Inspection on 21/02/07 for Parklands

This inspection was carried out on 21st February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Parklands 24/01/08

Parklands 16/03/06

Parklands 18/11/05

Parklands 04/02/05

Parklands 23/09/04

Parklands 16/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Parklands Callow Hill Lane Callow Hill Redditch Worcestershire B97 5PU Lead Inspector N Andrews Unannounced Inspection 21 and 22 February 2007 09:20 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 Parklands DS0000033906.V330401.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. Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parklands Address Callow Hill Lane Callow Hill Redditch Worcestershire B97 5PU 01527 544581 01527 544393 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Steven Sadhra Mrs Margaret Phillips Care Home 31 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (6), Old age, not falling within any other of places category (12), Physical disability over 65 years of age (12) Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There are no conditions of registration other than those referred to on the previous page of this report. Date of last inspection 16 March 2006 Brief Description of the Service: Parklands is a large, detached property situated in a secluded, rural setting on the outskirts of Redditch overlooking the Worcestershire countryside. The property stands in several acres of ground surrounded by lawns and woodlands. There are car-parking facilities at the front of the premises. The house has been adapted for its current purpose as a residential care home. The residents are accommodated on the ground, first and second floor of the premises in 7 double bedrooms and 17 single bedrooms. Six of the 7 double bedrooms and four of the single bedrooms have an en suite facility. The home has a passenger lift to assist the service users to gain access to the accommodation above ground floor level. Communal lounges, dining facilities, bathroom and toilet facilities are also provided. The home is registered to provide personal care for a maximum of 31 service users. This includes 30 older people above the age of 65 years of whom 6 may be people with a dementia illness and 12 may be people with a physical disability. One place is registered for a person with a dementia illness who is below the age of 65 years. The home’s main aim is to provide a high standard of care for elderly people based on individual needs in a homely and comfortable atmosphere while endeavouring to ensure that the residents retain their self-respect, individuality, privacy and independence. The home has operated successfully under the current proprietor and registered manager for a number of years. The fees range from £1400.00 to £1640.00 per month. Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The home was inspected against the key National Minimum Standards. Time was spent with the registered manager and, in part, the registered provider assessing the home’s response to the requirements and recommendations that were made as a result of the previous inspection. Various records and a number of different policies and procedures that the home is required to maintain were inspected. A tour of part of the premises was also made. Individual discussions were held with two service users and three members of staff. As part of the inspection Comment Cards were issued to the relatives/visitors of service users and to visiting professionals. A total of five Comment Cards were completed and returned. The majority of the responses to the questions that were asked in the Comment Cards were positive. Any additional comments provided are reflected in this report. What the service does well: What has improved since the last inspection? What they could do better: Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 6 There was a need to make improvements to various records/documents that the home was required to keep including the service users’ guide and care plans. The home’s medication and staff recruitment procedures and practices must be adhered to more rigorously in order to fully protect the service users. There was also scope for improving parts of the environment, staff training and for developing the home’s quality assurance system. The registered manager said that the staff could be more involved in care planning. She also felt that the key worker system and deputy manager’s post should be developed. 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. Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 7 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 Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 8 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, 2, 3 and 5. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. Information was available to enable prospective service users to make a choice about admission to the home. They had the opportunity to visit and their needs were assessed before they were admitted. They were also given a contract that told them about the service they would receive. However, some additional information needed to be included in the service users’ guide. EVIDENCE: A copy of the home’s statement of purpose was made available for inspection. It contained clear and relevant information. A copy of the home’s service users’ guide was also made available for inspection. The information it contained was also clear and relevant. However, the service users’ guide must also include, • the relevant qualifications and experience of the registered provider, • the physical environment standards met by the home i.e. the number and size of all the rooms, as specified in Standard 1.1 and, • information about how to contact the local social services and health care authorities. Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 9 The registered manager was advised to maintain a record in each of the service users’ individual files with the date indicating when a copy of the service users’ guide had been issued to them. Both the statement of purpose and service users’ guide should be checked for typographical errors. A copy of the statement of terms and conditions of residence (contract) was made available for inspection. The contents of the contract were satisfactory and included the information referred to in Standard 2.2. The registered manager confirmed that all of the service users and/or their representatives had been issued with a contract. Two of the three service users’ files that were inspected contained a copy of the contract. The registered manager said that a contract had been issued to the third service user but had not yet been returned. The registered manager confirmed that she and another senior member of staff were responsible for assessing the care needs of all prospective service users. The assessments took place usually in the service users’ home or in hospital. A copy of the form that was used to assess the needs of prospective service users was made available for inspection. The assessment form included a reference to all of the aspects of care listed in Standard 3.3. The service user files that were inspected contained a completed copy of the assessment form. The registered manager confirmed that prospective service users were invited to visit the home before being admitted in order to meet the service users and staff and to view the vacant room. The prospective service user was offered lunch. The service users with whom discussions were held said that they had visited the home to ‘have a look round’ prior to admission. The registered manager said that sometimes the needs of prospective service users were assessed during the pre-admission visit. The home had a trial period of four weeks following admission. A statement to this effect was included in the contract. Emergency admissions were not normally accepted. The registered manager said that people could be admitted in an emergency if they were mentally alert. The home had a satisfactory policy on emergency admissions. Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users’ health and personal care was based on their individual needs. The principles of respect, dignity and privacy were put into practice. However, more attention needed to be given to care planning and the administration of medication. EVIDENCE: The registered manager confirmed that all of the service users had a care plan based on an assessment of their care needs. A copy of the care plan was made available for inspection. The care plan contained a reference to all of the aspects of care listed in Standard 3.3. The files of three service users were inspected. The information contained on the files included care plans and risk assessments on falls and pressure sores. The review of one of the care plans was overdue by nearly four weeks and had not been reviewed since 28 December 2006. The care plans had a column headed ‘Actions to be taken’. The details in this column were not always recorded as specifically as they should be. The information tended to describe the needs of the service users rather than stating the action that should be taken to ensure that the service users’ needs were met. For example, in one care plan under ‘Falls’ it stated, ‘To assist (the service user) whenever she needs to get about’. The care plan Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 11 did not state what form the assistance should take or whether the service user required the help of one or two members of staff and/or a walking aid etc. A requirement was made as a result of the previous inspection that the programme of care plan development must be completed. The wording of the requirement has been amended and is repeated in this report. The registered manager said that it was intended that the key workers would fill any gaps in the care plans. There was evidence to show that the service users’ healthcare needs were being met. It was confirmed that all of the service users were registered with one of eight local GP surgeries. None of the service users had pressure sores. However, the district nurse had provided pressure relieving mattresses and cushions to several service users. The district nurse visited the home daily to administer insulin to three service users that were diabetic. The continence adviser visited the home to assess new service users and to provide training sessions for the staff. Nutritional screening was carried out on new service users. The screening was subsequently monitored, usually every month. An optician visited the home annually. The service users received hearing and dental care treatment when necessary. One service user received support from the community psychiatric nurse. Arrangements had been made for the occupational therapist to visit the home to support the staff with the care of one service user. The help of a physiotherapist had also been requested. The chiropodist visited every week and provided a service to about five or six service users during each visit. The home used the Boots Monitored Dosage System for the administration of medication. The home provided secure facilities for the storage of medication. Access to medication