Inspection on 24/01/08 for Parklands

This inspection was carried out on 24th January 2008.

CSCI found this care home to be providing an Adequate service.

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 21/02/07

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Parklands Callow Hill Lane Callow Hill Redditch Worcestershire B97 5PU Lead Inspector Penny Wells Unannounced Inspection 09:00 24 & 28 January 2008 th th 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.V372260.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.V372260.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 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.V372260.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2007 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. 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 fees are indicated in the service user guide ranging from £375 to £430 per week. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out without prior notice by two inspectors over two days. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was sent to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas where they believe they are doing well. This document was returned, completed by the registered provider. As part of the inspection questionnaires were sent to a sample of people using the service, their relatives, health care professionals and staff. A number of completed questionnaires were returned to us prior to our visit. Comments within these questionnaires are included within this report. The acting manager was present throughout this inspection. We also spoke to a number of other members of staff as well as people using the service and visiting relatives and nurses. A brief look around the home took place, which included communal areas and a sample of the bedrooms. The care documents of a number of people using were viewed including care plans, daily records and risk assessments. Other documents seen during our visit included medication records, staffing training and recruitment records. What the service does well: Information about the service is available to prospective users. Information is obtained by senior staff ensure the person can be supported and cared for at Parklands. Staff are respectful and caring towards people living at Parklands and work hard at providing good care. Entertainment is arranged and visitors welcomed. Parklands is a comfortable, safe and homely place for people to live. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 6 Comments received: We are happy with the home and care given’. ‘Generally well organised, friendly and cheerful.’ ‘Take good care of all the people when they need it most’. ‘Parklands is clean, friendly, inviting and external expertise is sought when needed’. ‘This is a well conducted home. I consider myself fortunate to be living here’. What has improved since the last inspection? What they could do better: The home would benefit from a registered manager to lead the development of the service. Care plans need to be up to date and detailed so there is a clear picture of the person’s needs, daily routines and lifestyle. The service need to develop the activities in and out of the home, meals and the choice individuals have in their daily routines. A review of the premises to ensure that there is equipment in place for people with physical disabilities and the environment is suitable for those with dementia. Aspects of infection control need attention. The service provides training for staff in care and safe working practices but needs to be undertaken by all staff so everyone has up to date knowledge. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 7 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.V372260.R01.S.doc Version 5.2 Page 8 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.V372260.R01.S.doc Version 5.2 Page 9 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 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for people considering moving to Parklands. There is an established process for new people to visit the home prior to moving in. This includes an assessment, which could be more detailed to ensure the service can meet the person’s individual needs. EVIDENCE: Parklands has a brochure, service user guide and statement of purpose that are available to people viewing the home, their relatives and professionals. The manager said that the service user guide could be in alterative format (large print, audio tape) if an individual needed this, but currently it is available in a standard format. These documents have been updated since the last inspection to include details of the new manager and deputy, and other information that was recommended should be included. The home has an established introductory and assessment process. This includes visits to the home prior to admission. At these visits senior staff assess the person to ensure that the service can meet their needs. Basic Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 10 details about the person are recorded and should be more detailed regarding the individual’s circumstances, needs and lifestyle to assist staff in supporting a new resident, particularly if they have dementia. If a person has been referred from social services an assessment is received and if a person is being transferred from a hospital a discharge letter is obtained. When further information is needed a senior member of staff visits the person in their own home or hospital and also speaks with relatives and professionals who know the person. A social worker responded in a survey ‘Good introductions, staff like to meet potential residents before admission, asking that they spend a day at the home’. Comments received about choosing Parklands: ‘I found Parklands more homely and staff friendly.’ ‘Good introductions to the home’. Each person living at Parklands has a contract, which includes the fee to be paid. Parklands does not offer an intermediate care service. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People using the service are looked after by caring, committed staff who are respectful of them and know about their individual health and personal care needs. Appropriate care is not always assured because staff have limited written guidance and not enough specialist equipment. EVIDENCE: Our observations were that people living at Parklands are looked after by caring, committed staff who are respectful to residents and know their individual health and personal care needs. Comments received about personal and health care: ‘Residents have clean clothing on.’ ‘The home acted upon the recommendations of the sensory impairment team for the benefit of the service user’. ‘When a review was carried out, it was approached positively by the staff involved’. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 12 ‘Care has always been excellent. All needs catered for and improvement in general health and demeanour seen’. ‘I do feel sometimes that they do not respond quickly enough to the bell when I need help’. The staff we met were knowledgeable about the individual needs of people. Each person has an assessment following admission and a plan of care according to their individual needs and lifestyle. This included details of their health and care needs including risk assessments for example - nutrition, skin and mobility. We also observed the support people received and spoke with some residents, keyworkers/carers and relatives. Verbal feedback indicated that the individual’s health and care needs were known and met. However the five care plans viewed did not reflect this nor gave a clear picture of an individual’s up to date needs and how these were to be met. Reviews were noted but rarely was there a full update. The acting manager or key worker was signing the recent reviews but it was unclear whether the person and their relatives had been involved in the review. One family confirmed they had not. For example a person’s care plan have been reviewed just before a fall, but not updated after the fall when the person’s health and care needs changed considerably. For persons being cared for in bed, it was unclear why this was, how to care for them and if appropriate how to support them to get up. For one such person for a week there was a record indicating that with support the person enjoyed getting up to join in social events but for other weeks there was no mention of this. There was not always a clear record of follow up when a health problem such as infection was identified. The care plan for a person, who had moved in a month ago, suffering with a dementia type illness, had been started but there was little information available for staff to know the individual’s routines and preferences, life history, details of the family (whom visit regularly). The assessment indicated the person walked with a stick at home and in the care plan ‘ with assistance of carers’ and we observed the person walking about safely yet alone. The plans also need to be person centred with factual daily records. We read ‘care as needed given’, ‘usual self to day’ which does not indicate how the person is or how they spent their day. The manager advised that she had received training in person centred planning in her last job and had held a training session in December 2007 for some of the staff about this. Assessments were recorded regarding people’s weight, risk of falling, bedside rails and skin care but not always reviewed or up to date. A senior member of staff explained that they were using a new method for checking weight if a person was unable to stand on the scales but was unsure how this worked. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 13 There was not a pictorial record (body map) for two persons who had skin lesions. A few people were being looked after in bed and in their bedrooms charts were being well kept to indicate that the person was being assisted with drinking and eating. It was a credit to staff that these people were comfortable and appeared well cared for. Drinking aids were observed in these rooms– syringes and beakers. It was unclear from the care plans, which aid should be used and the nurse inspector did not consider it good practice for syringes to be used. For one of these persons an armchair was at the head of the bed and the manager explained that this was an alternative to using bedside rails, which could be a risk to the person. There was concern that the person may fall out of bed. However this arrangement was not recorded in the person’s care plan, risk assessed and did not seem appropriate. The home was relying on the district nurses to provide pressure-relieving equipment for the frailer residents. If the care home is to continue to care for these people (who may be in bed, long term), specialist beds and equipment should be purchased by the home or the person re-assessed for a nursing home. The home is well supported by health professionals and people are encouraged to retain their own GP. At the inspection we met district nurses, who visit daily and indicated that they are alerted at an early stage when a person needs a nurse assessment. They considered people were well cared for and the environment had improved. A GP commented ‘Generally well organised, friendly and