Inspection on 27/03/08 for Parklands

This inspection was carried out on 27th March 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 30/03/09

Parklands 08/11/06

Parklands 29/11/05

Parklands 08/06/05

Parklands 22/12/04

Parklands 22/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Parklands Kensham Avenue Bradninch Exeter Devon EX5 4RD Lead Inspector Louise Delacroix Unannounced Inspection 09:00 27th March and 31st March 2008 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 DS0000022003.V359709.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 DS0000022003.V359709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parklands Address Kensham Avenue Bradninch Exeter Devon EX5 4RD 01392 881375 01392 882089 parklandsreshome@btconnect.com www.parklandsresidentialhome.co.uk Mr Roy Baker Mrs Heather Baker Mr Roy Baker Care Home 27 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) Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (27) of places Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2006 Brief Description of the Service: Parklands is a large detached home in grounds with views over the surrounding countryside. The home is registered to provide accommodation and personal care for up to twenty-seven older people who may also have dementia. There are ten rooms within the home that are registered for double occupancy. However, all bedrooms are currently used for single occupancy only. Eleven bedrooms have en-suite facilities. There is a passenger lift to the first floor and ramps fitted around the home to provide access for people using wheelchairs. An extension has been built to the side of the home and contains seven bedrooms and a shower room. All new bedrooms are over twelve square metres with en-suite facilities. CSCI inspection reports are displayed on the hall table. Fees for the home are £425 per week, which includes newspapers and toiletries. Hairdressing, phone calls and chiropody are not included in this price. Parklands DS0000022003.V359709.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 that the people who use this service experience adequate quality outcomes. The inspection was unannounced and took place over approximately eleven hours. Twenty-four people were living at the home, which included two people on a short stay. People living at the home contributed to the inspection, as did the manager and staff members. An Expert by Experience accompanied us from Help the Aged, who spent time speaking with six people in the privacy of their own rooms and with a group of four other people in the lounge. We also spoke with three other people living at the home; we spent time in the lounge to help gain insight into people’s communal experience. Information from these discussions and observation have been included in this report. Prior to the inspection, surveys were sent to people living at the home, visitors/relatives, and health and social care professionals, which have been incorporated into this report. As part of the inspection, three people were case tracked; this means that where possible we asked them about their experience of living at the home, we talked to staff about their care needs, we visited their rooms and looked at the records linked to their care. During the inspection, a tour of the building took place and records including care plans, staff recruitment, training and medication were looked at. The home has completed an Annual Quality Assurance Assessment (AQAA), which provides details about the service, and information from this document has also been included in the report. What the service does well: We received a high proportion of response to our surveys and people living and visiting the home told us about the warm and friendly atmosphere, and the good quality of care. Each month there is a full and varied calendar of activities that people can join in if they want. People told us how much they enjoy the regular activities and felt generally they could exercise choice within their daily lives. We found that the home has good relationships with families and friends, and visitors are always made welcome. The home is committed to providing good quality meals and people living at the home praised the standard of food. People feel that if they have a concern then they will be listened to and that the home will act appropriately. Staff are clear about their roles to report poor practice. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 6 There is on-going investment in the home, including equipment and décor, with a high standard of refurbishment in the first floor bathroom. People benefit from a warm and friendly atmosphere with staff who are caring and who are encouraged to attend training. Care staff spoke of people in a respectful manner and showed a strong commitment to their job. A high proportion of staff have an NVQ 2 qualification in care. There is a stable staff team, many having worked at the home for a number of years. The staff we talked to clearly enjoy their work and took a pride in providing a good quality of care and services. There is a good management team and staff told us there is a happy atmosphere in the home and they felt well supported. Safety checks are up to date. What has improved since the last inspection? What they could do better: We make requirements to clarify our expectations of providers when a regulation has been broken, and so a timescale for compliance is made. Improvements need to be made to the home’s statement of purpose to ensure that it contains all the information necessary to help people make an informed choice about whether the home is right for them. People need to be assessed before they move to the home, and if an emergency admission as soon as possible after moving to the home. This will help ensure that the home can meet their physical, mental and social care needs. A previous requirement made in 2007 has still not been met regarding medication and the way it is administered, which means parts of the administration process is