was restricted. The senior member of staff on duty was responsible for holding the keys to the medication storage. The keys to the medication storage were handed over from one senior member of staff to another at shift changeovers. There was an up to date list of the signatures of the staff that were involved in the administration of medication. Copies of prescriptions were kept by the home. A record of the medication that was returned to the pharmacy was maintained. The date of opening was recorded on the outside of the medicine containers/packets. The Medication Administration Record (MAR) charts were inspected. Photographs of the service users were being placed on the MAR charts to assist recognition. The medication that was written on the MAR charts by hand had been signed for and witnessed by two members of staff. Therefore, the requirement that had been made about this issue as a result of the previous inspection had been implemented. However, a gap was noted in the recording of medication for one service user on 20 February 2007. The home had a dedicated fridge for the medication that required cold storage such as insulin and eye drops. A daily record was kept of the minimum and maximum temperature. This was the incorrect temperature to record. The correct temperature that should be recorded is the current temperature. There were occasions when a service user attended a hospital outpatient department and, as a result, their Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 12 medication was changed. The hospital reported the change in the service users’ medication to the staff initially by telephone. In these circumstances the member of staff who receives the telephone call and records the change in medication should ask the hospital to repeat the information to another member of staff who should also make a written record of the changes made. The information should then be cross checked by both members of staff. This procedure should be followed in order to reduce the possibility of any errors. The home had a satisfactory ‘Policy on Medication’. Some of the staff that were involved in the administration of medication had received accredited training. Further accredited training had been arranged for five members of staff during May 2007. The staff with whom discussions were held understood the importance of upholding the service users’ privacy and dignity. The responses provided to the questions that were asked reflected good practice. The home had a mobile handset that enabled service users to make and receive calls in private. The service users were given their mail unopened unless it had been agreed previously that it should be given to their relatives in appropriate circumstances. It was confirmed that the service users wore their own clothes at all times. However, the home also kept a supply of spare underclothes, nightdresses and vests for use in an emergency. It was confirmed that staff were instructed during their induction on how to treat service users with respect. It was also confirmed that medical examinations and discussions of a confidential nature always took place in private. Screening was provided in shared rooms. The service users with whom discussions were held confirmed that the staff treated them with respect and always knocked the door before entering their bedroom. Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 13 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, 13, 14 and 15. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users were able to exercise choice in regard to their daily routines and activities. They were able to maintain contact with their relatives and friends and were encouraged to express their views and preferences. The service users received a balanced and wholesome diet. EVIDENCE: The home provided various social and leisure activities for the service users. These included cards, Bingo, skittles and manicures. A visiting entertainer came to the home each month to play the organ. Every month a physical exercise activity session was held called ‘exercises for health’. The home received the mobile library service that provided large print books. A member of staff had recently begun to organise a daily activity for the four male service users. It was stated that during 2006 the service users were taken out for pub lunches and to the Solihull Theatre. The registered manager said that it was intended to arrange outings during the coming year possibly to the West Midlands Safari Park and/or a garden centre. This matter would be discussed with the service users at their next meeting on 6 March 2007. The service user files that were inspected contained an individual ‘Daily Record of Activities’. However, these were not being kept up to date. It was recommended that one daily record of activities should be kept. This would serve the same purpose and be easier for the staff to maintain. An Anglican Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 14 Minister visited the home every month to hold a Communion service. Members of the local church also visited the home each week to talk to the service users. Posters containing details of the activities provided were displayed on the notice board. The registered manager felt that the number and variety of activities could be improved. Therefore, it had recently been decided that each week a designated member of staff would be responsible for organising activities for the service users. There were no unnecessary or unreasonable restrictions on visiting. The service users’ guide stated, ‘Family and friends are