cheerful’. The acting manager advised that a local pharmacist had carried out an inspection of the medication system the previous day and she thought it was behalf of CSCI. It was clarified that this was on behalf of the Health Trust and it was agreed that a copy of the report would be sent to us. At the time of writing this report, it had not been received. We therefore did not undertake a full inspection of the medication system but an inspector was introduced to the system and sampled how two persons medication were administered and recorded. There was no record to indicate whether any quantities of medication were carried forward from one month to the next – medications not used in the month such as those prescribed ‘when necessary’ or with a variable dose. For creams and eye drops, the date when opened was not recorded. Parklands DS0000033906.V372260.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): 12,13,14, & 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live at Parklands have their individual, daily routines respected and their visitors are welcomed. Group entertainment is regularly arranged. The service needs to develop the activities in and out of the home, and meals based on the choices and preferences of individuals and their daily routines. EVIDENCE: People who live at the home are encouraged to lead their own daily routines and maintain contact with family and friends who are welcomed to visit at any reasonable time. A programme of entertainment in the home is displayed and the deputy advised that outings were arranged in the summer. The home does not have an activities co-coordinator; the deputy plans the activities and external entertainers. There are daily in-house activities planned which care staff carry out when time permits. We observed in the main lounge the television continuously on which some of the residents confirmed they liked. However the seating in half of the room, Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 15 along the two walls, with tables in front of the chairs was not conducive to watching the television, chatting, receiving visitors, pottering about or other activities. On the afternoon of the inspection we observed musical entertainers visited but this did not suit all the residents, who were not offered an alternative activity or room unless they were able to leave the lounge themselves. One resident asked to go out for a walk but staff were unable to arrange this even though it was a sunny day. Comments received about the activities: ‘Possibly more activities for residents’ ‘Try to provide more interaction with service users. More mental and physical stimulation for them.’ ‘I think our residents would benefit from more physical activities’ ‘I feel the service users could be encouraged to do a few more activities within the home.’ ‘We do have entertainment once a week, there is always a list put up but it does not always happen. I do feel we could benefit from something other than music/singers and would like a little more stimulation.’ ‘Many activities for residents - Recently bring & buy to raise funds, carol singers, Christmas party & pantomime. ‘Orientation boards would be a good idea for those that are confused’. The home does not have transport to take residents out locally for example to the shops. Some people are able to rely on relatives and friends to take them out. The provider advised that suitable transport can be arranged to meet the needs of residents. Activities for people with dementia were not apparent and a user commented ‘Because a good proportion of the residents are confused, it would be a good idea to have ‘orientation boards’ with day, date, weather.’ This had also been raised by relatives at one of the residents and relatives meetings (minutes on display in the home) and the response from management had been that these items were too expensive. A relative has offered to make the boards, which will be of benefit to people. However as the home is registered to care for older people who may have memory loss and dementia, it was disappointing that specialist equipment and activities were not being provided. Another person commented ‘Home now has more confused people so I am not able to have many conversations with others.’ The service needs to develop the activities in and out of the home according to people’s individual interests and abilities. The acting manager was considering the appointment of an activities co-ordinator and this would be beneficial. How individuals spend their days should be recorded in their plan of care. We observed that the service was not always based on an individual’s preferences but on the home’s routines – showering on set evenings, getting ready for bed early evening, set meals and group entertainment. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 16 People are offered three meals a day with the main meal at lunchtime. They could eat in the dining room, lounges or their bedroom. Relatives of residents commented: ‘I make a point of going sometimes at mealtimes and my relative is very happy with the food.’ ‘The meals are always very good’. Menus were not available for residents but the cook showed us the menu plan and advised that they knew the preferences of individuals. There was a board indicating alternatives for lunch – soup or salad but not the main meal. A menu of all the meals (and alternatives) served for the day was not available to people to view. A record of what people eat was no longer being kept. We observed the lunch, which was roast pork with fresh vegetables followed by icecream. Not everyone was given a choice of the flavour of icecream or an alternative. There were times when a member of staff was not present in the dining room so another resident was encouraging a person to eat their meal. An agency care worker was assisting a person in bed with the meal and it may have been more appropriate if a permanent member of staff whom they knew better had assisted this person. For people having soft or liquidized diets, the foods were not separated out on the plate to make it attractive and interesting to eat. The contents of these meals was not always recorded. The evening meal was served at 4.15 pm – pate on toast, cake and two people had soup. The menu indicated eggs and beans on toast. Supper at 7.00pm was to be hot cross bun and biscuits and at 9.00pm a hot drink and toast. The staff said that about a third would be awake for 9.00 pm drinks and snacks. A review should take place to ensure that the interval between the last evening snack and breakfast is no more than 12 hours for individuals. Also that other meals are as nutritious as the lunches with healthy options included. There needs to be a review of meals and snacks so that people have a daily menu, choice at all mealtimes which includes nutritious foods, appropriate assistance from staff that know them and a record is kept of what individuals eat. Parklands DS0000033906.V372260.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. People living at the home, their families and staff know how to male a complaint. The service has complaints, whistle blowing and adult protection procedures in place and staff are aware of the importance of reporting any allegations of possible abuse. This needs to be supported by all staff having training about safeguarding vulnerable adults. EVIDENCE: Survey responses from residents & relatives indicated that people knew who to speak to if unhappy or wishing to make a complaint. The service has a complaints procedure and suitable policies and procedures to ensure that people are safeguarded. These procedures had been reviewed since the last inspection. The owner and senior staff indicated that there had been no complaints and commented ‘deal with niggles straight away’. The acting manager confirmed that she undertook training in protecting vulnerable adults in her last post and is familiar with the Worcestershire guidelines. The training matrix did not indicate if staff have received training in protecting vulnerable adults nor did the staff spoken with indicate they had received this training. Parklands DS0000033906.V372260.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, 21 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is providing people with a comfortable, homely, clean and safe place to live in but could benefit from some improvements. EVIDENCE: Parklands is a comfortable, safe and homely place for people to live. The premises has been a care home for over 20 years and rooms adapted and extended over the years to improve the facilities for people who live at Parklands. For example five of the 17 single bedrooms have ensuite toilets, some of the double bedrooms (seven) are let to one person and a smaller, double bedroom was being re-furbished as a single room. During the last year the home’s programme for maintenance has included a new call alarm system, upgrading of the water tanks, replacement furniture and carpets in some of the rooms, new domestic lighting in the communal rooms. Comments received about the environment: Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 19 ‘It is being updated as it was a little tired! It is always clean.’ ‘The home is clean and warm’. ‘Now the home employs cleaners, it is much better’. The communal areas were viewed and some of the bedrooms. There is a choice of places to sit as the home has two lounges and a dining room. We observed in the main lounge that the seating is in half the room, along the two walls, with tables in front of the chairs, which made the area cluttered. This lay out was not conducive to watching the television for those sitting on the same side as the television, chatting, receiving visitors, pottering about or other activities. The radiators in some of the communal areas are not covered but the owner has advised that these radiators have been risk assessed. The communal rooms were a comfortable temperature during the day but we noted that the lounges were cool at 5.40 pm. When this was mentioned to staff, they were able to turn the central heating on. We observed some fire doors, including bedroom doors, wedged open. These fire doors need automatic door releases fitted or the doors kept shut for the safety and privacy of people. The advice of the fire safety officer could be sought and residents consulted with. Parklands has extensive grounds which are unfortunately are not level. There are small, level areas for people to sit out including a new seating area. There are plans to improve the footpaths. The home has new domestic staff who are keeping the home clean and fresh. Parklands has bathrooms and a shower room but it was apparent from our observations and conversations with the acting manager and staff that the shower is used a lot and not the bathrooms. The bathrooms were not warm and welcoming, with aids that need updating to suit the current residents’ needs. Some of these rooms were being used to store furniture. This limited the choice for residents to have a bath. Bars of soap and communal toiletries were observed which is not hygienic or personal. Also all these rooms should have paper towels and soap dispensers. Aspects of infection control could be improved as outlined in the above paragraph. Also we observed - some waste bins did not have lids and pedal bins would be more hygienic, two rusty toilet frames which needed replacing, a hoist being stored in a lounge which was inappropriate, a hoist sling with a person’s name on was in another person’s bedroom and the most popular toilet in need of a clean and tiles replaced. The laundry was viewed and has suitable washing, drying and ironing equipment. The floor appears to be uneven and should be risk assessed. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 20 There is a separate sluice room with compact machine for the cleaning of commode buckets. Discussion took place with the acting manager about the safest methods for staff to deal with soiled laundry to avoid sluicing by hand. We had previously recommended that the home is assessed by an occupational therapist and this still applies because many of the people living at Parklands are frailer. We considered that some of the communal rooms and grounds could be better utilised so that people have more choice of where they spend time/sit. Parklands DS0000033906.V372260.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): 27,28,29, &30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The staff group is hardworking and committed to their work and provide people living Parklands with caring and respectful support. Staffing levels need to be reviewed to ensure staff have time to care and support each individual with their differing care needs and interests. The service provides training for staff in care and safe working practices but this needs to be undertaken by all staff so everyone has up to date knowledge to ensure the safety of people. EVIDENCE: Comments received about staff: ‘All staff are very helpful.’ ‘Staff are friendly and attentive to our relative’. ‘Staff really seem to care’ Comments from staff: ‘The owner and manager of parklands are keen to ensure the residents who live there always come first. They also are keen to keep staff fully trained in all aspects of care’. ‘The service gives good care and support and makes the home as comfortable and friendly as possible. It also provides training courses to keep us up to date with new methods’. ‘I have worked here for many years and think on the whole it is a good home but could be improved’. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 22 ‘Gives good care. The food is excellent. The home is clean and friendly’. ‘The induction process was very thorough’. ‘At Parklands we provide a good standard of care’. Our observations, the survey responses and discussions with some residents and relatives, a sample of staff (senior, carers (day and evenings), laundry and catering) are that people are looked after by a committed, caring, hard working and enthusiastic staff. Many of whom have experience and worked at Parklands for some years. Since May 2007 more senior staff appointed, including a deputy. We were pleased to hear that the home was now fully staffed and only using agency staff occasionally. Rotas were available. We observed how busy care staff were (especially in the evenings) leaving little time to spend talking with residents and initiate activities. People who live at Parklands have differing care and support needs including mental and physical frailties, which is demanding for staff. The staff came across as friendly, caring and those that had been at the home a long time, aware of people’s individual needs and routines. Information about training for staff was received. Various in-house training sessions on person centred planning, fire safety, risk assessing, infection control, health and safety had taken place during October – December 2007 and attended by some of the staff. Other staff still needed this training. The acting manager said training was being planned in safeguarding vulnerable adults and dementia awareness for the staff. Four staff had trained as first aiders in December 2007. Information provided by the provider and the training matrix indicated that 9 of the care staff, including agency care staff, had an NVQ in care and 4 were working towards an NVQ in care. This meets the national minimum standard of 50 of care staff having an NVQ in care. It would be beneficial for senior staff have an NVQ in care at level 3 or equivalent. Staff may benefit from further training in a person centred approach, promoting individual choice and interests. A sample of three staff files were viewed and indicated that the home has a suitable recruitment and vetting process. Photographs of staff need to be included in the files. The three staff that had been appointed in the autumn had commenced the induction programme but not yet completed it. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 23 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs a registered manager to lead and develop the service for the people who live at Parklands. Staff should receive regular supervision to support them in their jobs. All staff need up to date training in safe working practices. EVIDENCE: Parklands registered manager left in May 2007 and the owner arranged for senior staff to act up until August 2007 when another manager was appointed. The acting manager was present for the inspection. She is a qualified nurse and has 19 years experience of working in nursing homes and a care agency. The acting manager had a funded place to do the Registered Manager’s Award and this would be beneficial to both her and the home. Parklands needs a registered manager to lead the development of the service. The provider Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 24 indicated that an application for the manager to register with CSCI would