Inspection on 15/12/05 for Parkfields

This inspection was carried out on 15th December 2005.

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 11/05/06

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 Unannounced Inspection 15th December 2005 13.30p 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.V272968.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 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.V272968.R01.S.doc Version 5.0 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.V272968.R01.S.doc Version 5.0 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 12th May 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 intermediate care for seven people and 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 twostorey, 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. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out by two CSCI (Commission for Social Care Inspection.) inspectors. It commenced at 13.30 and totalled eight hours of inspection time. The inspection was carried out as a result of two complaints received by CSCI about the home, these complaints had initially been referred specifically for the service provider to investigate, however the processes involved in this investigation were not satisfactory, leading to CSCI completing an investigation of its own. The inspection included observing activity within the home, inspecting the premises, an ‘in depth look’ at records, for residents and staff, observing talking and listening to over half of the 49 people living there, as well as staff on duty at the time of the inspection. There were no visitors available to speak with on this occasion. These discussions were carried out in private on a one to one basis, or together in groups. Everyone was happy to share comments, which were explored and reflected in the main body of the report. The Registered Manager, Cheryl Fenton was present at the time of the inspection. Residents and staff were very welcoming and helpful throughout. What the service does well: What has improved since the last inspection? Although no major improvements were evident at Parkfields, it was noted that the home had introduced a form to check bedrails on a daily basis. When staff and residents were asked what they thought had improved, the general opinion of those spoken with was that “it was about the same”. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 6 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.V272968.R01.S.doc Version 5.0 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.V272968.R01.S.doc Version 5.0 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): 3, 4 and 6 Parkfields assessment processes need to be further improved to show there is sufficient information to clearly demonstrate that the home is able to meet the long and short term needs of people moving there. EVIDENCE: When the records of three residents were looked at in depth, including those of a person who had moved in for short term care, none of the assessment forms were seen to have all of the information written in as expected. There were a lot of gaps and some sections of the assessment forms were blank. Two of the assessment forms had not been dated or signed, therefore it could not be confirmed whether the person who carried out these assessments had the Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 9 knowledge and skills necessary to make a professional decision whether the home could meet the individual needs of the potential resident. Although the views of all the people spoken to confirmed they were happy to be living at Parkfields, and felt safe and well cared for, the home did not have adequate record keeping to prove this, or to demonstrate residents and family regular involvement in all aspects of care delivery. Earlier this year the home formally increased the beds available for intermediate care from 5 to 7, however during this inspection it became evident that the home is not actually providing the intensive rehabilitation associated with intermediate care but a “step down” facility from hospital. Step down/interim care is generally for individuals transferred from hospital that are waiting for a care package to be arranged before returning to their own home or sheltered accommodation. Observation of documentation within the home and forwarded to CSCI (Regulation 37 notifications) indicates that individuals admitted to Parkfields Nursing Home into a “step down” bed are often in the end stages of life. This potentially may impact on the atmosphere within the home, long stay residents, staffing levels and staff morale. Although the manager reports that staffing levels have increased to take account of the “step down” beds, observations of care documentation as described above suggests that the home is not geared to deliver this service. CSCI is to undertake discussions with the provider to review this condition of registration. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 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, &11 The process employed for the administration of medication has not improved and continues to place residents at risk of not receiving prescribed medication. Although staff appear sensitive to meeting the needs of residents in a respectful manner, this is not shown in care planning and medication management paperwork, which means there is no confirmation residents get the care they need and expect. EVIDENCE: Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 11 Comments received from the residents living at the home all agreed that they liked living at Parkfields, felt well cared for and the staff respected their privacy. However, this information is not shown in the residents records. When four care plans were looked at in depth, including those of a terminally ill resident, a resident with a specific infection and someone who was classed as a ‘step down bed admission’, it was seen that records had not been personalised with enough information about the people or their medical conditions to describe how those people needed to be looked after. In addition, there was no evidence to show the home had involved residents and family members in care planning. All records lacked information to promote the safety of residents, their visitors and carers. For example: • A resident with a