welcome to visit at all times’. The service users and staff with whom discussions were held said that visitors were always made welcome and were offered a drink and, on occasions, a meal. They also confirmed that they were able to see their visitors in private. The service users’ guide should include details of the home’s policy on maintaining relatives and friends’ involvement with service users at the time of moving into the home. The registered manager confirmed that the service users enjoyed the visits made by the members of the local church. The registered manager said that the service users were encouraged to retain their independence and to make choices in regard to the clothes they wore, the meals provided and where they ate their meals. The registered manager said that there were no advocates involved in helping any of the service users at the present time. However, the service users’ guide included details of how to contact the local advocacy service. Leaflets about the local advocacy service were also displayed in the ground floor corridor near to the main entrance. The service users with whom discussions were held confirmed that they were able to get up and go to bed when they wished. They also confirmed that they were able to bring some of their personal possessions with them when they were admitted to the home. The statement of terms and conditions (contract) stated, ‘At the discretion of the proprietor, items of furniture may be brought into the home by the service user’. The service users’ guide also stated, ‘Service users have the right of access under the Data Protection Act 1998 to their records and information held about them at Parklands’. A service users’ meeting had been held on 5 February 2007. A poster was displayed on the notice board in the main corridor informing service users that the next meeting would take place on 6 March 2007. The home operated a four-week menu. The record of the food provided was wholesome and varied. The meal that was observed during the inspection was nutritious and attractively presented. The service users were offered three full meals each day. Breakfast was served between 8.00 and 10.00 am. Lunch was served at about 12.30 pm and the teatime meal was served between 4.00 and 4.15 pm. Supper was served between 6.30 and 7.00 pm and a milky drink and biscuits was served at 9.00 pm. Drinks and snacks were available throughout the day. An assurance was provided that the service users preferred the teatime meal to be served at the relatively early time of 4.15 pm Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 15 rather than at a later time. The Sunday lunch was served at the slightly later time of 12.45 pm because all of the service users have a cooked breakfast. The cook had considerable experience and had worked at the home for seventeen years. She knew the service users’ individual preferences very well. The service users were consulted daily about the meals and a choice of food was always offered if the service users preferred an alternative to the meals available. The food preferences of new service users are recorded on admission. Cutlery with special handles was provided to assist service users that had difficulty in gripping ordinary utensils. One service user had liquidised food and others had their food cut into small pieces to aid their eating. The cook was aware of the service users’ special dietary needs and food allergies and these were catered for appropriately. The kitchen was well equipped. A record of the fridge and freezer temperatures was maintained. A cleaning schedule was in place. A list of the dates of the service users’ birthdays was kept in the kitchen so that these could be celebrated. It is good practice to display details of the daily menu near the dining room for the service users’ benefit. It is also good practice to retain a sample of the food provided for a period of 72 hours in case there is an outbreak of food poisoning. The Department of Health in the publication ‘Infection Control Guidance for Care Homes’ dated June 2006 also recommend not to serve soft boiled eggs to residents in care homes for older people. The service users with whom discussions were held spoke positively about the food. One service user said, ‘The food is very good, I can’t fault it’. Parklands DS0000033906.V330401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The home had a clear complaints procedure and other relevant policies and procedures to ensure that service users were protected from abuse. EVIDENCE: The home had a satisfactory complaints procedure. A copy of the complaints procedure was displayed on the notice board in the ground floor corridor near to the main entrance. Details of the complaints procedure were also included in the service users’ guide. A record of the complaints received by the home was maintained. Since the previous inspection the home had received four complaints. The registered manager had dealt with the complaints appropriately. Advice and guidance had been given to one member of staff following the receipt of one complaint. However, details of the most recent complaint were not available for inspection. The registered manager said that she was still in the process of writing the matter up and the information was at home. The registered manager was reminded that the details of all complaints must be kept at the care home and available for inspection at all times. The service users with whom discussions were held said that they felt confident about making a complaint. They also felt confident that any complaint made