertaken. Care team members, shared a wealth of information with one inspector to demonstrate how the home is planning to improve; recognising that attention to what could be seen as minor details could have a big impact on some residents’ lives. A full range of servicing, maintenance and regular monitoring of services is undertaken by the maintenance person and observation of these documents showed all to be up to date. Random testing of the hot water confirmed that water temperatures are maintained at the required temperature. Systems are in place to monitor the safety of bed rails and hoists were seen to have appropriate service labels in place. One hoist was seen to be out of order although staff said they were coping fairly well with this inconvenience. The home has obtained a new accident book that meets current legislative requirements and the manager has initiated a process for recording additional information, such as the action taken by staff following the accident/incident. Details of accidents were found clearly documented in residents care plans and CSCI is notified as required. Observation of records demonstrates that resident’s financial interests are safeguarded. Quality monitoring systems are now in place, feedback has been obtained from residents and/or their representative and the results collated. Staff questionnaires that have been sent out enable staff to reflect on their practice. The manager has commenced auditing infection control, medication and the home overall, although it was discussed that the process used appeared quite complicated and that an easier system may prove less time consuming. Since the last inspection the owner now conducts a formal quality monitoring process on a monthly basis and the outcome of this visit is sent to CSCI. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 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 3 2 3 3 3 4 3 5 X 6 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 3 21 X 22 2 23 X 24 X 25 3 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 X 35 3 36 3 37 3 38 3 Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 24 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 OP6 Regulation 16(1) Requirement The registered person must review the current registration categories to ensure that they are true reflection of the service provided. Care plan records must specifically identify any type of equipment used to care for that person, with accompanying information to ensure it works effectively. (Compliance not fully met within timescale of 20/3/06) Timescale for action 01/07/06 2. OP7 15 01/07/06 3. OP8 15 Care plan records must be detailed to reflect the changing needs and preferences as well as the actual care delivered for all individuals living at Parkfields. (Compliance not fully met within timescale of 20/3/06) 01/07/06 4 OP9 13(2) The homely remedies medication policy must be amended to include authorisation from individual resident’s GP and dated (Compliance not fully metauthorisation has been obtained from GP but specific homely medicines not listed). 01/07/06 Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 25 5 OP10 12(4)(a) All signage in areas accessible to residents and visitors which challenge privacy, dignity and confidentiality issues must be removed (Compliance almost met –dignity compromised during meal presentation to one individual) 01/07/06 6 OP21 23(2)(j) 7 OP8 13(4)(c) The registered person must ensure that the home has suitable and sufficient “assisted” bathing facilities to meet the assessed needs of residents. If a resident is able to remove protective bed rail padding then the home must consider suitable alternatives in order to reduce the risk of entrapment. 01/10/06 15/06/06 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 2 3 4 Refer to Standard OP3 OP9 OP16 OP30 Good Practice Recommendations It is recommended that the initial assessment form is reviewed so that staff are prompted to record the actual date that the assessment was undertaken. The “Sharps” box should be signed and dated on commencement and completion. It is strongly recommended that the home document any “minor concerns” that are raised. To assist the manager in reviewing staff training, it is recommended that a training matrix be devised. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE National Enquiry Line: 0845 015 0120 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. Parkfields DS0000017196.V293719.R01.S.doc Version 5.1 Page 27 - 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. 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