specific infection did not have a care plan to manage this condition. Furthermore, it was seen that the person’s bedroom had not been appropriately set up and equipped to manage it. • Risk assessments for moving and handling of the residents did not have enough detail to describe how this could be carried out properly. There was not enough detail about what type of equipment to use. Although some records state that a hoist needed to be used-it did not state which one. The home has three different types of hoist. • The home has introduced a new form to check bedrails installed on residents beds on a daily basis, however, the specific risk assessment forms in residents records about this matter had not been reviewed to include details about this. Furthermore, upon the tour of the home, when the inspector was introduced to the people whose records were checked, it was seen that two of the residents had bedrails installed on their beds, but there was no care plan about this in their records. There were some good examples of care plan records for some of the medical conditions experienced by people living at the home. Parkfields have developed professionally presented forms to manage many conditions. Unfortunately not all care plans contained the appropriate details necessary to make sure the residents receive the care they need. For instance: • • • There was no care plan guidance how to care for the persons skin attached to a ‘PEG ‘ feeding tube. A resident assessed as high risk of getting a pressure sore did not have a plan of care to prevent this from happening. Other sets of care records stated ‘nurse on air loss bed’ - but there was no guidance to staff to confirm what type of air loss bed and what settings it needed to be on. When this was explored further whilst looking round the home, it was seen that the home has a variety of specialist mattresses and beds, all with different control settings. One mattress was not working satisfactorily – the alarm light was on. This was brought to the attention of the staff member accompanying the inspector around the home. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 12 • Another set of records of a person admitted in October this year had not been reviewed since the admission date. The person was admitted to the home on a ‘step down’ basis following discharge from hospital. This has resulted in care plans not showing any progress the person had made towards being able to move out of the home, or show any changes in needs the staff had to meet. Two other care files were looked at as part of the complaint investigation including the records for an individual that had received respite care and for an individual who had recently passed away, both records showed similar recordkeeping shortfalls as described above. The unannounced inspection in May 2005 highlighted that the process of medication administration was not acceptable. Observations made at this inspection confirmed that the home has not met requirements and continues to place residents at risk by not having a robust system for medication practices and procedures. Examination of medication administration record (MAR) charts identified a number of gaps where a signature to confirm administration or an abbreviation for non-administration should have been. The manager was able to confirm that some of these drugs had been given during a drugs round that she had conducted. On other occasions it could not be confirmed whether drugs had actually been given, for example a tablet drug used to stabilise blood sugars and night sedation. Four MAR sheets examined had abbreviations entered, but it was observed that they had not been defined. It was concerning to note that a resident that had oral morphine written on their MAR chart for administration on a regular basis had a non-defined abbreviation entered for each drug round. The manager informed the inspector that the morphine solution was only to be given on an “as required basis”, however there was no instruction to indicate this on the MAR chart and no evidence to indicate that the home had sought clarification from either the residents GP or pharmacist. A recent complaint received by CSCI and investigated during this inspection identified poor recording within the homes records including MAR sheets, for a resident that was using continuous oxygen. There was no information to inform staff regarding the amount and frequency of oxygen required by the individual and the complaint was upheld. Another complaint investigated during this inspection related to an individual that was unable to swallow medication due to their deteriorating condition and it is concluded that the home should have had made provision for an alternative “fast acting pain killer” to be available when it was established that this resident was unable to swallow tablets. The CSCI pharmacist inspector is to visit the home to conduct a more in depth inspection of medication practices and procedures. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 13 All residents seen at the time of the inspection were well groomed in nicely laundered clothing. However, discussions with two staff members and observation of the storage of residents possessions in the laundry and first floor linen cupboard confirmed the home has a system where people share underwear such as continence pants. This is not acceptable. Furthermore, in various parts of the home unprofessional signage attached to residents bedroom doors was seen to challenge residents dignity and confidentiality. Although several people living at the home cannot verbally express their wishes and needs, the home must develop discreet, sensitive ways of ensuring resident care delivery. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 14 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): 14 and 15. The daily lifestyle at Parkfields offers choice in some aspects of the support people need, including a varied, well balanced diet, however the home needs to show that they respect other decisions and choices made by residents. EVIDENCE: When the main kitchen was visited it was seen that a variety of meals were in the process of being prepared to suit the needs and preferences of the residents. The home currently caters for people on sugar free diets, and those with swallowing or chewing challenges. Residents were observed to be served high tea, and discussions with a group of five of them at this time confirmed they always had a choice of what to eat. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 15 Three of these people described the different choices they had made for the meal being served. They all agreed the food was “usually very nice”. Staff were observed to be courteous and attentive to residents needs, providing knowledgeable assistance and support to those who required it on a on a one to one basis. Plenty of napkins and disposable protective covering for clothing was seen provided. One of the complaints received by CSCI stated that the food within the home was of a poor standard; this was not found not to be the case during this inspection. However the documents used to record actual dietary and fluid intake were not consistently well maintained. An incident that was brought to the attention of CSCI detailed a resident that did not want to go to the dining room to eat meals, although the home has informed CSCI that this was to encourage the resident to eat there was no evidence within the care file to support this. The resident’s choice should have been respected and the complaint was upheld. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 16 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, & 18 The complaints process within the home is not satisfactory and requires prompt action to ensure that residents and/or their significant others are listened to and their concerns acted upon robustly. Systems for protecting service users require improvement to protect the people living there from possible risk of harm or abuse. EVIDENCE: The May 2005 inspection report identified that the home’s complaints procedure was not directly accessible to residents and/or their significant others. One of the complaints received by CSCI identified that when the complainant asked for a copy of the complaints procedure staff were not aware of the procedure, thus indicating that the requirements from the previous inspection had not been met. The current process used by the home to log complaints is to record all concerns in a “complaints book”. Scrutiny of the complaints book showed numerous occasions when relatives/residents had raised concerns that had then not been investigated fully by the home or records kept of any investigative processes used, including an incident where a resident had complained that staff “twisted his arm”. This incident was not raised by the home via the local adult protection procedure. The manager confirmed that Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 17 this incident was investigated but that no written records were made; therefore it is not possible to establish the outcome of this serious complaint. A total of twelve complaints had been recorded in the complaints book since May 2005, none of these detailed the action taken to resolve the complaints or a record of the investigative processes used. The complainant had described an incident involving their relative and the inspector asked to view the incident report during the inspection, however the manager was unable to locate a copy of the report which indicates poor record keeping. The two complaints recently received by CSCI had been referred specifically for the service provider to investigate, it was disappointing therefore, that on receipt of the investigation report it was noted that it was actually the registered manager that had completed the report. The processes involved in this investigation were not satisfactory, leading to CSCI completing an investigation of its own. When the complaints were discussed with the manager in addition to concerns identified during the inspection the manager appeared quite defensive and reluctant to acknowledge some of the areas requiring improvement. CSCI are to meet with the service provider to discuss all concerns raised. At the inspection in October 2004 a statutory requirement was made stating: “ By the end of March 2005, the registered person must ensure that all staff receive additional training in adult protection procedures and recognising and dealing with adult abuse”. Following the unannounced inspection in May 2005, this timescale was extended to the beginning of September. Records of three staff members were looked at, and there was no evidence to show that the above training for these personnel had been carried out. This is not acceptable.CSCI will be considering further action to be taken if the home cannot offer assurance this shortfall is rectified at the earliest opportunity. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 18 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): 19,20,21,22,24,25, &26 The standard of the environment in this home is satisfactory, although some additional equipment and improved infection control systems are required to make Parkfields a safe and homely place to live. EVIDENCE: The home has three lounges and a dining room, which therefore provides residents with a choice of communal spaces. All bedrooms are single rooms that either have en-suite facilities or are fitted with a wash hand basin. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 19 The complaint received by CSCI detailed that the home was not clean, however the inspectors observed the home to be clean and without unpleasant odour, although some parts of the building are starting to show signs of wear and tear. CSCI recognise some new carpets have been fitted in the corridor, however, many others were seen to be stained and worn – especially in some of the residents bedrooms. Systems seen to control the spread of infection were also lacking, as appropriate equipment such as gloves and aprons were not freely accessible in high-risk areas such as the sluices. A safety belt attached to the bath seat in a communal bathroom was visibly soiled. This was discussed with a staff member accompanying an inspector. In addition to this, barrier-nursing protocols were compromised. In the bedroom of a person with an infection clean gloves and aprons were piled on top of a wheelchair with a moving and handling sling, and the clinical waste bin did not have means of opening it without touching it. Steroid skin cream was also seen kept in the resident’s tooth mug with her toothbrush and denture cleanser. Furthermore, on the tour of the home a stock of used toiletries and skin cleansing foam was seen kept for communal use in the downstairs sluice. Externally, a clinical waste bin was seen to be unlocked, and in need of cleaning as several loose items of waste were seen lying in the bottom of it. Maintenance records as well as testing of the hot water confirmed that water temperatures are maintained at the required temperature. When weight records were looked it, several residents who were bedridden had not been weighed. Discussion of this issue with the manager confirmed that the home did not have appropriate equipment to carry this out. As the home registered to care for frail and terminally ill people the home must ensure it has the equipment to do this. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 20 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 & 30 The procedures for the recruitment and training of staff need to be improved to offer protection to people living in the home, and show that residents are actually supported by the committed staff group that meet the needs of each individual in a sensitive and professional manner. EVIDENCE: Although the manager confirmed that the home had managed to achieve appropriate staffing levels at all times without using agency staff, this has been as a result of her covering the shifts herself. This has impacted on the time she has to oversee and manage the team as well as carry out the majority of the home administration. A requirement made at an inspection in October 2004 stating ‘By the end of December 2004, the registered manager must be supernumery and must not be included in the staffing numbers’ has not been complied with. It was confirmed that an administrator is employed at the home, although this is a part time position covered at a weekend. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 21 A sample of three staff files looked at identified similar deficits in the home’s recruitment practice as seen at the Inspection in May of 2005. Three files did not contain application forms, two files did not contain written references, recent photographs were not present on all files and there was no evidence of a health declaration being completed by all three employees. Only one CRB disclosures was present in the files examined. The manager reported that prospective staff sometimes come to the home after being introduced by the local Job Centre and do not always complete an application form. This therefore results in the home not obtaining a full employment history prior to the individual commencing employment. This is not acceptable practice. Shortfalls in the training records for staff also resulted in not being able to establish whether all individuals had the appropriate training expected for them to carry out their role. For instance, when the certificates manual handling training were looked at, they did not ascertain whether the team had received training to use the hoists in the home. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 22 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, 33,37 & 38 The registered provider has employed a registered manager for the staff team to be effectively managed, however systems for the health, safety and welfare for residents, staff and visitors need to be improved and adjusted to make sure that they are kept up to date, to meet changing needs as well as necessary legislation. EVIDENCE: Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 23 Staff responded positively to this inspection indicating that a satisfactory management approach is in place and that staff are committed to resident centred care. Residents made positive comments about the staff team and the management of the home when this issue was discussed, however, evidence to show this needs to be actioned. Residents who had lived at the home for some years commented that the home does not hold residents meetings and that they had not filled in satisfaction surveys. As recorded earlier, from records seen, it was not clear that all staff have received mandatory health and safety training. This was seen reflected in working practices, around the home. • Chemicals seen in plastic containers had handwritten labels that did not comply with COSHH regulations in a residents bedroom as well as a sluice. • When the accident book was looked at, further improvements were seen to be needed as the forms are kept in a loose leaf format and do not comply with data protection guidelines. The accident forms could not be audited properly as they were not in sequential or timely order. This issue was identified at the last inspection. • When the details written in the accident records were looked at it was seen that there had been no written follow up of some accidents to ensure they did not happen again. When records were checked for an accident involving two staff members, a resident and hoisting equipment, it was seen that there was no record of follow up or retraining of the staff involved in the incident. • One of the complainants had stated that the manager seemed unaware of a fall involving their relative. In an investigation conducted by the manager and later CSCI, the manager reported that she was unaware of the fall because the staff had not reported it, either verbally or in writing. This lack of reporting and recording information is clearly not acceptable. Although some records of staff supervision were seen in the staff files looked at this information had not been dated or signed by the people concerned. All of the above information highlights the need for the home to improve its ‘safe systems of work’ to ensure it fully meets all of the legislation it is expected to. It also reflects the outcome of discussions held at the inspection that confirm the manager has not had the opportunity of sufficient supernumerary quality time to enable her to carry out these aspects of her role. This must be prioritised. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 24 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 x 2 x 3 2 4 2 5 x 6 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 2 ENVIRONMENT Standard No Score 19 2 20 3 21 2 22 2 23 x 24 2 25 3 26 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 2 34 x 35 x 36 x 37 2 38 2 Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 25 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 OP3OP4 Regulation 14 (1) Requirement All service users admitted to Parkfields must have a full detailed assessment which accounts for the persons needs and preferences before they move into the home. All care plans must contain risk assessments specific to each person’s needs , including bedrail safety, moving and handling and control of infection issues. Service user care plans must show evidence of residents or relative involvement according to the person’s wishes. Care plan records must specifically identify any type of equipment used to care for that person, with accompanying information to ensure it works effectively. 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. When admitting residents on a short term basis, the home must DS0000017196.V272968.R01.S.doc Timescale for action 20/02/06 2 OP7 15, Sch.3 (1)(b) 15, Sch.3 (1)(b) 15 20/02/06 3 OP7 20/03/06 5 OP7 20/03/06 4 OP8OP11 15 20/03/06 5. OP8 12 (1)(a,b) 20/02/06 Parkfields Version 5.0 Page 26 6. OP9 13(2) inspection-requirement from May 2005 report). develop a system to ensure written information is in place and cascaded to staff to raise awareness to ensure effective care delivery. The homely remedies medication policy must be amended to include authorisation from individual resident’s GP and dated (not assessed at this All signage in areas accessible to residents and visitors which challenge privacy dignity and confidentiality issues must be removed The complaints procedure must be reviewed and updated and must be in a format suitable for the service user group. (Previous timescale of 30/11/04 not met.) 20/03/06 7 OP10 12 (4)(a) 20/02/06 8 OP16 22 20/03/06 9 OP18 12(1), 18(1) of 31/03/05 not met). The registered person must ensure that all staff receive additional training in adult protection procedures and recognising and dealing with adult abuse. (Previous timescale All parts of the home including carpets must be kept clean and in good repair. All equipment for bathing residents including safety belts must be kept in a clean condition. Appropriate equipment to monitor the weight of all residents at Parkfields must be provided. The practice of using communal underwear including net pants must cease. Barrier nursing protocols in the home must be implemented to meet the Health Protection Agency guidelines for this matter. DS0000017196.V272968.R01.S.doc 20/02/06 10 11 OP19 OP21 23 (2) 23(2) (j) 06/04/06 20/02/06 12 OP22 23(n) 06/04/06 13 14 OP26 OP26 13 (4)(a) 13 (4)(a) 20/02/06 20/02/06 Parkfields Version 5.0 Page 27 15 OP26 13 (4)(a) 16 17 OP26 OP26 13 (4)(a) 13(4)(a) 18 OP27 12(1) Personal protective equipment must be available in all high risk areas such as sluices, bathrooms and toilets. Used toiletries and skin cleansing foam must not be kept in sluices for communal use. Infection control management systems must be further improved to ensure clinical waste awaiting disposal is securely bagged and stored in clean storage containers. The registered manager must be supernumery and must not be included in the staffing numbers. (Previous timescale of 31/12/04 not met.) 06/02/06 06/02/06 06/02/06 20/02/06 19 OP29 19, Sch2 The registered person must 20/02/06 ensure that information and documents as required by Regulation 19 Schedule 2 are obtained prior to commencement of employment, including a full employment history. Copies of these documents must be retained on each staff file. (Previous timescales of 01/08/ 05 not met). 20 OP30 18 (1)( C) 21 OP36 18(2) timescales of 01/09/ 05 not met). Individual training needs must be up dated and met in order to clearly show staff fully meet the needs of all residents, including mandatory training. All care staff must receive formal recorded supervision at least 6 times per year. (Previous 06/03/06 06/03/06 22 OP37 17 (1) 23 OP38 17 Up to date records must be maintained in the home for residents and staff as identified in Schedules 3 and 4. Accidents must be recorded in a format that conforms to the Data Protection Act as well as the Health and Safety at Work Act. (Previous timescales of 01/08/ 05 not met). DS0000017196.V272968.R01.S.doc 06/03/06 06/03/06 Parkfields Version 5.0 Page 28 24 OP9 13 (2) from May 2005 report). 20/02/06 All medicines administered/not administered must be recorded immediately after the transaction with either a signature or a defined abbreviation so that gaps in the administration record do not occur. (Compliance not met The home must commence 20/02/06 monitoring the temperature of the treatment room to ensure the temperature does not exceed 25 degrees centigrade. (Not The Manager must regularly audit the medication to ensure the integrity of the MAR charts is maintained. Records of the food provided for residents must be in sufficient detail in order to demonstrate that the diet is satisfactory. The registered person must ensure that staff are aware of the complaints procedure and that all complaints are dealt with and investigated appropriately with records kept. The registered person must ensure that staff are aware of their responsibilities to report and record all accidents and incidents. 20/03/06 25 OP9 13 (2) assessed at this inspectionrequirement from May 2005 report) 26 OP9 13 (2) 27 OP15 Schedule 4 (13) 22 20/03/06 28 OP16 20/02/06 29 OP38 17 20/02/06 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 OP8 Good Practice Recommendations The home is advised to obtain written consent from residents or their significant others prior to photographing wounds. DS0000017196.V272968.R01.S.doc Version 5.0 Page 29 Parkfields 2. 3. 4. 5 OP8 OP9 OP38 OP7 If it is not appropriate to weigh a resident then the home should record the reason why the resident has not been weighed. The monitoring of the temperature of the drugs fridge should indicate a daily minimum and maximum temperature. The home is strongly recommended to commence a planned preventative maintenance programme regarding the use of bed rails. It is recommended that the manager commences auditing care documentation to ensure staff adhere to policy. Parkfields DS0000017196.V272968.R01.S.doc Version 5.0 Page 30 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.V272968.R01.S.doc Version 5.0 Page 31 - 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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