would be taken seriously and dealt with quickly and appropriately. The home had clear, relevant policies and procedures on the protection of vulnerable adults from abuse, whistle blowing, physical restraint and dealing with the service users’ money and financial affairs. However, the policy and procedure on the protection of vulnerable adults from abuse must include the name and telephone number of the Adult Protection Coordinator. The policy Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 17 on whistle blowing should state that members of staff may refer a concern to the CSCI in accordance with the Public Interest Disclosure Act 1998 without having to exhaust the home’s own internal mechanisms first. An incorrect reference to Abacus House in the policy ‘How we cope with difficult situations’ should be deleted and replaced by a reference to Parklands. The registered manager confirmed that no incidents of alleged or suspected abuse had occurred within the home or been reported or had otherwise come to her attention since the previous inspection. The registered manager also confirmed that she had had no reason to refer any member or former member of staff for consideration for inclusion on the POVA register. The registered manager confirmed that training on abuse awareness had been provided for all the staff during 2006. However, the registered manager had not undertaken training on the protection of vulnerable adults from abuse at a management level. Parklands DS0000033906.V330401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users lived in a clean, homely and well-maintained environment. However, some improvements were necessary in order to ensure the safety of the service users. EVIDENCE: The home was accessible, safe and well maintained. Since the previous inspection four bedrooms had been refurbished and provided with en suite facilities. The home had an annual development/improvement plan and a record was kept of items of routine maintenance and repair. The home also had a business plan for 2007. A maintenance man was employed for 16 hours per week. A gardener was also employed for one day per week to help maintain the garden and grounds. The Environmental Health Officer had carried out an inspection on 7 September 2006. The registered manager stated that the subsequent letter dated 14 September 2006 had not been received until 21 February 2007. The letter referred to two items. The first item related to the guidance issued by the Food Standards Agency ‘Safer Food Better Business’. The registered manager said that the home intended to Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 19 adopt this guidance. The second item related to staff training. The registered manager said that basic food hygiene training had been provided for the cook, assistant cook and thirteen other members of staff on 2 February 2007. The registered manager stated that the Fire Safety Officer had not visited the home for over a year. However, the registered provider confirmed that the local Fire Safety Officer was satisfied with the arrangements relating to the fire precautions in the four recently refurbished bedrooms on the ground floor. There was fluorescent strip lighting in the dining room and lounges on the ground floor that was out of keeping with the domestic nature of the environment. The registered manager stated that replacement lighting and chairs were included in the home’s improvement plan. The carpet in the main corridor needed to be replaced and handrails provided in the corridor near to the recently refurbished bedrooms. Standard 22 was not fully inspected on this occasion. However, a recommendation was made in regard to Standard 22 as a result of the previous inspection that an assessment should be carried out as necessary by an occupational therapist for service users with sensory impairments. The recommendation had not been implemented. The wording of the recommendation has been amended and is repeated in this report. The premises were clean, tidy and free from unpleasant odours. The laundry facilities were appropriately sited and contained two washing machines, one of which had a sluicing facility, and a tumble dryer. The laundry also contained hand-washing facilities. A recommendation was made as a result of the previous inspection that the hand sink in the laundry should be identified by a suitable notice and consideration given to extending the floor tiles to cover the entire floor. The recommendation had been implemented. However, the laundry floor needed to be painted. The laundry also contained paper towels and a liquid soap dispenser. The staff cleaned manually the commode pots using anti-bacteria spray and/or bleach. The home does not have appropriate facilities to carry out this task and manual cleaning is not the recommended method of decontamination. Disposable commode pots should be used. The home provided protective gloves and aprons and these were seen being used by the staff. The home had a satisfactory policy and procedure for the control of infection. The service users with whom discussions were held said that their bedrooms were kept clean. They also said that their clothes were laundered to a satisfactory standard. Parklands DS0000033906.V330401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users appreciated the care and commitment shown to them by the staff. However, further advanced training was needed and staff recruitment procedures followed more rigorously in order to fully protect the service users. EVIDENCE: The home operated a four-week duty rota. A copy of the staff duty