unsafe. Recording of controlled drugs needs to be improved so that there is a clear audit trail. Another unannounced inspection is planned by our pharmacy inspector to check on the progress of required work. We looked at the records of staff recruited in the last year. We found that in some cases staff have started to work at the home before satisfactory references and criminal records/protection of vulnerable adults checks had been received and we saw that other key information was missing from staff files. (This has also been raised at a previous key inspection - see report dated 8th November 2006). This practice may result in people living at the Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 7 home being at risk of harm or abuse. We took copies of records during the inspection and will seek further legal advice relating to this issue. The home was told to make alternative night staffing arrangements until all the appropriate information had been obtained and an immediate requirement was made to ensure that staff at the home are suitable to work there. Recommendations are good practice statements or advice and are linked to the relevant National Minimum Standards (NMS) for a service. The home’s statement of purpose needs additional information about the day care services provided. Care plans need to be developed further to ensure that staff are provided with written guidance as to how to manage identified risks. People need to be involved in their own care plans and have this involvement recorded. Key information needs to be in the main body of the care plan not in daily notes, which will make it easier to review and help with a consistent approach by staff. People’s decision about having a key and participation in activities should be recorded to show they have been given a choice, and records should be kept as to how confidentiality is maintained when discussions take place in the home’s office, which is centrally located. Activities should meet the needs of all the people living at the home. Minor amendments to the home’s complaint policy and safeguarding policy will help ensure that the home’s acts in people’s best interests, and the home should contact the local safeguarding team for advice regarding a person’s allegations about people visiting the home. Advice should be sought to maximise the ability of people to use the garden independently and improvements to the ground floor communal toilet/bathroom would make it a pleasanter place to use. 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 DS0000022003.V359709.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 DS0000022003.V359709.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): We looked at standards 1 and 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The statement of purpose lacks key information and therefore does not enable people and their families to make an informed choice about the home. An inconsistent approach to assessment prior to people moving in means that without detailed information assurance cannot be given that care needs can be met. EVIDENCE: Each care home must have a statement of purpose and service user guide. This should set out the home’s aims and objectives and the range of facilities and services. We looked at the home’s statement of purpose, which they told us, was given to people considering moving to the home. There is information missing from the document. For example, there is no detail of the relevant qualifications of the management team and the staff i.e. NVQs. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 10 There is a general lack of clarity over the home’s registration i.e. there is no reference to providing care for people with dementia or how their needs will be met or the age range of people. There is no reference to dementia training despite the home’s registration in this area or how care will be provided to reflect current dementia care practice. There is no reference to how activities will be structured to meet people’s needs or what changes have been made to the environment to help maintain independence. It does not state that the service provides care not nursing care, or how district nurses work with the home. There is no reference to the home’s policy on emergency admissions or how people are consulted about the way the home is run. There is a brief reference to regular visits from a vicar but this does not currently happen and there is no reference to meeting other religious or spiritual beliefs. Currently the home has no minibus, which the statement of purpose says the home has. The statement of purpose does not contain the fire precautions and associated emergency procedures, apart from in relation to visitors, or give details of the size and number of rooms. There are details of the complaints procedure (see standard 16) but there is no reference to reviewing people’s care plans, which details their care needs. In response to our survey, eleven people told us that they had received enough information about the home before they moved in but seven people said that this wasn’t the case. Generally relatives/visitors felt that they had received enough information about the care home to help make a decision, although one person felt this wasn’t the case. The home’s statement of purpose acknowledges the trauma of people leaving their own home to move to residential care and states their aim to make this transition as smooth as possible. It describes how they aim to visit people in their own home before they move in and there is encouragement for people to spend the day at the home. We talked to the management team about two people who had recently moved to the home. We were told that one was an emergency admission; instigated by a health care professional. While the second was on a private basis, and that no pre-admission assessment had taken place. In the home’s AQAA, it states that an improvement in the last twelve months has been ‘to ensure that no resident is admitted without a home assessment being