Inspection on 07/09/07 for Parkland House

This inspection was carried out on 7th September 2007.

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 19/09/06

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 Unannounced Inspection 7th September 2007 9.20 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.V339416.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.V339416.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 Mrs Susan Elizabeth Gooding Care Home 52 Category(ies) of Dementia - over 65 years of age (52), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (52), Old age, not falling within any other category (52), Physical disability over 65 years of age (52) Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia - over 65 years of age (Code DE(E)) Mental disorder, excluding learning disability or dementia - over 65 years of age (Code MD(E)) Old age, not falling within any other category (Code OP) Physical disability - over 65 years of age (Code PD(E)) 2. The maximum number of service users who can be accommodated is 52. 19/09/06 Date of last inspection Brief Description of the Service: Parkland House is a care home for up to 52 people above retirement age, who need help with personal care, and who may also have dementia, a mental disorder, or a physical disability. Nursing care is not provided, apart from that which the local district nursing service can provide. A detached and extended period house with a large garden, the home is in a residential area on the western outskirts of Exeter. It 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. Accommodation is on two floors. The property has been extensively refurbished, including The Coach House where accommodation is provided for more independent people. There is a passenger lift between the ground and first floors in the main building; a stairlift is fitted in the Coach House. The home has two lounges, a sun lounge, a lounge/dining room, a large dining room, and a kitchenette/dining room. The majority of bedrooms are for single occupancy only, with one double room available. Half of the bedrooms have en suite toilet facilities. There are baths adapted for people with mobility problems, and level access shower facilities. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 5 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. Weekly fees at the time of the inspection were £372 - £666. The fee level partly depends on individuals’ needs, and the particular room. Fees do not include the cost of hairdressing, private chiropody, staff escort duties (charged at the hourly pay rate for care staff), entry fees or tickets on outings, dry cleaning, newspapers (which are charged at cost price) and toiletries. Inspection reports for the home, produced by the Commission (CSCI), are with other information about the home, kept in a file available in the entrance hallway. Copies can be provided on request from the person-in-charge. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place as part of our usual inspection programme. There were 50 people living at the home on this unannounced site visit, which lasted 12 hours over two days. Sue Gooding, the manager, had previously returned a CSCI questionnaire about the home, including an assessment of what they do well, and their plans for improvement. We had also sent surveys to 13 people who lived at the home; seven were returned (five anonymously), six of these being completed with help from relatives, advocates or activities staff. Four surveys were returned of six sent to health and social care professionals (including GPs, specialist community nurses and care managers). Seven staff surveys were sent out, with two returned. The inspection included ‘case-tracking’ of five people – the sample including people new to the home, people with mobility problems, people with more complex physical or mental health needs, and people who rarely had visitors. This involved looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (preadmission assessments, medication sheets, etc.), talking with staff, and observation of care they received. We spent time with at least 22 people who lived at the home, some individually in their rooms and some who were sitting together in the lounge areas. Eleven spoke with us in some depth. Others were unable to give their views in detail, because of frailty or disability, but we observed general care and interactions with staff during our visit. We also spoke with one visitor and six care or ancillary staff, as well as the manager. Other records seen included those relating to staff, peoples’ personal monies, the kitchen, health and safety, and quality assurance. A tour of the building included the kitchen and laundry. We ended the visit by discussing our findings with the manager and Anne Taggart, Group Operations Manager. Information gained from all these sources and from communication about the home since the last full inspection (in September 2006) is included in this report. What the service does well: One visitor said they appreciated the home’s communication about their relative’s medical needs, and the ‘plain wholesome food’. They also felt the home made good efforts to find things for restless people to do. A health care Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 7 professional said the home provides a ‘happy, sociable atmosphere, with activities often going on to engage people in groups.’ Another said there was good continuity of care, with long serving senior care staff - described as ‘excellent.’ A third felt there was, ‘Great care, an appropriate, gentle, lovely atmosphere.’ People are given comprehensive information about the home, to help them in deciding where to live. The home also assesses prospective residents’ needs before confirming that the home can meet those care needs and offering them accommodation, further helping to ensure the success of admissions to the home. The home is managed well, being run in the best interests of people living there. Complaints, concerns and opinions are used to improve the service people receive and to safeguard them. Positive links are maintained with peoples’ families, friends and the community around the home, so that they can enjoy familiar, supportive and interesting relationships or encounters. The home works with community-based professionals to ensure people receive good health care. People benefit from a well-maintained and homely environment, which is being adapted for their needs. Catering arrangements meet their preferences, as well as their social and health needs. What has improved since the last inspection? What they could do better: Staff are told about the people they care for, but some care plans need more individualised detail, to ensure staff know peoples’ current needs and how to meet them in a personalised way. And the home must ensure staffing arrangements are sufficient to meet the needs of all the people who live at the home, and meet them in a timely way. People have a variety of opportunities for recreation, although the home needs to ensure opportunities relate to individuals’ interests, preferences and capacities. Efforts are made to give individuals choices and control of their Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 8 lives, although some people need more support for this to be achieved. People would also benefit from additional action to promote their privacy and dignity. The health and safety of everyone at the home is promoted, although some additional attention is needed to ensure their welfare. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Parkland House DS0000055233.V339416.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.V339416.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 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. People have access to information about the home that helps them decide where to live. The home assesses prospective residents’ needs before confirming that the home can meet those care needs, thus promoting the success of admissions to the home. EVIDENCE: Pre-admission care plans provided by care managers were seen for people funded through Social Services, as well as the home’s own full assessment of their needs. The home’s pre-admission assessment for a self-funded person was also seen, with further assessments completed on their admission. The manager confirmed she assesses the needs of every prospective resident before their admission, expecting to meet the person concerned to do this. Thus it is not the home’s policy to take emergency admissions. Staff spoken Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 11 with felt the assessments gave them sufficient information, and that the home was suitable for the people admitted in recent months. The home’s admission letter was seen, which included confirmation that the home could meet the person’s assessed needs, confirmed their room number, and their weekly fee. The manager said she offers people the home’s Statement of Purpose and brochure when she first goes to meet them. Or she gave it to those looking round the home on behalf of others. One person said they looked around, adding that they were ‘shown round without loss of peoples’ privacy and dignity’. The Statement of Purpose included required details. Information is not in an adapted format more suited to the needs of people with dementia, but the manager is intending to address this. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Involvement of community-based professionals helps ensure people receive good health care. Medication systems are generally well managed, promoting peoples’ safety. Staff have general information about people, but some care plans need more individualised detail, to ensure staff meet individuals’ current needs, in a personalised and consistent way. People would also benefit from further action to ensure their privacy and dignity, promoting their rights. EVIDENCE: Care records for five people were checked. Everyone had a care plan, recording care needs, with regular reviews noted, and additional information relating to visits by health professionals, etc. Care records included a ‘Dementia and wandering’ care plan, but these were in the same wording for everyone. Two people had been losing weight; action had been taken to address this, but was not reflected in monthly reviews and two staff who were asked were not aware of it. A risk of choking identified in a review was not reflected in the person’s care plan. Additional information added to one care plan was not signed or Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 13 dated. The manager intends to develop care-planning systems, by involving more staff in record-keeping and establishing key workers for each person. Although their personal histories, hobbies and religious persuasion had been recorded, people did not have social needs care plans. Three peoples’ daily notes had relatively little reference to fulfilling occupation of their time, although we were told later that activities staff keep separate records. A social care professional felt the home communicated well with health care professionals, and ensured people got to hospital appointments. Care records showed dentists, opticians, chiropodists, district nurses, continence advisers and psychiatrists had visited various people. One person felt their relative’s appetite and strength had improved since their admission. There was regular monitoring of certain risks to individuals’ health (malnutrition, falls, and pressure damage to skin). Five peoples’ medication records and blister-packed medicines were seen. Three were on relatively small numbers of medications. None were