rota was made available for inspection. The staff rota contained the names of all the staff, their positions and the hours they worked. In the mornings, in addition to the registered manager, there was usually a senior care assistant and three care assistants on duty. The registered manager said that sometimes the number of care assistants increased to four. During the afternoon period, in addition to the registered manager, there was normally a senior care assistant and two care assistants on duty. In the evenings a senior care assistant and two care assistants were on duty. The total number of care hours provided throughout the working day was 301 hours per week. The registered manager confirmed that there were always two members of staff on waking duty at night. The home also employed a cook, an assistant cook, a clerk and a maintenance man. A housekeeper and a domestic member of staff were employed for a total of 55 hours per week. The home had a vacancy for a deputy manager, one full-time and one part-time care assistant and one night care assistant. The home used agency staff at times. The registered manager must obtain written confirmation from the employment agency that the agency staff that work in the home have undertaken an enhanced CRB disclosure check. The service users with whom discussions were held spoke positively Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 21 about the staff. One service user described them as ‘very good, very friendly and very kind’. She said, ‘I can’t complain about any of them’. The relative of one service user stated in the Comment Card, ‘Although not the smartest of places, there is always a pleasant atmosphere and the staff are friendly to both residents and family. Bathrooms and toilets are very clean’. In addition to the registered manager and other support staff, as outlined above, the home employed a total of fourteen care staff. Only four members of the care staff had completed the NVQ level 2 training. This number was less than the 50 trained members of staff required by the National Minimum Standards. However, it was pleasing to note that a further five members of staff were undertaking and, in some cases nearing the completion of, the NVQ level 2 training. The files of two members of staff were inspected. The files contained a copy of their individual contracts, job descriptions, training details and other relevant information. One of the files contained evidence to show that an enhanced CRB disclosure check had been obtained. The registered manager subsequently confirmed that an enhanced CRB disclosure check had also been carried out in respect of the second member of staff. However, neither of the two files contained a photograph of the member of staff or proof of identity and one of the files contained only one written reference. The registered manager confirmed that all the staff had been issued with a copy of the code of conduct and practice set by the General Social Care Council. The registered manager was advised to ensure that when there is a break in service and/or a member of staff terminates their employment and is subsequently reemployed by the home a new application for an enhanced CRB disclosure check is carried out. The registered manager confirmed that all new members of staff underwent an induction. The home’s staff induction programme was in the process of being reviewed. However, it was confirmed that it met the ‘Skills for Care’ standard. It was also confirmed that all the staff received a minimum of three paid days training per year. The registered manager said that individual training and development assessments and profiles had been introduced. However, these needed to be developed further. Parklands DS0000033906.V330401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect for the service users’ best interests. However, further development was needed in some areas. EVIDENCE: The registered manager had considerable relevant experience and was competent to run the home. She had successfully completed the Registered Managers’ Award training in February 2006 and had also obtained the NVQ level 4 qualification in September 2006. However, evidence should be obtained to confirm the units covered by the NVQ 4 training. The registered manager had also obtained the D32 and D33 Assessor qualifications. The registered manager had undertaken Conflict Management training in April 2006. She had also undertaken training in continence care and training in other core areas. A requirement was made as a result of the previous inspection that the registered manager must undertake training in first aid at Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 23 work and in risk assessment. The requirement had been implemented. The registered manager confirmed that she had undertaken training in first aid at work in September 2006 and risk assessment training on 14 February 2007. The registered manager had a satisfactory job description but did not have a contract. The appointment of a deputy manager would greatly assist the registered manager in the discharge of the managerial responsibilities. The registered manager said that the post was being advertised. The service users with whom discussions were held said that the registered manager was very approachable. The home had an annual development plan and a business plan. The annual development plan was linked to the quality assurance system. A requirement was made as a result of the previous inspection that a quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. The requirement had been implemented. It