carried out’. We looked at an assessment, which was brief and did not show, who had been involved or how care should be provided or when the assessment took place. There is no reference to interests (this was also the case with three other people’s assessments) but there was a risk assessment abut walking outside, which states that ‘staff need to know where (the person) is at all times’ but not why or how the staff achieve this. It states that it is ‘more practical for (the person) to walk in the garden rather than the roads’ Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 11 but again this does not specify the risks. We were told that the person chose to walk in the garden. The daily notes state the person went for a ‘short walk’ or ‘out for a walk’. The person went out for the day with visitors when we inspected. The management team told us that for the second person no assessment was undertaken to ensure the home could meet their needs, but that they were already known through day care services and that it was a short stay. The statement of purpose does not indicate that this is a service that the home offers, which prospective residents should be told. We looked at assessments for three other people. Again there was no reference as to who had participated in the assessment or evidence of a preadmission assessment. For two people identified, as being diabetic there was a lack of information about their care needs. There were no risk assessments about skin care, despite regular references in one person’s daily notes to a sore or to how foot care was managed. For the second person, the assessment under diet only said ‘appears to like everything’ and there was no reference as to how sugar levels are monitored and by who, although health records showed this was taking place. The management team told us they had requested support from a specialist in diabetic care but had not yet received a visit. None of the assessments focused on the individuality of people or their preferred daily routines, apart from their choice in what time they got up. People’s religion is recorded but not how the person will be supported with their faith. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to care planning will help provide continuity of care and better guidance to staff, while changes to medication practice will help reduce risks to people living at the home. People are generally well cared for by caring staff. Minor improvements will increase people’s privacy and dignity. EVIDENCE: We looked at people’s care plans to help us judge whether appropriate care is delivered to people on an individual basis. Care plans should provide guidance to staff about how to provide care. We looked at four care plans in detail, and a list of dates indicate that they have been reviewed but changes to care had not been logged, although daily notes show that changes had taken place. For example, one person has been provided with mattresses either side of their bed and a specialist high/low bed is in place, which is set on a low setting. The home has responded to concerns about the person falling out of bed by making these changes but the care plan makes no reference to this risk or what has Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 13 been put in place to address it or who has been consulted. Daily notes show that a specialist cushion has been provided to reduce the risk of pressure sores but again this has not been included in their care plan. A person told us on two separate occasions that they could not eat in the dining room but that they would like to. The management team told us that this was because of their eating needs and to help maintain their dignity. However, their care plan made no reference to this decision and whether the person had been involved or how staff should remind them of the discussion. Instead, there was just a note that food should be cut in small pieces to prevent choking. Despite the lack of detailed information on care plans, we had positive responses to our survey question ‘do you receive the care and support you need?’ Thirteen people said ‘always’ and four said ‘generally’ and one person talked about their own home. Nine visitors told us that the care home always met the needs of their relative, with one saying usually and one saying sometimes. One person said the care was ‘excellent’. However, another person expressed concern about the impact of the high level of needs of people with dementia or mental health needs. In care plans, there are records of visits by GPS and district nurses, which show that the home maintains regular contact with health care professionals but as noted in the assessments section of the report there is a lack of written detail about how care should be provided. However, the outcome for people living at the home based on survey responses appears positive. We spoke with one GP who praised the quality of care at the home and the service they provided. We received six surveys from GPs and two from district nurses, all of which were complimentary about the home, although one person said occasionally the home does not seek health advice early enough and attempt to resolve issues themselves. While another said the home was ‘reliable at seeking help’. Seven people said the home always sought advice and acted upon advice, while one person said usually. Seven people said that individuals health care needs are always met and one person said usually. One person said ‘patients appear happy and well cared for’ while another said that ‘Parklands are competent in delivering on individual’s health care once directed and overseen’. Thirteen people living at the home told us that they always received the medical support they needed and four other people said they generally did. A relative said that the home cared for people well when they were poorly and another person said ‘if medical assistance is needed, it is dealt with immediately’. Nine visitors felt that the home always provided the support and care