soon been submitted. The home has a quality assurance programme to audit the service and the owner advised that there is an annual business plan. The manager and deputy advised that questionnaires had been completed by residents, relatives and some professionals. The owner indicated that the feedback was positive although the analysis of the surveys was not available in the home or in the service user guide. There were on going checks, with the owner visiting weekly and completing a monthly report. The owner had completed an annual quality assurance assessment for the commission. However an annual audit was not available in the home. The majority of the requirements and recommendations from the last inspection had been implemented or were being worked on. The acting manager has commenced a programme for staff to receive supervision. From the staff records viewed it was apparent that some staff have not been receiving supervision regularly and two of three new staff not received their first supervision. This may need to be shared amongst the senior staff to ensure that all staff receive support and supervision at regular intervals. Staff development plans and appraisals were yet to be done. The administrator keeps monies on behalf of people living at the home. These were kept safely and records kept for the monies. The home is not acting as appointee for anyone or keeping valuables for residents. People can only access their monies when the administrator is at work and if they need monies at other times, it is arranged. More residents should be encouraged to look after their own monies, keeping it safely in their bedrooms so they can have access to it at anytime. A health and safety policy and procedure is in place, and there were good records to indicate that services and equipment in the home were regularly maintained. The fire log indicated that fire safety checks were being carried out, with the required frequency, fire drills were undertaken and there was fire risk assessment. An up to date certificate of electrical safety could not be located. The training matrix indicated that there had been various training sessions in safe working practices during October – December 2007. Some staff still need up to date training in safe working practices such as fire safety, infection control, health and safety. There are 4 first aiders and more staff should be trained to ensure that there is a first aider on each shift. The service keeps an Accident Book and notifies CSCI (as required), of accidents or incidents involving a resident. Parklands DS0000033906.V372260.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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Parklands DS0000033906.V372260.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 OP19 Regulation 23(4) Requirement Fire doors must be kept shut or fitted with automatic door closures for the safety of people. A risk assessment needs to be carried out and the advice of the fire brigade sought. Timescale for action 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should clearly indicate the current personal and health care needs and lifestyles of the person to ensure staff have detailed information to be aware and respond to the current needs of residents. The use of syringes for assisting people with drinks should be discouraged unless clearly stated in the person’s care plan and risk assessed. The medication records should include ‘carried forward quantities’ to enable accurate audits to be undertaken. Eye drops and creams should be dated when opened and discarded within the manufacturers recommended timescale. DS0000033906.V372260.R01.S.doc Version 5.2 Page 27 2. 3. 4. OP7 OP9 OP9 Parklands 5. 6. 7. 8. 9. 10. OP12 OP12 OP13 OP14 OP15 OP15 11. 12. 13. OP22 14. 15. 16. 17. 18. 19. OP26 OP26 OP30 OP36 OP38 OP38 The activities in and out of the home are developed so that people’s individual interests are recognized. An activities co-ordinator should be appointed. The home would benefit from having a vehicle for people to go out. Individual choice, preferences and daily routines should be promoted and recorded. The daily menu, indicating the choices of food at mealtimes, should be available for all residents. There should be a review of the times, choice and nutritional value of meals and snacks, how people are assisted with eating and drinking and a record kept of meals and snacks provided to individuals. All staff should receive training in safeguarding vulnerable adults. The seating arrangements in the main lounge should be reviewed in consultation with all the residents. There needs to be a review of the home, bathrooms and gardens to ensure that all areas are suitable for frail people to use and where necessary specialist equipment and environmental adaptations provided. The advice of a qualified occupational therapist should be sought to assist in this review. The laundry floor should be level and painted. Aspects of hygiene and infection control should be improved. All staff should be appropriately trained in care, safe working practices with a minimum of 50 of the care staff attaining a NVQ level 2 or above. Staff should have regular supervision to support them in their jobs, including a development plan and appraisal. A current certificate of electrical safety should be at the home. There should be a member of staff trained in first aid on every shift. Parklands DS0000033906.V372260.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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.V372260.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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