was stated that an audit was undertaken of each standard every year. The last audit was carried out in November 2006. The registered provider said that the audit took about three weeks to complete. The registered provider completed monthly reports in accordance with Regulation 26. These were more focussed and more immediate than the quality assurance system. The registered provider should continue to develop the quality assurance system in order to promote the standards of care. The home had issued questionnaires to all of the service users in June 2006. Some of the service users’ responses had been included in the service users’ guide. The registered manager said that questionnaires would be issued to the service users again during 2007. Questionnaires had also been introduced for relatives/visitors and a separate questionnaire for visiting professionals. It was stated that there had been a poor response from visitors. It was pleasing to note that the registered provider had carried out a thorough review of all of the home’s policies and procedures. The registered provider stated that he intended to ensure that all of the policies and procedures were understandable to staff and that they were implemented in practice. The registered manager confirmed that no one connected with the running of the home acted as an agent or as an appointee on behalf of any of the service users. It was also confirmed that the home held money in safekeeping on behalf of 21 service users. The money was kept in individual wallets in a safe. Access to the safe was restricted to the registered manager and the clerk. Individual accounts were maintained of the service users’ money. A random check was carried out in respect of two service users’ money and accounts and, in the case of one amount, there was a small accounting error of ten pence. The service users’ accounts were not independently audited. The registered manager was advised to ensure that none of the individual amounts held by the home on behalf of the service users exceeded the limit of the home’s insurance. A requirement was made as a result of the previous inspection that receipts must be given for all monies managed on behalf of service users. The requirement had been implemented. Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 24 The registered manager confirmed that staff supervision meetings were being held but not at the required frequency. The registered provider confirmed that risk assessments had been carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3. Risk assessments were carried out based on specific areas of the home and on specific hazards. The fire risk assessment had been carried out in December 2006. Legionella tests had been carried out on the water supply in January 2007. A water risk assessment had been carried out on 19 February 2007. The boilers and central heating system had been serviced on 30 November 2006. The passenger lift was serviced on 3 January 2007 and the hoists were serviced on 4 October 2006. The registered provider confirmed that thermostatically controlled mixer valves had been fitted to all hot water outlets used by the service users. The fire alarms, fire zones and emergency lighting had been serviced on 3 January 2007. PAT testing had been carried out on 24 April 2006. The laundry equipment met had been checked on 3 October 2006. The home had a health and safety policy and relevant information on COSHH and RIDDOR. A record of accidents was maintained. Three requirements had been made in regard to Standard 38 as a result of the previous inspection. The first requirement was that a member of staff who holds a qualification in first aid at work must be on duty in the home at all times. The requirement had not been fully implemented and still stands. The registered manager confirmed that she was the only member of staff with a first aid at work qualification. However, arrangements had been made for two more senior members of staff to undertake the first aid at work training before May 2007. The second requirement that staff must receive food hygiene training updates had been implemented. It was confirmed that all the staff apart from the registered manager and two other members of staff had undertaken the training on 2 February 2007. The registered manager said that she and the two other members of staff that had not undertaken the training would complete the training by June 2007. The third requirement was that all staff must receive fire safety training every three months and participate in at least one fire drill every year. Participation must be closely monitored and recorded. The first part of the requirement that all staff must receive fire safety training every three months had not been fully implemented and still stands. However, it was pleasing to note that fire safety training was provided during the inspection by an external trainer and a further training session had been arranged for 16 March 2007. The second part of the requirement that all staff must participate in at least one fire drill every year had been implemented. It was stated that moving and handling training had been arranged for 28 March and 11 April 2007 for all the staff that needed to do it. Some staff had attended a dementia study day on 10 November 2006. The registered manager said that it was expected that all staff would have received training in dementia awareness by the end of 2007. A valid certificate of employer’s liability insurance was displayed in the main corridor. Parklands DS0000033906.V330401.