Inspection on 27/06/06 for Parklands

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Parklands 20/04/07

Parklands 21/02/06

Parklands 26/05/05

Parklands 21/01/05

Parklands 30/09/04

Parklands 22/10/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Parklands 21-27 Thundersley Park Road South Benfleet Essex SS7 1EG Lead Inspector Carolyn Delaney Key Inspection 08:00 27th June & 5 July 2006 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 DS0000015555.V299426.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 DS0000015555.V299426.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parklands Address 21-27 Thundersley Park Road South Benfleet Essex SS7 1EG 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) 01268 882700 01268 882749 Canaryford Limited Mrs Tina Ann Coveley Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54), Terminally ill (12) of places Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Nursing and personal care to be provided for up to 54 Older People. Nursing and personal care for service users who have a terminal illness and are over the age of fifty-five years not to exceed twelve. Nursing and personal care to be provided for up to a maximum of six service users who are over the age of forty years and under 45 who do not have a Terminal Illness. Nursing and personal care to be provided for up to a maximum of eight residents who are over the age of forty-five years and under 65 and do not have a Terminal Illness. 21st February 2006 Date of last inspection Brief Description of the Service: Parklands Nursing Home is a purpose built establishment, which provides nursing and personal care for up to fifty-four older people. The home can admit up to eight people who have a terminal illness. Parklands is situated close to the local shops and amenities in South Benfleet. The home has been recently extended to provide a fourteen-bed unit for people who require a period of rehabilitation or respite care. The range of fees for accommodation and / or nursing care at the home ranges from £338 - £ 650 per week. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced Key inspection carried out on 27th June and 5th July 2006. Lead inspector Carolyn Delaney carried out the inspection. As part of the inspection process a number of the Commissions ‘ Have your say about..’ service users questionnaires were posted to the home prior to the inspection visit and four residents responded. In addition a further six residents living at the home were spoken with during the inspection visit. The relatives of fifteen residents at the home were contacted by post so as to offer them the opportunity to make comments about the services provided by the home. At the time of completing this report ten of these people had responded. Four health and social professionals were also contacted for their views about the home. Two of the four responded. The comments and views of residents and those people who responded to questionnaires have been used in conjunction with the findings of the inspection visit so as to make a judgement about the level of services provided by the home and have been included throughout the report. Records including assessments, care plans, daily care notes, and medication records and risk assessment documents in respect of five people living at the home were examined. Five residents and one relative were spoken with during the inspection Six members of staff including two temporary agency staff and the homes manager were spoken with and a number of records including duty rota’s and staff recruitment files were examined. A tour of the premises was carried out. Key standards as identified in the intended outcomes sections of this report are inspected at each key inspection. Key standards are identified for each section of the report. Where other standards have not been assessed these will have been assessed at previous inspections. Reports in respect of previous inspections may be accessed via the Commissions website www.csci.org.uk. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Some people who have been admitted to the home for intermediate care have not had a proper assessment of their needs carried out before arriving at the home. Some of these residents were spoken with during the inspection and some did not feel that the care was good or as expected. One resident said that he spent most of the day in a wheelchair and that staff assisted him to walk only when it was time for meals, whereas he would normally be up and about more at home. Another resident complained that staff expected him to retire to bed very early in the evening and residents were observed to be encouraged to go to bed very shortly after the evening meal at about 6pm. A number of external health and social care professionals who are involved in the provision of intermediate care at the home also expressed some concerns Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 7 about how this care was provided and indicated that residents relatives were not always happy with care at the home. Care plans describing the care needs and support that each individual requires are generally well written but they lack details of residents particular choice for such areas as preferred times for getting up and going to bed etc. The routines of the home mean that staff often make decisions without consideration for the wishes of the people who live there. Staff are provided with training and information so as to care for the people living in the home. However there are significant shortfalls in the care actually provided by staff. A number of people living at the home who are confined to bed have developed pressure sores whilst in the home. Records including care plans and risk assessments are not consistently maintained and do not provide evidence that staff provide care and support so as to minimise the risks of skin damage to those people who are not mobile and who may need to spend prolonged periods of time in bed. The local tissue viability nurse specialist has also raised concerns about care practices in the home and feels that more could be done to reduce the risk to residents. On the day of the inspection two members of temporary staff were observed to feed three residents who were being nurse in bed. Staff did not assist these residents into a suitable