they would expect for their relative and two said this was usually the case. One person commented ‘support and care are wonderful. During my mother’s very severe chest problem the care was brilliant, the support to me Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 14 was wonderful to’. The majority of visitors also said that they were always kept up to date with important information i.e. hospital admission, with one person telling us that they are phoned immediately if there is a problem. One relative told us that they had ‘total confidence in the care provided’. We made a previous requirement when we last visited the home to improve medication practice in the recording of medication and how it is administered. The management team have tried to make changes to address these issues and told us they have worked closely with local surgeries but some people’s medication is still being managed in a way, which is unsafe because the staff who administer the medication cannot confirm that it is the correct medication. This is because the management team place medication in dosset boxes, which other staff then administer from. Our pharmacy inspector confirmed that this is unsafe practice. The management team told us that although some medication is still ‘potted up’ at night, they now ensure that the staff who administer it witness the procedure to confirm it is the correct drug. There have been good steps to address how medication is recorded with the use of medication administration record sheets that contain few gaps, although some handwritten amendments to these sheets have not been double signed, which is best practice. The home’s AQAA stated there were no controlled drugs in the home but when we inspected there was one prescription. We looked at the storage of these controlled drugs and saw that they are not recorded in a controlled drugs book, which should provide an audit trail and requires double signatures. We saw some medication that had been prescribed by a GP from another area in early 2007 but it had not been used. We were told that it was kept to reassure the person who lived at the home, although the medication was still ‘in date’; the home had not checked with the person’s current GP that it was still suitable. As part of our inspection, we asked if people felt that staff respected their dignity and privacy. In response to a question in our survey, seventeen people living at the home said that staff listened and acted on what they said, although one person said this depended on the time the staff had. One person felt they were not always listened to. During the inspection, people told us that their dignity was respected whilst being supported with washing and dressing. Four health care professionals felt that individuals’ privacy and dignity was always maintained while four people said this was usually the case, with one person giving an example of practice that could be improved. During the inspection, the ten people we asked did not have a key to their room, although we were told by the management team that people had declined to have one, it was not recorded on people’s care plans that this was the choice they had made. All of the eleven people we spoke to during the inspection agreed that the staff were warm and friendly, and maintained their Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 15 dignity in personal care tasks. One person told us that they had been reassured that only female care staff would provide personal care to them, which was their choice. People told us that their clothes were well cared for and staff said items rarely went missing. The office is located in a central part of the home, which means that it is accessible to people living at the home but in the minutes for a residents’ meeting in September last year the concern that ‘all the committee members thought that any private discussions should not be done in the office as everyone can hear and confidentiality is broken’ was raised. We were conscious during the inspection that the three open doors in the office could compromise confidentiality and we asked for doors to be shut. Parklands DS0000022003.V359709.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Minor improvements will help the large range of activities meet people’s individual needs. The ethos of the home is to welcome visitors and generally promote choice and provide a good standard of food. EVIDENCE: The management team and staff have worked hard to promote the activities available to people living at the home, including giving two staff members the responsibility for this area of care and providing training in this area, which we saw Age Concern certificates for. Activities are well publicised and people could tell us what forthcoming events were planned. There are also regular visits from a local Baptist church. In response to our survey, ten people told us that there were always activities to take part in and six said usually and two said sometimes and one said never. One person said ‘there’s always something going on’ and another that they ‘enjoyed the singing’. Relatives also commented positively on the selection of activities. On the day of the inspection, we were told that activity staff members were on another training course to further their skills and knowledge. Increased Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 17 activities was recognised by the people who responded to our survey and spoke to us on the day of the inspection. Many welcomed the choice of visiting singers, exercise, bingo, quizzes etc and there was evidence of small weaving looms in some rooms, including one person who told us they preferred to stay in their own room. The home also has visits from Pets as Therapy and relaxation sessions. People told us they enjoyed seasonal events celebrated at the home, such as Easter and Christmas. One person said they used to have trips out and these were missed; however the management team said that they are looking to buy a mini-bus, which the home