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 2 3 3 X 3 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 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5 Requirement The service users’ guide must be amended in accordance with the guidance given in this report so that it includes all of the information detailed in Standard 1. Copies must be available in the home and given to any prospective service user. The care plans must set out in detail the action which needs to be taken by the staff to ensure that all aspects of the service users’ needs are met and all of the care plans must be reviewed at least once a month. (Previous timescale 31/03/06 not met). The Medication Administration Record (MAR) charts must be completed at the time when the service users’ medicine is administered. A record of the correct current temperature of the fridge that is used for storing medicines that require cold storage must be maintained. The home’s policy and procedure for the protection of vulnerable adults from abuse must include DS0000033906.V330401.R01.S.doc Timescale for action 30/04/07 2 OP7 15 30/04/07 3 OP9 13 31/03/07 4 OP9 13 31/03/07 5 OP18 12,13 30/04/07 Parklands Version 5.2 Page 27 6 OP18 12,13 7 OP18 13,18 8 OP19 13,16,23 9 OP27 13 10 OP28 18 11 OP29 19 12 13 OP36 OP38 18 13,18 14 OP38 18, 23 the name and telephone number of the local Adult Protection Coordinator. The whistle blowing policy must be amended in accordance with the Public Interest Disclosure Act 1998 to enable staff to refer any concerns to the CSCI without having to exhaust the home’s internal procedures first. The registered manager must undertake training in the protection of vulnerable adults from abuse at a management level. The carpet in the main corridor on the ground floor must be replaced and handrails provided in the corridor near to the four recently refurbished bedrooms. Written information must be sought to confirm that all the agency staff used by the home have obtained a recent enhanced CRB disclosure check. Arrangements must be made for staff to receive training that will enable a minimum of 50 of the care staff to attain a qualification at NVQ level 2 or equivalent. The home’s staff recruitment procedures must be developed in accordance with the requirements of Regulation 19, Schedule 2 and Standard 29. Care staff must receive formal supervision at least six times a year. A member of staff who holds a First Aid at Work qualification must be on duty in the home at all times. (Previous timescale 30/06/06 not met). All staff must receive fire safety training every three months and their participation must be closely monitored and recorded. (Previous timescale 31/03/06 DS0000033906.V330401.R01.S.doc 30/04/07 30/06/07 30/06/07 30/04/07 30/06/07 31/03/07 30/09/07 30/06/07 31/03/07 Parklands Version 5.2 Page 28 not met). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP9 Good Practice Recommendations A record should be kept of the date when each service user was issued with a copy of the service users’ guide. Two members of staff should record independently any changes in the service users’ medication that are reported to the home by telephone in order to avoid the possibility of errors. The registered manager and staff should continue to consult the service users about the programme of social and recreational activities arranged by or on behalf of the home and a record of the activities provided and the service users that take part should be maintained. Relatives, friends and representatives of service users should be given written information, preferably in the service users’ guide, about the home’s policy on maintaining relatives and friends involvement with service users at the time of moving into the home. Details of the daily menu should be displayed near the dining room for the benefit of the service users, a sample of the food provided should be retained in the home for 72 hours and soft-boiled eggs should not be served. The home should adopt the guidance issued by the Food Standards Agency ‘Safer Food Better Business’. The fluorescent strip lighting in the dining room and lounges should be replaced with suitable alternative lighting that is more in keeping with the domestic character of the home. The advice of a qualified occupational therapist should be sought in order to ensure that the home provides all of the recommended disability equipment and environmental adaptations to meet the needs of service users including those with sensory impairments. The laundry floor should be painted. Disposable commode pots should be used. The process of developing the individual training and DS0000033906.V330401.R01.S.doc Version 5.2 Page 29 3 OP12 4 OP13 5 OP15 6 7 OP19 OP19 8 OP22 9 10 11 Parklands OP26 OP26 OP30 12 13 14 15 OP31 OP31 OP35 OP38 development assessments and profiles should be completed. Information should be obtained to confirm the units covered in the NVQ level 4 training completed by the registered manager. The registered manager should be issued with a statement of her terms and conditions of employment (contract). The money and accounts held on behalf of the service users for safekeeping should be independently audited at least every three months. The home’s quality assurance system, including the use of questionnaires, should continue to be developed as an effective way of monitoring and ensuring the quality of the service provided. Parklands DS0000033906.V330401.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Parklands DS0000033906.V330401.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. 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