Inspection on 19/09/06 for Parkland House

This inspection was carried out on 19th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Parkland House 07/09/07

Parkland House 13/12/05

Parkland House 15/07/05

Parkland House 12/01/05

Parkland House 16/06/04

Parkland House 18/03/04

Parkland House 10/02/04

Similar services:

Manor Lodge

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Parkland House Parkland House Barley Lane Exeter Devon EX4 1TA Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 19th September 2006 09.15 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 Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkland House Address Parkland House Barley Lane Exeter Devon EX4 1TA 01392 251144 01392 252774 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) Peninsula Care Homes Limited John Surel Bayliss Care Home 49 Category(ies) of Dementia - over 65 years of age (49), Learning registration, with number disability over 65 years of age (2), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (49), Old age, not falling within any other category (49), Physical disability over 65 years of age (49) Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the category of Learning disability applies for one named service user only. On the termination of the placement of the named service user, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 16th December 2003. The maximum number of placements, including that of the named service user, will remain at 49. 13th December 2005 3. Date of last inspection Brief Description of the Service: Parkland House is a care home for up to 49 people above retirement age who have dementia or a mental disorder, with or without a physical disability. Nursing care is not provided, apart from that which the local district nursing service can provide. The Home also offers day care, but only cares for a maximum of 49 people including residents. The Commission does not regulate day care services. The home is a detached and extended period house, with a large garden, on the western outskirts of the city. Accommodation is on two floors. In a residential area of Exeter, the home is not too far from some local shops and a bus route to the city centre, with St Thomas shopping centre less than a mile away. The property has been extensively refurbished, including The Coach House where accommodation is provided for more independent service users. There is a passenger lift between the ground and first floors in the main building; a stairlift is fitted in the Coach House. Residents have the use of two lounges, a sun lounge and a spacious hallway. The Home also has a large dining room, a lounge/dining room, and a kitchenette/dining area that is used for activities and where residents can make themselves drinks or snacks. The majority of bedrooms are for single occupancy only, with a small number of double rooms being available. Half of the bedrooms have en suite toilet facilities. There are baths adapted for people with mobility problems, and level access shower facilities. The gardens are well kept, with good wheelchair access to covered sitting areas, and with a walkway around the gardens. A courtyard garden has been created which gives an improved view from rooms overlooking it. There are car-parking areas at the front of the Home. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 5 A six-bedroom extension is currently being built, which will be subject to registration procedures before it can be used as accommodation. At the time of the inspection, weekly fees were £363 - £810. These did not include the cost of hairdressing (from £5.50), chiropody (£13), accompanied appointments (i.e. staff escort costs – an hourly rate of £6.50 charged); travel to appointments using the home’s transport and mileage costs for outings being charged at 40p per mile; papers and toiletries - charged at cost price. Inspection reports produced by the Commission (CSCI) about the home are available in an information file kept in the home’s entrance hall. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. There were 45 residents at the home on the day of this unannounced inspection. John Bayliss, Home manager, had returned a CSCI pre-inspection questionnaire. Completed CSCI surveys or comment cards were returned from seven residents or their families, two care staff, and two community-based health or social care professionals. The inspector spoke with 12 residents in some depth, around the home. Two had asked to speak to the inspector, and were positive things about the home. The inspector also met with others who were less able to give their views; all looked at ease, able to observe activities going on around them or move between rooms as they wished. The inspection incorporated ‘case-tracking’ of five residents, including a bedbound resident, and new residents. This involved looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (pre-admission assessments, medication sheets, personal monies records, etc.), talking with staff, and observation of care these residents received - especially where they were unable to give their views in depth. The inspector also spoke with three members of the care staff, the cook and the manager, during the eight hours spent at the home. Other records seen included those relating to staff, health and safety, and quality assurance. A tour of the building included the kitchen and laundry. The inspector discussed her findings with Mr Bayliss at the end of the inspection. Information gained from all these sources and from communication with the service since the last inspection is included in this report. An additional inspection was carried out on 22 May 2006, with an Environmental Health Officer from Exeter City Council. This was because of an increase in falls causing bone fractures, at the home. Potential environmental issues were