position in accordance with the persons plan of care before feeding them their meal which put these people at risk of aspiration / choking. There are activities provided by the home and the homes hobby therapist is keen to improve resident’s quality of life by providing a range of stimulating and enjoyable activities. However the provision of activities is not sufficient for the numbers of people living at the home and their varying needs and wishes. The hobby therapist is employed for 30 hours per week and this is generally during the day between Monday and Friday. Residents who were spoken with and particularly those who have been admitted to the home for a period of rehabilitation feel that there is very little for them to do to keep occupied. A number of residents and relatives who completed survey questionnaires also commented that more activities could be provided. Meal times at the home, in particularly lunchtimes appear very chaotic. Staff tend to serve meals according to an alphabetical list, which means that people sitting at the same table have meals served to them at different times, which does not promote a congenial setting for residents to enjoy their meals. Some residents complained at having to wait for meals while others sitting next to them had already finished their meal. The support provided at mealtimes for those people who are less capable was seen to be very poor. Staff were observed to feed residents without any interaction with them and two Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 8 members of staff conversing with each other while assisting residents with their meals. Resident’s views about the food provided by the home were mixed. Two residents said that they were not happy with the food; one stating that it was ‘horrible’. Two others who were spoken with said that the food was ‘alright’. The staffing levels and the way in which some staff work does not ensure that resident’s needs are best met. The majority of people who spoke with the inspector or completed surveys feel that there is not always sufficient staff available to assist residents. Residents complained at having to wait for long periods to receive assistance when they wished to use the toilet etc. There have been concerns over the past three regarding how the home recruits staff. It was very disappointing to note that staff recruited to work at the home had not had all of the checks carried out, as are required by law, to ensure their fitness and suitability to work in a care home. References were not checked so as to determine that they were from a candidates previous employer, work histories were not checked for gaps etc and Criminal Records Bureau (CRB) disclosures and PoVA First checks were not obtained before a person starts work at the home. These checks are part of a good systematic approach to recruitment to minimise risks of abuse or harm to people living in care homes. The registered providers attitude to concerns raised in respect of staff recruitment is defensive and poor. Overall the home could be managed better and in a way that puts the people who use the service first. Only 32 of the overall standards and 24 of key standards have been met. 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. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 6 Outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The registered persons do not ensure that all people who are offered a place at the home have had their nursing and / or care needs assessed as is required by regulation so as to determine that the home can meet the individual’s needs. Parklands does not consistently provide care for those people who are admitted to the home for a period of rehabilitation in a manner which meets the expectations of residents, their relatives and the other health and social care professionals involved in the provision of rehabilitative / intermediate care. EVIDENCE: Parklands provide intermediate care for up to six people at the home. This service is commissioned and funded by Castle Point & Rochford Primary Care Trust and Essex County Council Social Services. The aim of this is that Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 11 residents will be offered a placement period of up to six weeks following their discharge from hospital where they are supported by the homes staff and physiotherapy and occupational therapy staff from the Primary Care Trust with a view to being able to move back to their homes following their stay at Parklands On the day of the inspection it was noted that a number of residents who had been admitted to the home for a period of rehabilitation had moved into the home without an assessment of their nursing and care needs having been carried out by the home. The homes manager said that each individual’s needs were discussed as part of the regular multidisciplinary team meetings held at the home and that from this a decision was made as to whether the home could meet the individuals needs. However when the inspector attended one of these meetings it was clear from this meeting that there were a number of shortfalls in the care provided and that the expectations of both the resident’s relatives and the health and social care professionals were not being met satisfactorily. Four of the professionals who attended the meeting were provided with survey questionnaires so as to offer them the opportunity to make comments about the services provided by the home. At the time of writing this report two had responded. Comments were made about poor support in assisting residents with medication and overall poor care such as dressings not being changed in accordance with care plans and residents being left for long periods when they used the call bell to ask for assistance to use the toilet etc. One healthcare professional commented that staff did not always demonstrate a clear understanding of the care needs of residents and that specialist advice was not always incorporated into the resident’s plan of care. On the day of the inspection it was noted that a number of the people who had been admitted to the home for rehabilitation were not supported by staff in respect of improving their mobility. For example a number of residents who required support in improving their mobility before being discharged home spent a lot of time sitting in wheelchairs and there was little evidence that staff encouraged mobility and exercise. One resident complained that he was ‘put to bed very early’ and when at home would normally remain up much later. There were fairly detailed pre- admission assessments in place for those people who had been admitted to the home for a long-term placement. In addition there were copies of letters, which had been provided to these residents or their representatives confirming the homes ability to meet the needs of the resident. There were signed contracts of terms and conditions in respect of the placement at the home which included details of fees and what facilities and treatment etc was to be included in the cost of care. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 12 Of the four ‘Have your say about…’ care homes surveys completed by residents at the home all four stated that they had received enough information about the home before they moved in so as they could decide if it was the right place for them and all stated that they had received a contract when they moved into the home. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. In generally information about each residents nursing and care needs including risks to health are well recorded. However staff do not always act in accordance with the planned care, which exposes some people living at the home to unnecessary risks to their health and welfare. Nursing staff do not always act in accordance with the homes policy and procedure for the safe administration of medicines. Residents and their relatives feel that staff treat people living at the home with respect and promote privacy and dignity. EVIDENCE: The care plans and risk assessment documents which were assessed on the day of this inspection were generally but not consistently well written and contained detailed information about the residents nursing and care needs and the actions, care and treatment staff were to provide so as to ensure that these needs can be met. However information about each persons preferences Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 14 for receiving support and spending their time was not recorded in most cases. It was clear that staff did not always act so as to ensure that resident’s needs were met and that they were protected from harm and injury. For example two residents who are cared for in bed, were observed to be fed their lunchtime meal whilst in a lying position in bed. Both of these residents were being fed by agency staff one of whom had not worked previously at the home and informed the inspector that he was not aware of the residents needs. It was particularly concerning to note that both these residents had been assessed as being at particular risk of choking when being fed and care plans clearly indicated that both these residents should be assisted to sit in an upright position when being assisted with feeding so as to minimise the risk of choking. The homes manager commented that the practices observed by the inspector were as a result of the need to use agency staff to cover absence of regular staff who were attending training. However this is unacceptable and there was no evidence that the homes permanent staff had provided any information for the temporary staff so as to ensure that they could provide safe and proper care for the people living at the home. At the time of this inspection eleven of the forty-nine residents (22 ) had pressure sores. Of the eleven five had developed while the resident was living in the home and the other six people had been admitted to the home from hospital with pressure sores. The local tissue viability nurse specialist has expressed concerns about the practices at the home in terms of managing the risks to people who may be at particular risk of developing pressure sores. It was noted that some care plans were not very clear in respect of how often a person whose mobility is reduced should have their position in bed etc changed so as to reduce pressure to vulnerable areas and minimise the risks of pressure sore development. It was also not clear as to what protocol was in place in respect of when advice should be sought from external wound care specialist or the rationale used when choosing a particular pressure relieving device. This information was not recorded in care plans for those people who may be at risk of developing or have existing pressure sores so as to ensure continuity of good practices. One healthcare professional involved in the commissioning of intermediate / rehabilitative care beds also commented that specialist advice was not always incorporated into the care plan and carried out consistently. Of the four ‘Have your say about…’ care homes surveys completed by residents at the home one stated that they always received the care and support they need, two stated that they usually did and one that they sometimes did. All stated that staff usually listened to them and acted upon what they said. On the day of the inspection the Medication Administration Records (MAR), which were assessed, were noted to be well maintained with staff signatures indicating when medicines were administered. Medicines were noted to be Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 15 stored safely. The procedures for ordering, receiving and disposing of medicines were also noted to be satisfactory. However both healthcare professionals who responded to the survey provided by the Commission commented that they had some concerns about the administration of medicines to people living in the home. One commented that on a number of occasions that staff did not support residents to take their medicines but rather left them with the resident without checking that they had been taken before signing the MAR to indicate that they had been taken. This practice was observed on the morning and evening when staff administered medicines at mealtimes. Staff were observed during the inspection to treat residents in a manner, which promoted their privacy and dignity. Residents, their relatives and healthcare professionals confirmed that meetings and treatments were carried out in private. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. The programme of activities provided by the home meets the needs of some but not all of the people who live there. The daily routines are not flexible and do not best meet the needs of a number of people living at the home. EVIDENCE: The home employs a ‘hobby therapist’ to provided activities for the people living at the home. The ‘hobby therapist’ is employed for thirty hours per week, Monday to Friday during the day. There appear to be very little in the way of activities provided during the evening. The ‘hobby therapist’ was spoken with and she was seen to be very enthusiastic and committed to improving the lives of the people living at the home through the provision of stimulating activities such as cinema & bingo clubs, music and reminiscence. Where residents were capable they were supported to go out to local shops and cafes etc. Residents have access to garden area and a number of residents were sitting outside on the day of the inspection. The local library provides a supply of books on a regular basis and staff said that the bingo club was popular among some residents. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 17 Two of the seven relatives who responded to the questionnaire provide by the Commission commented that there could be more provided in the way of stimulation. Two of the four residents who completed the ‘Have your say about..’ survey also commented that there was not always enough activities available and two residents who were spoken with also commented that there was very little to do during the day. Two of the seven residents relatives who completed surveys indicated that in their opinion the home did not consult them if the resident was unable to make choices about their care. It was disappointing that one resident who was admitted for a period of rehabilitation was encouraged to go to bed at a time much earlier than that of his choosing and it was recorded in the daily care records for this individual that on one occasion he had ‘refused to go to bed at 18.30.’ Residents may receive visitors at any reasonable time. Two of the seven relatives who completed comment cards said that staff did not welcome them in the home. These people provided no further information. Breakfast is served between 08.30 and 10.30. Residents have a good choice including cereals, scrambled egg and toast. Most residents who were spoken with at this time said that they enjoyed their breakfast. Three of the residents who completed the ‘Have your say..’ survey said that they were usually satisfied with the meals at the home and one said that they were always satisfied. One resident who was spoken with said that the food was ‘horrible’ and that he was meant to have extra snacks and food but that this was not always provided for him. It was recorded in his care plan that extra snacks were to be provided however it was not evident that this did happen. Two others who were spoken with said that the food was ‘alright’. One resident’s relative who was spoken with during the inspection commented that the food was generally fairly good but that the resident had a very small appetite and that a smaller plate of food had been requested but that staff did not provide this. The resident also said that when she ordered an omelette that it contained ham despite the fact that staff were aware that the resident is a vegetarian. It was noted that mealtimes at the home appeared very chaotic. For example staff provide meals to residents in alphabetical order, which means that some residents have finished their meal while others sitting at the same table have not received theirs. This does not provide a congenial setting for mealtimes. It was also noted that one of the two agency members of staff working at the home at the time of the inspection was not aware of the content of the meal he was feeding to a resident. The practices of both agency staff when feeding three residents at the home were dangerous and unacceptable. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 18 It was also noted throughout the inspection that the interaction between staff and residents was particularly poor. One permanent member of staff was observed to stand by the side of a resident when feeding their lunchtime meal and engaging in conversation with another member of staff while providing little or no interaction for the resident. The evening meal is said to be served between 4.30pm and 6.30pm. However on the day of the inspection the meal was commenced shortly after 4pm and completed by 5.30pm. This taken with the comments made about residents being put to bed very early means that a number of people may not have any food between 5.30pm and 08.30am the following morning (15 hours). The manager said that toast etc is provided at 8pm. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Records in respect of complaints are not maintained in line with regulation and do not indicate the outcome of complaint investigations or whether the complainant is satisfied with the outcome. EVIDENCE: The homes complaints policy and procedure is posted in the homes foyer and details about how to make a complaint are contained within the homes service users guide and statement of purpose. Each of the four residents who completed the ‘Have your say about..’ survey stated that they knew whom to contact if they wished to make a complaint. Of the ten residents relatives who completed comment cards four said that they had made complaints to the home. No further information was provided regarding whether they were satisfied with the outcome etc. A number of resident’s relatives indicated that they were not aware of the homes complaints procedure. Records indicated that there have been two complaints received by the home since the last inspection. One resident had made both complaints. The first complaint was regarding staff not relaying information to the resident’s relatives. The second was regarding the resident being left sitting at the dining room table for two hours after breakfast. It was recorded that staff had asked Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 20 the resident to sit at the table until the district nurse had arrived at the home to redress the residents’ leg ulcers. It was not clear from the response that staff at the home accepted that this practice was unacceptable or whether the complaint was substantiated. Staff at the home are provided with information and training regarding the protection of vulnerable people. There have been no alerts made regarding alleged or witnessed abuse of anyone living at the home since the last inspection. However some staff practices as described within the health and personal care section of this report put some people living at the home at risk of unnecessary harm. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Parklands provides accommodation, which is suited to the needs of the people who live there. EVIDENCE: The layout of the home is suited to the needs of the people who live there. One resident complained to the inspector that ‘the noise from the laundry was driving her mad’ particularly when the weather was hot and the windows were opened. This matter was referred to the homes manager to deal with. Throughout the inspection the home was noted to be clean and free from unpleasant odours. Each of the four residents who completed the ‘Have your say about..’ commented that the home was always clean and fresh. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. The deployment of staff and routines of the home does not meet the needs of the people living there. Staff are not recruited according to a consistent and robust procedure, which is in line with current regulations and protects the interests of the people living at the home. Staff are provided with training opportunities and support so as to prepare them for their roles within the home. EVIDENCE: Staff are employed in the home in the following numbers; 10 care staff and two nurses between 7am and 12 midday, six care staff and two nurses during the afternoon, one nurse and four care staff at night. In addition an extra member of care staff is employed between 5pm and midnight and 6am and 11 am. The home can accommodate up to 54 people many of who are very dependant upon staff for assistance with normal daily activities of living. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 23 Six of the ten relatives who completed surveys said that in their opinion that there were not always sufficient numbers of staff on duty at the home. A number of resident’s relatives, health and social care professionals also commented about the length of time that residents had to wait for staff assistance. One relative commented that at times there were not enough staff on duty at night. On the second day of the inspection it was also noted that staff did not deal with requests for assistance promptly and that call bells went unanswered for some time. Of the four residents who completed the ‘Have your say about..’ survey two said that staff were sometimes available when needed and the other two said that staff were usually available. One resident commented that it was difficult to get staff at ‘changeover time’ It was noted during the inspection that key times such as meal times particularly at lunchtime were chaotic. Due to the routines for serving meals residents are not served meals in a manner, which promotes a congenial setting. This an example of how the routines of the home were staff orientated and not in the best interests of the people living at the home. The home relies heavily on the use of temporary agency staff to cover for maternity, sick and annual holiday leave. This has an impact upon the care provided to the people living at the home as temporary staff are not provided with enough information and support so as to provide good quality and safe care. At the time of this inspection five staff had National Vocational Qualification to (NVQ) level 3 in care and a further seven had level 2 qualifications making a total of approximately 30 of care staff. The home has a detailed training programme for both care and nursing staff providing both mandatory training such as safe moving and handling, fire safety and health and safety as well as a number of specialist courses and training days. A number of files were assessed for staff who had been employed to work at the home since the last inspection. Records did not indicate that all of the checks as required by regulation in order to protect the interests of the people living at the home had been carried out. For example no checks had been made so as to assure that references had been obtained from a candidates previous employer, checks were not made in respect of previous employment histories and PoVA First & Criminal Records Bureau (CRB) disclosures had not been obtained prior to the person commencing employment at the home. The home has a very poor history of complying with regulations regarding the employment of staff and an Immediate Requirement notice was issues at the inspection requiring the responsible individuals – the homes manager and owner to take immediate and ongoing action so as to ensure that people recruited to work at the home are subject to rigorous checks so as to protect the interests of the people living at the home. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 24 Since the inspection the homes owner has written to the Commission to express his disagreement with the findings of the inspection regarding the recruitment and employment of staff at the home. However there are no factual inaccuracies in the information as recorded by the inspector. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 36 & 38 Outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not always managed so as to best meet the needs and interests of the people who live there. The home is well maintained in relation to maintenance, repair and regulatory checks of premises and equipment. EVIDENCE: The registered manager is a competent and skilled nurse with a good background in home management and the home has policies and procedures in place so as the home is managed well. However there were a number of areas identified during the inspection, which indicate that the home is not always run Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 26 in the best interests of the people who live there. Assumptions are made by staff about resident’s daily activities. For example a member of staff commented that residents are tired by 6pm and therefore go to bed. However a number of residents feel that they are not given the opportunity to make decisions about how they spend their time. Routines within the home are not flexible, are driven by staff and not the needs of the residents. The registered provider