selfmedicating, the manager confirming no-one currently living at the home could be enabled to look after their own medication. Records were kept of medication received into the home and of those disposed of. Stocks and records for three controlled drugs were appropriately kept apart from one item with a limited shelf life once opened, with no evidence of when it was opened. Other items had dates of opening written on them. The drug fridge thermometer reading was below temperatures recommended for a fridge, although daily records kept showed more appropriate levels. The manager agreed to look into this, to ensure safe storage temperatures. We saw staff treat people with courtesy at all times during our visit, and most people said this was usual. One person said that whilst most staff knocked on their bedroom door and waited for an answer before entering, others just walked in; a community-based professional also noted this. Someone with poor sight said staff did not always identify themselves on entering. There were no door signs to show if someone should not be disturbed, but the manager said this was being addressed. Bedroom door locks are fitted on request, subject to risk assessments. The great majority of care staff at the home are females. Some staff said people were asked if they preferred male or female carers to help them with personal care, although there was nothing in records seen to show this had been discussed with anyone. The home has cordless phones that people can request to use, or they can use the office phone in private. There is a phone in a corridor that people can use without having to ask staff for access, but someone pointed out there is no privacy when using it. Parkland House DS0000055233.V339416.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. 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 various opportunities for fulfilment and for people to exercise choice or control of their lives, although these could be linked better to some individuals’ interests, preferences and capacities. Positive links are maintained with peoples’ families, friends and the community around the home, helping to ensure they benefit from supportive and interesting relationships. Catering arrangements meet peoples’ preferences, as well as their social and health needs. EVIDENCE: There are three dedicated and popular activities staff, who work at weekends as well. The month’s activities programme was displayed around the home. It included trips to a local castle, a choral recital, garden centre, animal centre and Exeter Cathedral. A communion service, a cooking session and peoples’ birthdays were also listed. Four people went out for coffee with activities staff, on one day of our visit – something one person had said they particularly enjoyed. A music group was also clearly enjoyed by people. Pottery pieces were seen in peoples’ rooms and around the home, made at the home’s pottery session. Some activities were food-centred – such as a chocolate Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 15 fountain - to encourage extra diet intake. Staff said one person case-tracked attended the church service held at the home. Three surveys had said sometimes there were activities they could take part in (as opposed to ‘usually’ or ‘always’, as others did). A fourth suggested there should be more activities suited to people with poor sight, and they would like to go for more walks. A fifth said they could no longer participate in the planned activities. Whilst there is obviously very good investment in activities provided by activities staff, there was no clear link between activities provided and what individuals wanted to do, or used to do when in better health. It was not clear from observations, records and conversations that each person was given the same amount of opportunity for fulfilment, whatever their state of wellbeing. Care staff do not yet have a full role in this, although staff one-toone time with people had been discussed at a recent staff meeting to encourage more appropriate opportunities. The manager also hoped this could be progressed once staff vacancies were filled. Surveys completed by relatives were positive about the home. A visiting relative felt communication by the home was very good, this occurring on a one-to-one basis rather than through relatives’ meetings, etc. They also named staff whom they particularly appreciated. Staff seen helping people with mid-morning drinks in one lounge asked people if they wanted a second or third cup. A visitor commented that fish tanks recently set up around the home had been obtained as the result of a suggestion made by the Residents’ Committee. It emerged that residents’ meetings were attended primarily by the Residents’ Committee, with less involvement of other residents. One person not on the committee wasn’t sure if they were able to attend the meetings. Bedrooms were very personalised with people’s own possessions. Two people in their rooms did not have call bells within reach; both said they would like to have one, and the manager is addressing this. One person said that although some staff knew how they liked things arranged in their room, other staff reorganized it. The manager hopes that a keyworker system will resolve such issues. She is reviewing how the home provides information (such as on noticeboards) to make it more accessible to people through larger print, etc. One person in a lounge/dining room said everyone sat together at the dining table for lunch, and staff served them nicely. The majority of people spoken with said they enjoyed the food provided. Fish and chips were well received in the main dining room, during our Friday visit. There was a calm atmosphere with staff circulating and helping people politely. The week’s menu seen included standard English dishes. The cook said she made cakes daily. Staff were seen helping people with sliced fresh fruit in the afternoon, a usual practice. Cauliflower cheese was available at teatime, besides sandwiches, etc. The cook confirmed people could have everything on the teatime menu, rather Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 16 than having to choose either the light meal or sandwiches, fruit or cake. The day’s menu is on a board outside the main dining room, but is not in a format more suited to people with dementia. One person who ate in their room said meals could be hotter, and portions smaller sometimes. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and practices in use ensure complaints, concerns and opinions are heard, and used to improve the service people receive and safeguard them. EVIDENCE: A visitor said they were easily able to discuss any concerns with senior staff and get issues resolved. A social care professional said some concerns they raised were dealt with swiftly whilst others had a slower response; health care professionals felt concerns were dealt with appropriately. One complaint has been received since the last main inspection. Concerns were raised about care practices at the home, as well as the level of information given to staff unfamiliar with the home. The complaint was investigated by the manager on behalf of the service provider, with the conclusion that the complaint was unsubstantiated. Nevertheless, action was taken to remind staff of the care standards and behaviour expected by the home, with additional monitoring by senior staff, and improvements made to procedures for informing agency staff. There were three other complaints recorded in the home’s complaints book, with evidence of the home’s response, including a timely response to complaints. Forms for making a written complaint are included in the Service user Guide given to people admitted to the home, with information on Age Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 18 Concern’s advocacy service. The complaints procedure is in the hallway. The manager is looking at producing a format more suited to people with dementia. The manager has been involved in Devon County Council safeguarding procedures, to protect the welfare of someone living at the home. The matter was dealt with appropriately and sensitively by the home. The manager said all staff have had recent updates on safeguarding. Staff spoken with said they had, and were able to describe unacceptable practices, what action they would take if they witnessed them, and where to find contact numbers for reporting concerns to relevant people or organisations outside of the home. All but one staff who were asked said they were aware of the home’s gifts policy. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a clean, well-maintained and homely environment, which is being adapted for their needs. EVIDENCE: People who were asked said they liked their rooms and had sufficient lighting, hot water, etc. Some had moved rooms, to accommodation more suited to their needs and preferences. The home has a part-time handyman, and people who were asked indicated minor repairs were attended to quickly. Phone numbers were displayed in the office for the company’s electrician, plumber, etc., for use in emergencies. A relative said there had been a lot of refurbishment at the home. The manager has been trying to improve the environment for people whose sight might be affected by physical disorders or dementia. This is being done by Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 20 improving lighting and the general brightness of the home through colour schemes using lighter but contrasting shades. Some new bedrooms were built this year, and others had to be refurbished after being flooded. Windows in the upstairs lounge have been replaced, and blinds have been fitted, to improve ventilation, temperature control, etc. A bedroom had been prepared ahead of someone’s admission with an aid that would promote their independence, following a pre-admission assessment of their needs. One person said there was a ‘lovely big bath’ (– a hydrotherapy bath, preferring to use this to the level access shower closer to their room) Although the main entrance does not have level access, there is another wheelchair-accessible entrance, and ramp access to the garden. There are paths in the garden that follow a circular route, or that go from one door to another, helpful to people with cognitive problems who wish to walk unescorted. New carpets in bedrooms are not patterned, to avoid causing perception problems for people with dementia; the manager said such consideration would be given when recarpeting communal areas. People felt the home was kept clean and fresh. One person commented there was a ‘healthy smell that does not rely on air fresheners’. Domestic staff were seen working on into the late afternoon. One room had an odour, but the manager had taken advice to address the cause and the room was also to be refurbished. Staff in the laundry were seen carrying out good infection control practices regarding transport of soiled laundry, use of disposable protective clothing, and handwashing. The washing machine programme in use showed that appropriate measures are used for dealing with soiled laundry, to ensure it is cleaned thoroughly. The home has a separate sluice area. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are benefiting from staff development, which has been improved since the last inspection, but the home must ensure staffing arrangements are sufficient to meet the needs of all the people who live at the home. Those living at the home are protected from unsuitable staff by the home’s policies, but some evidence is needed to show that recruitment procedures are entirely robust. EVIDENCE: A visitor felt there were usually enough staff around, and surveys completed by relatives did not raise staffing issues. Two other surveys said staff were not always available when people wanted them. One person living at the home said staff were busy in the mornings, so they looked after someone who sat in the lounge with them - as seen during time spent in that lounge. A two-hour period of observation, in a morning, showed staff went into the lounge at least once every 15 minutes, and often every five minutes, although they did not always stay to engage with people. Of two people in their bedrooms, one said staff popped in to check on them at intervals, and the other said they didn’t see staff very often or they were called away whilst chatting. One felt staff took longer to answer call bells at weekends. Care staff spoken with said there were no domestic staff at Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 22 weekends, with care staff taking on some cleaning duties. They also confirmed there were usually nine care assistants on duty in the morning, supported by 2-3 activities staff, a cook, domestic staff, an administrator and the manager. Some felt this was sufficient given the current needs of people living at the home, some being quite independent, and that the allocation of staff to different parts of the home was satisfactory. There were six carers in the afternoon and evening to look after 50 people, and some staff felt this was not sufficient to meet peoples’ needs. A concern was raised since the last inspection about a fall that resulted in serious injury. At the time, there were three staff in an area with 19 bedrooms. The manager reviewed the situation, and there have been no further serious injuries. She is currently reviewing catering staff support during this time, to reduce non-care duties that care staff have to undertake. She is also looking at night staffing arrangements - three awake staff on duty with regard to introducing twilight shifts and reducing non-care duties they undertake. She is aware of fire safety considerations also. Individuals’ dependency levels are assessed before admission and reviewed thereafter. But overall dependency levels within the home are not monitored to inform staffing levels. One person said when they got very panicky, staff were very good with them. One person also noted staff were patient with less able, more confused people. The manager confirmed nearly half of the staff have an accredited care qualification or its equivalent. A further 15 staff are undertaking care courses at present (as their first qualification or a higher qualification than their current one). Three community-based professional felt staff had necessary care skills, one adding staff were ‘always very supportive’. One person living at the home commented that there was plenty of staff training, as did staff spoken with – who indicated the manager was very keen on training. Recent training included caring for people with impaired sight (a recommendation made at the last inspection) and wound care, besides learning through the care qualification staff were taking. Training on diabetes and Parkinsonism is being obtained, since people at the home have needs due to these conditions. Ancillary staff are being enabled to gain qualifications in their fields of work. There was evidence of one-to-one supervision with staff. Observation of staff engagement with people showed it was usually positive or neutral when it occurred. And staff always gave people their time on such occasions – not rushing them, or not leaving until the person had responded to them, for example. However, on other occasions, staff did not engage with people, missing opportunities to enhance peoples’ wellbeing through positive relationships. The manager is aware of the need to address differences in communication styles with staff, and to encourage care staff to develop skills Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 23 in engaging with people so that meeting their needs for fulfilment and positive experiences is not the responsibility of the activities staff alone. Three personnel files were checked and found to have most of the information required before individuals start working at a home. However, there were gaps in their employment histories, which the manager was able to explain, but a record of the reasons had not been kept. She said she would ensure this was done in future. Rotas and conversations with staff showed low usage of agency staff usually, with recruitment in progress to fill recently occurring staff vacancies. Staff spoken with noted that new staff already had care work experience, and felt they were keen to learn. One confirmed that they had time to work with or supervise more junior staff. Induction records in use met recognised standards for induction. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from good management input, which ensures the home is generally run in the best interests of people living there. Action is taken to promote the health and safety of everyone at the home, although some additional attention is needed to ensure their continued welfare. EVIDENCE: Sue Gooding, the manager, was registered with the Commission in July 2007. She has gained management experience in both hospital and care home settings, mainly in working with older people and people with sensory impairment. Two people said she was available and approachable; another emphasized they felt the home was very well run. Staff spoken with also felt the manager was supportive, although staff surveys said they would like more Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 25 support when short-staffed. The manager said she had undertaken most of the roles within the home since her appointment, and would be working ‘hands on’ the following week as one of the care team. One person said there was a Residents’ meeting the next week, and these were useful occasions. A staff survey completed some time prior to this visit had said they wanted more staff meetings so staff could air their views. Staff spoken with said there are monthly staff meetings, or more often if needed. Minutes seen included a night staff meeting. One person said they had completed the home’s survey on the service they received, but they weren’t sure of the outcome. The manager said surveys had also been sent to relatives, but not to visiting professionals. Results were still to be collated, and findings would then be shared with the Residents’ Committee and made available on the notice boards. The home does not act as appointee for anyone living there, leaving people to retain control of their finances as they wish. Some people hand personal spending monies to the home for safekeeping; receipts had been given for such deposits. Cash balances and records held for three people were checked, and found to tally. Two signatures had been obtained to verify transactions recorded, with corresponding receipts available. Accidents were analysed by the manager, and the Group Operations Manager saw results. Following concerns raised by an Environmental Health Officer about falls resulting in fractures, the manager had agreed to include location in audits, although this was still to be done. One person said they got about easily and didn’t feel there were any hazards in the environment, although they used the lift rather than the stairs for their own safety. The manager had obtained an ‘Age Concern’ training pack on accident prevention (including falls), which she intends to use in coming weeks with staff. One staff survey had suggested more equipment was needed. Staff spoken with felt they had sufficient to do the job expected of them currently. They thought the three lifting hoists were sufficient, since most people were quite mobile - as appeared to be the case during our visit. The only bedrails in use were integral to newly purchased beds, reducing risks from improperly fitted rails. The Group Operations Manager confirmed kitchen facilities would be refurbished by October 2007 (- a part of the wall above the stove being exposed at present). The cook said she had just completed a food hygiene course, and was completing records based on the latest good practice guidance for food safety when we met her. The kitchen looked well organised, with food portions in fridges covered, etc. She records the temperature of hot foods before serving them. Action is being taken to ensure temperatures of frozen food deliveries are recorded also, to ensure food safety. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 26 Staff confirmed they had had recent updates on fire safety, manual handling and infection control. Training on safety with household chemicals was currently being given. All carers are first aiders (appointed persons); those spoken with were able to describe signs of a fractured bone, for example. A hard wiring safety certificate was seen, obtained November 2006 and valid for five years. Additional fire safety equipment had been obtained (for evacuating people, etc.) in the light of new national fire safety requirements. Fire alarms and automatic door closers were checked weekly. Other fire safety checks had not been recorded at recommended intervals in recent months. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 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.V339416.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO – N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement You must ensure that each person has a comprehensive, person-centred, detailed plan of care, generated from the preadmission assessment of their needs. And you must review it, to inform ongoing care Timescale for action 30/11/07 2 OP29 19 & Schedule 2 - So the current care plan is clearly identifiable and includes social needs, to ensure people have all their needs, including changing needs, met. You must have thorough staff 30/09/07 recruitment procedures that include a satisfactory written explanation of any gaps in individuals’ employment histories - So that people living at the home are protected from unsuitable staff. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP10 Good Practice Recommendations The arrangements for personal care should ensure that peoples’ privacy and dignity are respected, with particular regard to personal care-giving (gender of carer, etc.), entering bedrooms, and easy access to a telephone for use in private - So that people feel they are treated with respect and their right to privacy is upheld. 2 OP12 Activities should be made available that are flexible and varied to suit individuals’ preferences, needs and capacities, in a person-centered way that reflects former interests, etc. and takes account of their abilities and disabilities (due to dementia, etc.) - So that the lifestyle they experience in the home satisfies their recreational interests and needs. 3 OP14 You should ensure individuals are helped to exercise choice in their lives, regarding attending residents’ meetings, how their room is arranged, etc. - So they all have the same opportunities and rights. 4 OP27 You should ensure staffing numbers and skill mix of staff are appropriate to the assessed needs of the service users, the size, layout and purpose of the home, at all times - So that peoples’ various needs are met, in a timely way, throughout the week, whatever the time of day. 5 OP38 You should evidence that all required fire safety checks are carried out at recommended intervals - So that peoples’ safety and welfare are promoted. Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Parkland House DS0000055233.V339416.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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