discussed with Mr Bayliss, who had already asked an Occupational Therapist to carry out an assessment of the home in view of the falls. A recording system had recently been put in place to monitor accident trends, and new risk assessments were being introduced. More handrails were being fitted. As a result of discussions during the visit, Mr Bayliss upgraded lighting in bedrooms. The home was also required to ensure care plans have sufficient detail to ensure that staff know fully how to meet residents’ needs. And that care plans are reviewed sufficiently to reflect changing needs. It was also required that audits of accidents should include a broad range of possible factors, and be used to inform future action, to promote the health, safety and welfare of all those at the home. These matters were followed up at this Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 7 inspection, and it was positive to note that there had only been one serious fall since the visit in May 2006. What the service does well: What has improved since the last inspection? A stairlift has been fitted in the Coach House, to assist residents in that part of the home who have mobility problems. To reduce the risk of falling, the level of bedroom lighting has been improved, the environment has been assessed by an Occupational therapist to look for possible hazards or improvements, and a more detailed audit is used, to try to identify any causal factors. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 8 Domestic cover at weekends and activities staff hours have been increased, improving the service to residents. The induction programme for new staff is now based on nationally recognised comprehensive standards. 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. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 9 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 Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 10 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): 3. The home does not offer intermediate care (– St.6). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good assessment of prospective residents’ needs, ensuring that the home can meet the care needs of those who go to live there. EVIDENCE: Residents’ surveys said they had enough information before moving in, to help them decide if the home was suitable for them. One included, “Good brochure and information given by the manager”. A new resident said staff had taken time to welcome them when they first moved in, and said they were settling into the home. The manager or his deputy (who has a mental health qualification) meet prospective residents – usually in their current care setting - to assess their needs, to ensure the home could care for the person if they chose to live at the home. Two such pre-admission assessments were seen – these were readily available to staff, very comprehensive and detailed, including all areas suggested in the National Minimum Standards. There was also good information from a Community Psychiatric nurse and social workers, telling staff about care needs, possible risks, medication, etc. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 11 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): 7 - 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have adequate information about residents, but some care plans need more detail, and clarification - to ensure staff know how to meet all needs, including changed needs. Regular reassessment and multidisciplinary working ensures residents receive good health care. Management of medication is adequate, but some minor improvements would promote safer systems. There is good respect for residents, with promotion of their privacy and dignity. EVIDENCE: Each resident had a care plan, and these were very individualised. Staff had used pre-admission assessment information to develop a very good initial care Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 12 plan for one new resident. Another was less well developed - the night care plan developed after admission did not reflect the resident had been having a specific problem at night before admission, etc. However, care records and staff indicated the problem had not occurred since the resident moved into the home. Social histories had been completed in most care records seen, giving staff a complete picture of the resident by including their life history. Care plans had been reviewed monthly, with detailed evaluations and daily notes that informed well about the success - or otherwise - of care given. For example, daily notes in one resident’s care records showed that appropriate strategies described in their care plan, for managing aggression, had been used successfully. Where changes to planned care had been made, new guidance for staff was added to the existing plan, but without clarifying what care was discontinued - which could lead to confusion about current care. Residents and their supporters have an opportunity to be involved in care reviews for the resident, with care plans seen set aside for review meetings. A new staff said they had been given time to read care plans during their induction, finding them useful. Staff were able to give the inspector relevant information about residents. A resident said, “We’re looked after well” when asked if staff looked after residents’ health needs. Surveys reflected this, with respondents saying they always or usually got the medical support they needed. Two people commented that if there’s any doubt, a doctor is always called. Individuals’ care records seen included up-to-date assessments relating to residents’ nutrition, skin or tissue health, and safe handling/moving. These had been used to inform care planning – obtaining pressure-relieving equipment when a possible risk of tissue damage was found, for example. Records showed residents’ weights were