used to own. We looked at the records for four people with differing care needs and saw that one person had participated in a wide range of events over three months, including visits from the donkey sanctuary, a birds of prey demonstration and a visit from The Body Shop but for three less able people there were notably less activities with approximately three each in a space of three months. Unfortunately, on the day of the inspection the staff members specialising in organising activities were training and the remaining staff were busy and appeared to have little time to stop and sit with people. The television remained on throughout the inspection, despite on occasions in the afternoon nobody watching it, particularly during some children’s programmes. One person in another area of the lounge said ‘what a damn noise’ when discussing the television and others said they did not know what to do with themselves and ‘give us something to do, a duster, clean the windows’. However, in the days before the inspection, there had been a number of activities, which people said they had enjoyed. Visitors told us in their surveys how they felt welcomed by staff and the visitors’ book showed that visits are a regular feature for many people living at the home. We also saw that friends and families take out people for the day. We received many positive comments about the friendly and family atmosphere of the home such as ‘ the care home is truly fulfilling the idea of being a home from home’ and that there is ‘genuine care and good motivation in a loving environment’. Relatives told us that the home ‘is just the best’ and about ‘the happy atmosphere’. Rooms have now been fitted with phone lines to help people maintain their independence. During the inspection, we asked people about choice. People told us that they were happy with the times that the times they got up and most people were seen exercising choice as to where they ate and how they spent the day. A health professional commented that the home was run in a person centred way and the general view from visitors is that the home support people to live the life they choose. This was also apparent from talking to staff. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 18 All the people we spoke with, without exception, praised the food saying it was good and plentiful, and used fresh vegetables, sometimes from the kitchen garden. This was also confirmed by the positive responses and comments in the surveys we received. The management team and kitchen staff spoke about their commitment to good quality local food and providing food which reflects the seasons. One person who needed added fibre said they were given bran flakes and prunes for breakfast, as recommended by the doctor, and another person and their relative said their specialist diet was well catered for. Another person with some sight difficulties said staff were willing to cut up food if they requested help, and were good at giving them softer foods, which they could manage. However, the home will need to consider its vegetarian options as a meal served on the day of inspection contained some meat. We were told that currently there are no vegetarians living at the home. Currently there is not a standard choice of menu at each mealtime nor is the menu published so that people know in advance what they would be having,. The management team said they would discuss this with people living at the home to discuss the best way to rectify this. People told us the meals are ‘excellent’ and ‘very good’. Relatives commented on the ‘wonderful food’, ‘excellent food’ and how the home keeps people ‘well fed’. We saw how a member of staff warmly greeted someone who had been out for the morning. Once they found out that they had not eaten, they reassured them that a meal would be made for them and went away to arrange this. This shows that the home responds to the individual needs of people, which echoed the comments from respondents to our survey. Parklands DS0000022003.V359709.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care staff are clear about their role to safeguard people living in the home, and people living and visiting the home feel confident their concerns will be listened to and acted upon. However, amendments to the home’s polices to promote the involvement of external agencies will further improve the home’s response to safeguarding issues and help ensure appropriate advice is sought. EVIDENCE: In November 2007, we visited the home to look at concerns raised by an anonymous caller, which related to poor medication practice, an injury to a person not being dealt with appropriately, suitability of a staff member and lack of choice regarding getting up. As a result requirements were made to improve medication practice and the notification of serious incidents in the home. We also made recommendations to improve practice regarding recording choice, recording of injuries/incidents, and training records. However, there was no evidence that people were not being cared for appropriately. In the home’s AQAA, it is recorded that there have been no other complaints. Medication is the only area that still requires improvement. We looked at the home’s complaint procedure and saw that small amendments were needed, such as a timescale for the home to respond to complaints and an up to date contact number for CSCI. People living at the home told us that they knew how to speak to if they are not happy, and seventeen people out of Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 20 the eighteen that responded to our survey said that they knew how to make a complaint. The majority of visitors to the home also felt confident about how to make a complaint and health professionals and visitors told us that the home had generally responded appropriately to any concerns they have raised. Comments from GPs included a ‘very good relationship with Parklands and they contact us appropriately’ and ‘staff are always approachable and responsive in all