does not make unannounced inspections to the home and provide reports in respect of these visits to the Commission in accordance with Regulation 26. The home has in place policies and procedures for safeguarding valuables and monies handed in for safekeeping and there are locked storage facilities for those who choose to retain possession of their valuables and monies. However where monies are held for safekeeping on behalf of residents there were no receipts available in respect of expenditure for services such as hairdressing and chiropody. The homes manager said that the owner keeps a list of financial transactions however this was not available on the day of the inspection. Newly appointed staff receive appropriate induction and there is a system in place for the supervision of staff and there was evidence that this is carried out on a regular basis. Regular meetings are held so as to ensure tat staff working at the home are kept up to date with developments within the home. There is a dedicated maintenance person employed by the home and there were no safety issues observed during the course of the inspection in respect of the maintenance of gas, electrical, mechanical or fire safety equipment at the home. Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X X 1 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 3 X 3 Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 & 4 Requirement The registered persons must ensure that a detailed assessment of each individuals nursing and general care needs is carried out for each person to be placed at the home prior to their placement so as to determine that the home can, taking into consideration the needs of the other people living at the home and the homes resources, effectively meet these needs. This requirement is outstanding from the last inspection and the previous timescale of 28/02/06 has not been met. 2. OP6 4 & 14 The registered persons must ensure that the home is run so as to meet the specific needs of people admitted for a period of rehabilitation. The registered persons must ensure that staff act in accordance with the homes policies and procedures, and the DS0000015555.V299426.R01.S.doc Timescale for action 30/09/06 30/09/06 3. OP8 13(4) 30/09/06 Parklands Version 5.2 Page 29 care planned for each individual so as to ensure that their health needs are met and risks to health and welfare are minimised. This with particular reference to the management of risks to residents of developing pressure sores and ulcers and ensuring that all staff providing care to residents are aware of their needs and carry out care and support in accordance with planned care. This requirement is outstanding from the last inspection and the previous timescale of 28/02/06 has not been met. 4. OP9 13(2) The registered persons must 30/09/06 ensure that all nursing staff act in accordance with the homes policies and procedures, the NMC Codes and relevant legislation in respect of the safe handling and administration of medicines. The registered persons must ensure that so far as it is possible that people living at the home are supported and encouraged in making choices about how they would wish to receive care and assistance with carrying out activities of daily living so as to promote and maintain independence. This requirement is outstanding from the last inspection and the previous timescale of 30/03/06 has not been met. 30/09/06 5. OP14 12(2) & (3) Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 30 6. OP15 16(2) (i) The registered persons must ensure that residents receive in adequate amounts, suitable wholesome and nutritious foods at any reasonable time and in a setting, which is safe, congenial and suited to the persons needs. The registered persons must ensure that staff act in accordance with the homes policies and procedures & information recorded about residents so as to protect residents from the risk of unnecessary harm. The registered persons must ensure that at all times there are sufficient numbers of suitably skilled and competent staff employed so as to meet the needs of the people living at the home and that the ensure that the employment of any persons on a temporary basis at the care home will not prevent service users from receiving such continuity of care as is reasonable to meet their needs. The registered persons must ensure that staff are only be employed at the home once all of the necessary checks have been carried out so as to protect the interests of residents living at the home. (Previous timescales of 25/5/05, 28/2/05 and three previous set dates have not met) This must be addressed with immediate effect. 30/09/06 7. OP18 13(4) & (6) 15/09/06 8. OP27 18(1)(a) & (b) 30/09/06 9. OP29 19&sch 2&4 10/09/06 10. Parklands OP32 4 The registered persons must ensure that the home is run and DS0000015555.V299426.R01.S.doc 30/09/06 Page 31 Version 5.2 11. OP33 24 & 26 12. OP35 17(2) & sched. 4 managed for the benefit of the people who live there and that the routines and staff practices are flexible and suit the needs of residents. The registered person must implement systems to monitor and improve the quality of care provided by the home and carry out visits in accordance with Regulation 26 of the Care Homes Regulations. The registered persons must ensure that the home is run and managed for the benefit of the people who live there and that the routines and staff practices are flexible and suit the needs of residents. 30/09/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP12 Good Practice Recommendations Care plans should be reviewed and amended to include resident’s wishes regarding daily activities of living. The homes hobby therapist should plan activities which staff can implement and assist residents with at times when she is not working at the home, i.e. in the evenings and at weekends so as to ensure that residents are provided with opportunities for stimulation and occupation. The manager should ensure that staff act in accordance with the homes policies and procedures and the training, which they receive. The manager should ensure that there are clear lines of accountability and responsibility for staff in the home. 3. 4. OP30 OP31 Parklands DS0000015555.V299426.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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