relatively stable. The manager confirmed that most specialist services would be accessed through the resident’s GP. An Occupational therapist currently visits some residents, and a physiotherapist was due to visit another. Care records showed an optician visited regularly. A resident who suffered from depression appreciated that staff checked on them regularly when their mood was low. One resident who had had a serious fall and now used a walking frame said, “I haven’t any problem getting about – the staff help me” – as was later observed. A resident in bed received regular attention from care staff during the inspection, and looked comfortable and cared for. A resident with poor sight said staff remembered to leave items in their usual place in their room, so they could find them easily. Staff were overheard speaking kindly when attending to residents in bedrooms, etc. A survey - completed by a relative whose parent had been cared for at the home through their last days - said the care they all received was excellent. Systems were in place to ensure prescribed medicines and other items were recorded when received or returned to the pharmacy. Records for the latter were on loose unnumbered pages, so it would be difficult to know if a sheet was missing. Controlled drug stocks checked were as noted in the record book. There is a fridge for medication needing cool storage; records of temperatures Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 13 (including minimum and maximum readings daily, as is good practice) showed they were kept in appropriate conditions. Administration sheets seen were signed appropriately for medication taken orally, and had the resident’s photo, to ensure items were given to the right person. However, it was noted that no record was made on administration sheets when tubes of skin creams, etc. were given out to be kept in residents’ bedrooms, so appropriate usage was less easily monitored. Also, punch-holes on the sheets had occasionally removed part of the information for staff (including medication names). This could lead to lack of clarity about what was to be administered. A relative said, “Staff treat the residents with respect (even at times under trying circumstances)”. More able residents said frailer residents were treated well by staff. Residents and visiting community-based professionals confirmed staff respect residents’ privacy with visitors. Shared rooms have curtains between beds and separate furniture for each resident’s property, to provide some privacy. Shared toilets and bathrooms had door locks to promote privacy; a broken lock was brought to the manager’s attention, which he said would be attended to. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 14 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): 12 - 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a good variety of opportunities for fulfilment, to enrich residents’ lives. Good links are maintained with residents’ families, friends and the community around the home, helping to ensure residents benefit from supportive and interesting relationships. There is good promotion of residents’ choice, offering them control in their lives. There are good catering arrangements that meet residents’ preferences, as well as their social and health needs. EVIDENCE: A resident’s survey said they had never had any cause to doubt that the home was the right place for them. A newer, younger resident said there was nothing for them to do, but added that the home was trying very hard to address this; Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 15 the resident had been asked what outings they would enjoy, and later during the inspection they were taken out, with another resident, to a local stately home. A resident said they were always invited to the church service at the home, or to other events, but that they weren’t ‘pestered’ if they said they didn’t want to go. The home employs activities staff, for 90 hours of staff time, Monday-Friday; there are regular weekly events, and ‘ad hoc’ ones. Staff use their own cars for residents’ transport or outings, the manager confirming they have appropriate insurance cover. Surveys said there was usually or always activities arranged by the home that the respondent could take part in if they chose to. One included, “Excellent and lots of them”, and two were positive about the weekly quiz. A resident said they particularly enjoyed the flowerarranging sessions, since this was part of their previous occupation, as seen noted in their care records. Another said, “We have some very nice trips”. A resident said they didn’t use a phone themselves but that staff passed messages to them from family, etc. A relative’s survey similarly said there was always someone to help them or pass a message. Others said staff made visitors feel welcome, and that visitors could have a meal with the resident if they booked it in advance. A variety of ‘activities’ also keep residents in touch with the world around the home – visits by the local donkey sanctuary’s animals, newspaper reading and discussion, for example. Notices at the home inform residents how they can contribute to local recycling initiatives that the home is supporting. When asked if staff or routines were flexible around the residents’ wishes, one resident said, “They find out what your habits are and they work around you”. A notice to staff reminded them not to rush residents – during meals, or after the church service, for example. A resident confirmed they had been asked how they wished to be addressed. Bedrooms reflected residents’ lives, being personalised with their possessions. Information on ‘Age Concern’ and its support service was available in the manager’s office. Some notices at the home are in larger print, making the information more accessible. When asked if they liked the food, residents’ comments included, “I look forward to it!” and “The food is excellent…plenty of it; they make sure you get a fruit dish…it’s not stodgy food”. Menus provided looked balanced and varied. Residents said there was plenty of food, including fresh fruit, that choice is offered and that staff knew residents’ preferences. A resident needing a special diet said, “The cook has turned herself backwards to get nice things for me”, adding that the cook also checked to see if they had eaten enough. One resident said they liked laying the tables; the mealtime observed was organised, and pleasant, with tablecloths, cutlery, and vases of flowers on each table. Residents appeared to be enjoying the meal; the cook and a senior carer helped serve the food and staff circulated, offering assistance politely. Meals could be taken in residents’ bedrooms, if they wished it. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 16 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good response to concerns, ensuring they promote improvement of the service residents receive. There is an adequate range of safeguarding policies and practices in use, to try to protect residents from abuse. However, some improvements are needed to fully protect people. EVIDENCE: When asked if they felt able to speak to anyone if they had a complaint, one resident said, “I know the manager would help me”. He was seen to be available to residents, during the inspection, answering queries, etc. Other residents felt able to make a complaint if they had one. Surveys said the majority knew who to speak to if they were not happy – two mentioning the manager or the senior carers. And that most knew how to make a complaint, one noting there was relevant information was on noticeboards (as seen during the visit). The manager said the complaints procedure could be provided in large print, although it was not routinely offered. He confirmed the home has not received any complaints since the last inspection. The commission have not received any complaints either, and nor had the two community-based professionals who returned surveys. When the concern about serious falls was raised with Mr Bayliss in May 2006, he was open to discussion and Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 17 suggestions; he was keen to resolve any contributory problems, having already started to address the matter himself. Residents’ surveys said they had received contracts, which protects their rights. Those asked said they felt safe at the home. Two of three staff spoken with had knowledge of safeguarding, what was deemed abusive practice, and knew they should report any concerns. A new staff, who had completed their induction, had had some relevant training but was not clear about types of abuse. One did not know local organisations they could speak to outside of their employing organisation, not having had a recent update. The manager said training on safeguarding is provided regularly by an external trainer, but it was not clear whether this would include local procedures. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 18 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy good, well-maintained accommodation, where adaptations are being increased to meet residents’ needs and promote independence. Systems are in place to promote good standards of hygiene, protecting residents’ wellbeing. EVIDENCE: The environment was orderly, yet very homely and with décor well attended to. The gardens are attractive, with paved paths making various seating areas and circular walks easily accessible. Staff and residents said minor repairs were attended to promptly. Residents, when asked if they could get about safely, did not identify any hazards. Some appreciated having rooms with plenty of natural light. Bedrooms were individualised, the general nature of the original Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 19 house having been retained. A resident confirmed they could lock their door if they wished to, and said they found the various handrails and grabrails helpful. Ramps facilitated access to some areas, including the garden. Brass stair treads have been fitted to define the top and bottom steps more clearly, where there is patterned carpet (which can cause perception difficulties for people with dementia); this was a suggestion made by someone on the residents’ committee. It has already been discussed with the manager that specialist advice be sought on carpeting in future, to ensure appropriate designs are purchased. There were three cleaners on duty most of the day, and the home looked very clean. Residents’ surveys and conversations indicated this was usual, one saying if there was an odour it was gone the next time they visited. There was an odour in one room; the manager said the carpet was steam-cleaned almost daily and that it would be attended to the next day (when maintenance staff were back on duty). There was a wash temperature guide displayed for staff information, and an appropriate washing machine programme in use, in the laundry – ensuring thorough cleaning of washing. Staff described appropriate procedures for handling soiled laundry, which minimise cross-infection risks. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 20 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): 27 – 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers and the skill mix are good, having recently been improved to ensure residents’ needs can be met. The staff as a team have good knowledge and skills to guide practice and ensure residents’ safety. The home has adequate recruitment policies, but these need to be followed fully, so that residents are cared for only by suitable people. There is adequate training and support for staff, but some would benefit from more formal support and more training, to enable them to meet all residents’ needs well. EVIDENCE: Residents said, “The staff are very nice – I’m very happy here”, staff were “friendly, patient” and helped them with their problems. Resident/relative surveys said staff were always or usually available when they needed them, and that they always or usually listened and acted on what the residents said. One resident commented there were fewer staff available in the evenings, when asked if there were enough staff. Others felt there were sufficient. On Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 21 the morning of the inspection, there were two kitchen staff, three domestics, two activity staff and an administrator on duty in addition to eight care staff and the manager, for 45 residents. Later in the day, there were five staff initially, with another coming in later to cover a sickness absence. Overnight there were to be three staff. Care staff were seen to be busy with physical care-related tasks during the inspection. Social aspects of care such as sitting talking with residents in lounges or accompanying anyone in the garden was much less seen. Such care can be very important to increase the wellbeing of someone with dementia or mental health problems. The manager said he is considering employing another staff for the first part of the morning, and has recently increased the activities staff hours. Staff said that a recent increase in domestic cover at weekends was appreciated, and that other staffing issues were being addressed as much as possible (a number of staff being pregnant). Agency staff were employed to maintain numbers, for example. The pre-inspection questionnaire said just over half of the care staff had a recognised care qualification, ensuring a basic level of knowledge and skill. Three staff spoken with had a qualification or were undertaking one. The manager said the home funds any staff to take an initial qualification, with some financial support towards higher qualifications. Senior carers and staff were said to be supportive and available to give advice, promoting safe care. Three staff files checked had required recruitment information apart from one that had one reference instead of two. The manager confirmed that gaps in employment history are discussed, but discussions were not recorded. Full police checks had been obtained before staff were employed. All had had some relevant work experience prior to joining the home. Residents’/relatives’ surveys said they always got the care and support they needed, one adding, “Lovely care staff, helpful and considerate”. Residents said staff knew their needs, as reflected by two community-based professionals who were satisfied with care provided to residents they visited. The induction programme for new staff is now based on nationally recognised standards, as recommended at the last inspection. A new staff’s signed-off induction record was seen; they said they had shadowed experienced staff initially, before being able to give care under supervision, ensuring residents’ safety. Another staff who said they’d completed their induction had not had their record signed off. Formal supervision – to promote staff development - was not well established, as reflected in a staff survey. The pre-inspection questionnaire showed some residents had sight problems, noted also in case-tracking, but staff had not had any training or updates on such needs. Conversation with one resident suggested staff might benefit from developing their understanding of sight problems, so they could better anticipate potential problems for poorly sighted residents. One staff spoken with said they had attended a very useful study day on dementia. Of two staff surveys, a longer serving staff felt training opportunities had improved, but a newer staff felt training offered had not yet materialised. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 22 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): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from good management input, which ensures the home runs well. Good systems in place help ensure the home is run in residents’ best interests. Good practices regarding residents’ financial affairs safeguard their monies. There is adequate promotion of residents’ and staff health and safety, although aspects need attention to ensure the ongoing welfare of those at the home. EVIDENCE: John Bayliss was registered as manager by CSCI in September 2004. He had obtained the Registered Manager award (with NVQ4 in Care) in 2003. Since Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 23 the last inspection, he has attended some updating relating to dementia care as well as on health and safety topics, to ensure he can lead on current good practice. One resident said, “The home seems informal, but it’s organised”. Mr Bayliss has an ‘open door’ policy, as seen when residents sought him out during the inspection. One resident commented that Mr Bayliss was “kindness itself”. Staff said the manager was approachable, and that staff meetings were useful occasions. There is evidence of ongoing improvement of the service provided by the home, as described elsewhere in this report. A resident said there was “mutual co-operation” between residents and staff. Others said residents’/relatives’ meetings were useful, and suggestions were acted on – provision of more gravy at meals, for example. Minutes of meetings were available. A Residents’ Committee meets monthly with Mr Bayliss – discussing plants for the gardens, and the proposed extension to the home, for example. One survey said it provided “an opportunity to speak our minds or air any queries on general matters concerning the home”. Two residents said they had completed a ‘quality of care’ survey recently. The manager had placed the analysis of results in the information file in the home’s hallway. It included comparison with