interactions with the primary health care team’. The home’s policy on safeguarding vulnerable people states that the home should ‘investigate’ when abuse is suspected, which conflicts with another statement ‘contact police – seek advice’. Inappropriate intervention by the home may later jeopardise a successful police investigation. The policy does not contain local contact numbers for police, safeguarding team etc that would make it more user friendly. A person approached us on two occasions about their concerns about the management of their money and made accusations about people outside of the home. Another person living at the home made a disparaging comment about what the person was saying, which caused them further anxiety. Staff told us these accusations were a regular occurrence and that they offered reassurance, which the management team confirmed. However, there was no reference to this anxiety in the person’s care plan and we could not see a record of accusations and how staff should respond. The management team felt confident that the above accusations were unfounded but they had not sought advice from an appropriate agency i.e. the safeguarding team or police to ensure they were acting in the person’s best interests. In June 2007, the home contacted CSCI about allegations against a staff member, which is good practice, but did not promptly follow the advice given to contact the safeguarding team, which is not safe practice. However, they told us that when they called for advice, they were told they had acted appropriately in their response to the allegation. A staff member told us that the home took concerns about poor practice seriously and gave an example. Both staff members that we spoke to were clear about their duty to report poor practice, could recognise what was abusive practice and knew who to contact both internally and externally to whistle-blow. Parklands DS0000022003.V359709.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 19,20,21,23 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained with evidence of on-going investment making it a clean and attractive environment to live. However, people living at the home would benefit from a more accessible and secure garden. EVIDENCE: The home is well maintained with on-going investment in the home as recorded in the home’s AQAA, and as seen during our tour of the home. For example, an attractive large bathroom and toilet has been fitted on the first floor with an adapted bath and there has been major investment in laundry equipment and for the disposal of incontinence waste. The home has also invested in more pressure relieving mattresses. There is a large well equipped kitchen, which staff told us was good to work in, although suitable flooring is still due to be fitted there and in the first floor Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 22 bathroom. Throughout the communal areas there are attractive floral displays, which according to the home’s AQAA are regularly changed. The home has a large garden, including a pond and vegetable patch. Currently there is direct access to the road as there are no gates, and access to storage areas and a residential area. In places the paths are uneven but the owner told us that plans were in place to rectify this. It is an attractive space but currently the layout does not enable all the people living at the home to safely use the area on their own. We talked about how the garden could be made more accessible to people with dementia to help maximise their independence and choice. The manager has plans to develop the garden to encourage exercise and independence for people living at the home. One person’s records showed that they regularly walked around the garden on their own. Other people told us they do make use of the gardens in the summer, but that the member of staff who had been good at escorting them outside had left, and some people were not sure if other staff would be so good at providing this support. There is a spacious communal lounge, which has a large flat screen television mounted on a wall which divides the room; the other half of the lounge has views onto the countryside and during our visit people sat in a range of easy chairs, with some individuals sitting and chatting to one another. People also use the dining room to meet, for example to complete puzzles. There is a decked area outside of this room, which the owners have plans to extend further. In response to our surveys, one person suggested that a further communal toilet would be useful on the ground floor. People told us that most people using the communal areas, which we observed during our visit, used the ground floor toilet. We saw that the downstairs communal toilet would benefit from regular attention by staff throughout the day to ensure it remains pleasant to use. Connected to the toilet is a bathroom with an adapted bath. The owners told us they planned to update both of these areas, which are tired in appearance, although this is not recorded in the home’s AQAA. For example, the sink is marked, as are some floor tiles, and parts of the bath seat are rusty and oil had leaked onto the floor. We visited all of the bedrooms in the home and could see how they had been personalised by the people living in them, i.e. people’s own furniture, pictures and photographs. There is an on-going programme of investment by updating the décor and investing in good quality carpets, we discussed the use of patterns and how this may not always be appropriate for some people with dementia because it can be visually distracting and lead to falls. People that we spoke to were happy with their bedrooms and the furniture provided. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 23 During our visit, the home was odour free in both communal areas and people’s individual rooms. People were positive about the standard of cleanliness, and staff and the home’s AQAA told us that the cleaner was fulltime. Sixteen people in their surveys said that the home was always fresh and clean and one said usually this was the case. Staff were clear about how to prevent cross infection when dealing with soiled laundry and clothes. The laundry is sited away from the main home and staff were positive about the quality of the equipment and the investment by the owners. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 24 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): We looked at standards 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are up to date with mandatory training and provide care in a kind and generally timely manner. However, the home’s recruitment proves is not robust and therefore potentially puts people living at the home at risk. EVIDENCE: On the day of the inspection, both of the owners assisted us, plus the deputy manager. The rota showed that there are three care staff in the morning and two in the afternoon, plus a member of the management team. There is also a cook, a kitchen assistant, and two domestic assistants. We were told that the cook and the kitchen assistant also prepare the tea time meal. Staff and the owners told us that the staff members who usually oversaw the activities at the home were both on an activity-training course on the day of the inspection. The staff rota is recorded in the home’s daily diary and this showed us that there were two staff on duty as night with the owners on call, and staff told us that there two waking night staff. Twelve people who live at the home told us in their surveys that staff are always available when they needed them and five said usually, with one person saying sometimes. One person commented that they only had ‘to wait a few minutes if they are busy with someone else’ although somebody else felt that ‘at times the shortage of staff needs to be addressed’. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 25 We observed on the day of our visit that staff were busy and that sometimes people had to wait until they were free, and that at times there was little staff interaction with people but when this did take place it was carried out in a kind and warm manner. People told us on the day of the inspection, that care staff generally responded quickly to calls, although at times they had to wait if there were staff shortages. Staff told us that staffing levels at weekends were improving and a relative said there was little staff turnover. In the home’s AQAA, it states that out of the ten care staff employed by the home, eight staff members have an NVQ 2 in care, and the remaining two are working towards this qualification, which is a good achievement. During the inspection, we spoke with two members of staff and they both confirmed this training and could tell us about their approach and style of caring, which showed a good understanding of their role. Care homes need to be able to show that their recruitment processes protect the people who live there and there is set information that need to be kept to evidence good practice. We looked at three staff files belonging to people who have been recruited since the home’s last key inspection. All of these were missing required documents and showed that the home’s recruitment process is not robust. For example, incomplete employment histories for all three people, no written references for two people, no proof of identity for three people, no POVA checks or CRB check for two people and no reference from the last care position for one person. People living at the home told us that staff are ‘very good’ and all the people we spoke to said that staff were warm and friendly. Eight relatives told us that staff always had the right skills and experience and three said this was usually the case. Relatives told us that there was a family atmosphere. Five health professionals said staff always had the right skills and experience and three said usually. The two staff members we spoke to confirmed that their mandatory training is up to date in areas such as infection control, and moving and handling. They could tell us how infection control was managed in the home and gave examples of good practice. One person told us about a three hour training course in understanding dementia and another said this was an area that they would like training in, having completed their induction. A staff member told us that the home offered good opportunities for training. We looked at range of training certificates for different staff members and saw confirmation for the above and for medication training for senior care staff. Staff told us they felt well supported to carry out their caring role. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 26 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): We inspected standards 31,33,35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can feel confident that the home is well managed and safe, and their opinions will be valued and acted upon. However, people are not fully protected by some administrative processes. EVIDENCE: Mr and Mrs Baker have run the home for many years and a care manager supports them. Mr Baker has completed the Registered Managers Award. Staff were very complimentary about the management team, feeling that they are provided with good support and are praised and encouraged to work as a team. Staff, relatives and health professionals told us that the management team are approachable. However, while many aspects of the management of the home were entirely satisfactory, one aspect of administration was poor. As Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 27 reported in the Staffing section, recruitment processes are unsatisfactory and place people at risk. The home does not manage any money on behalf of people living at the home. There is a fairly recently formed residents’ committee with a spokesperson who is well able to encourage people to consider issues and to vocalise views to the managers. Ideas that have been put forward from the committee include a small trolley shop, a post box for people to put their own mail into