results for the last two years, to show where improvement had been achieved or otherwise. Records for three residents’ personal monies, held by the home for them, were checked. Receipts were available where requested and two signatures obtained, for expenditures shown on records, as is good practice. Copies of recent accounts were sent to the next-of-kin when a top-up was needed at the home, for them to check. The administrator confirmed that residents’ personal monies are not paid into any bank account for the business, which ensures monies are always available independently of the business. She also confirmed that no concerns have been raised with her, by next-of-kin, about accounts kept. The inspector pointed out that receipts from one source were named but undated, which could give rise to queries when trying to correlate receipts and written entries over time. The manager said he would address this with the company concerned. Both the laundry and kitchen were clean and orderly, with washable surfaces (including flooring) and hand wash facilities, to promote good hygiene standards. The manager had information on the new food regulations (although the food safety policy had not yet been reviewed, according to the pre-inspection questionnaire). Food in fridges were covered and dated; storage temperatures were measured twice daily, and were in appropriate ranges. Such measures help to ensure food used is fit to eat. Records were seen of monthly checks on window restrictors, which help ensure the safety of people on upper floors. Staff felt it was a safe work environment, with generally reliable equipment, although one staff felt wheelchairs needed attention; the manager said the handyman checked them, but did not keep records. A new wheelchair had been purchased recently. A notice showed staff had been reminded of good practice regarding falls prevention; care records Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 24 show that accidents are reported to GPs. There has been only one accident resulting in a bone fracture since the visit in May 2006. One resident who was noted on the previous visit to fall regularly (without injury) was still regularly named in accident records; the manager said the resident was actually sliding themselves to the floor from furniture, rather than falling, but staff were still noting each incident. The manager confirmed an electrician has checked the electrical hard wiring recently, but the relevant certificate is still awaited. Fire safety checks were recorded at recommended intervals apart from fire alarm tests, which had not been recorded regularly during May and June 2006. The manager felt sure checks had continued but not been recorded; alarm tests were recorded regularly since June 2006. A resident had recently left the home unescorted, placing themselves at risk. Staff said action had been taken to prevent this recurring, in that they had reminded workmen to ensure certain exits were not left open. However, risk assessments had not yet been updated to show this. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations It is recommended a) You ensure that each service user has a comprehensive, detailed plan of care generated from the pre-admission assessment of their needs, to be the basis for the care to be delivered on admission, and b) That you ensure the current care plan is clearly identifiable (with discontinued care identifiable as such, etc.), so that all residents’ needs, including changed needs, are met. It is recommended you ensure that records are kept of all medicines administered and leaving the home to ensure that there is no mishandling. This includes a) Recording when topical preparations (tubes of skin creams, etc.) are given out, to monitor appropriate DS0000055233.V306676.R01.S.doc Version 5.2 Page 27 2 OP9 Parkland House 3 OP18 4 OP29 5 OP30 6 OP38 use over time; b) Preserving prescribing information on administration sheets - avoiding punch-holes through information to avoid uncertainty about what is to be administered; and c) Maintaining a robust audit trail (for example, where loose sheets are used to record returned items, by numbering the pages). It is recommended you ensure that there are robust procedures for responding to suspicion or evidence of abuse or neglect (including whistle blowing), to ensure the safety and protection of service users. This includes that all staff are aware of definitions of abuse and aware of local procedures (local authorities/agencies to whom concerns may be reported, etc.). It is recommended you ensure that there is a thorough recruitment procedure ensuring the protection of service users, which includes obtaining two written references before appointing a member of staff, and evidencing that any gaps in employment records are explored. It is recommended you ensure that there is a staff training and development programme that ensures staff fulfill the aims of the home and meet the changing needs of service users. This includes a) Evidencing progression of each staff’s induction programme; b) Providing training & updates relevant to residents’ needs, including caring for people with sight problems; and c) There is a system for identifying training needs with individual staff (such as individual training & development assessments & profiles, or regular formal supervision). It is recommended you ensure that the safety and welfare of service users and staff are promoted and protected. This includes a) By ensuring fire alarms are tested at recommended intervals; and b) Promptly reviewing risk assessments after any related occurrence and recording action taken to prevent a recurrence/minimise risks. Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Parkland House DS0000055233.V306676.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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