which is then posted by staff, a request for old hymns with the visiting preacher. The managers, who are currently pursuing a request to have a Church of England vicar to offer communion, have positively responded to all these ideas. We saw evidence of all these new initiatives. We were told that surveys have been sent out to and that these were going to be collated. We discussed how the outcomes of the quality assurance could be feedback to respondents and how minutes from residents’ meetings could be improved. When this has been collated the home agreed to send CSCI the outcome. The home’s AQAA shows that Parklands complies with health and safety legislation in relation to the maintenance of equipment, and health and safety checks. We spoke about ensuring that hazardous chemicals are stored safely because of the home’s dementia registration. Radiators in bedrooms are covered to help promote people’s safety and the manager told us that all upper windows are now restricted to the width recommended by environmental health and the local environmental officer confirmed the home’s history of compliance. We looked at the home’s record of accidents and incidents and these are now easier to track and audit. We are appropriately informed of deaths at the home and provided with suitable detail about health intervention at these times. Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 2 x 3 x x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x N/A x x 3 Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)(a)(b) (c) Schedule 1 Requirement Timescale for action 31/05/08 2. OP3 3. OP3 4. OP9 5. OP9 The statement of purpose must contain all the required information to enable people to make a decision about whether the home can meet their needs. 14 (c) Before people move to the home, there must be appropriate consultation with the person or their representative. If an emergency admission, this must take place as soon as possible after arriving at the home. 13 (4) (c ) Where risks have been identified to the person’s health i.e. diabetes then guidance must be in place as to how this will be managed. 13 (2) Medication must be administered in a safe manner to protect people living at the home. Staff must know that the drugs they are administering are correct. (Previous timescale of 22/09/07 not met) 13 (2) Controlled drugs must be recorded in an appropriate book with two signatures when they are administered and a running total kept so that there is an DS0000022003.V359709.R01.S.doc 09/05/08 09/05/08 09/05/08 09/05/08 Parklands Version 5.2 Page 30 6. OP29 19 (1) (a) (b) Schedule 2 audit trail. Staff must have a full employment history, two written references, including one from their last care position, proof of identity and POVA/CRB checks before working at Parklands to help protect the people living there. (Previous timescale of 22/08/07 not met) 11/04/08 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 OP1 Good Practice Recommendations The statement of purpose should state that day care services are provided, how this is staffed and how many people attend, to ensure that people moving to the home are aware that this service is offered to others. The person living at the home or their representative should sign their care plans. Key information should be in care plans rather than in daily notes e.g. how to support a person with eating difficulties and how this has been agreed. Care plans should evidence how a person’s health needs will be managed i.e. increased falls or pressure care. Monthly reviews of peoples’ care needs are recorded but these would be improved by detailing how the identified goals for their care are going to be met. Where risks have been identified there should be clear guidance to staff as to how they should provide support and respond so that care is consistent in approach and can be measured i.e. allegations of financial abuse. Current GPs should be consulted about medication that is kept but unused and prescribed by another GP to ensure that it is still suitable. DS0000022003.V359709.R01.S.doc Version 5.2 Page 31 2. OP7 3. OP9 Parklands 4. 5. OP10 OP10 6. OP12 7. 8. 9. 10. OP16 OP18 OP18 OP19 11. 12. OP21 OP36 People’s decision regarding a key for their rooms should be logged on their care plans. Confidentiality should be maintained at all times and steps should be taken to ensure that people’s privacy and dignity is maintained. The steps taken should be recorded and made known to people living at the home. Staff should ensure that activities provided include one to one sessions for frailer people or people who do not like group activities. Records should be kept if people choose not to participate. The home’s complaint procedure should be updated to contain a timescale for the home to respond to complaints and a current phone number for CSCI. The home should contact the local safeguarding team for advice regarding allegations made by a person living at the home. Local information i.e. police, safeguarding team and Care Direct should be added to the home’s safe-guarding policy to make it more user friendly. The garden should be designed based on specialist dementia advice to maximise the independence of the people living at the home and offer stimulation. The home should ensure that areas such as the pond and storage areas have been risk assessed to ensure the safety of people with dementia is maintained. The downstairs communal toilet and bathroom should be maintained to the same standard of cleanliness and decor as other areas of the home. Where areas for development have been identified in staff supervision records, there should be clear action points as to how this will be addressed and how it is reviewed. Job descriptions should be clear to reflect support systems put in place. (Not inspected on this occasion). Parklands DS0000022003.V359709.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000022003.V359709.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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