Inspection on 18/05/07 for Parklands Court Nursing Home

This inspection was carried out on 18th May 2007.

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 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 Court Nursing Home 20/05/08

Parklands Court Nursing Home 25/04/06

Parklands Court Nursing Home 30/01/06

Parklands Court Nursing Home 07/03/05

Parklands Court Nursing Home 07/09/04

Parklands Court Nursing Home 05/02/04

Parklands Court Nursing Home 24/11/03

Parklands Court Nursing Home 07/10/02

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

CARE HOMES FOR OLDER PEOPLE Parklands Court Nursing Home 56 Park Road Bloxwich Walsall West Midlands WS3 3ST Lead Inspector Rosalind Dennis Key Announced Inspection 18th May 2007 09:30 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 Court Nursing Home DS0000020791.V339308.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 Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parklands Court Nursing Home Address 56 Park Road Bloxwich Walsall West Midlands WS3 3ST 01922 711844 01922 491137 rogersal@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited 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) vacant post Care Home 150 Category(ies) of Dementia - over 65 years of age (60), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (60), Old age, not falling within any other category (150), Physical disability over 65 years of age (90) Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No more than nine service users in the category TI(E) aged 50 years and over may be accommodated in Harrison, Samuel and Collins Houses. Service users not to exceed the maximum number registered for at any one time. Of the 90 service users in the category PD(E), 29 may be accommodated at the home for intermediate care in the category PD. Service users in the categories PD(E), TI(E), MD(E) and DE(E) may be 50 years and over. 25th April 2006 Date of last inspection Brief Description of the Service: Parklands Court is set in attractive landscaped grounds, close to Bloxwich town centre, shops and public transport. The five small modern detached houses accommodate up to 30 service users in single rooms. Each house being independent of the others for staffing, both care and some ancillary such as house keeping, each having its own facilities such as lounge, kitchenettes and bathrooms. Catering and laundry services are provided centrally from a further building which also accommodates the management and administration services. Each house is dedicated to the needs of different categories of care needs: nursing care for frail elderly people and specialised care for people with Alzheimer’s Disease and other dementia related conditions. Fees for the home range from £407 to £610. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, in that contact was made with the home the day before the inspection to ensure that the acting manager or a management representative would be available to assist with the inspection, this is generally considered necessary because of the size of the home. The inspection was conducted by three inspectors who arrived at the home at 09.30 and the inspection concluded at 18.30 when feedback was given to the management team. All ‘key’ standards were assessed during the day- that is those areas of service delivery that are considered essential to the running of a care home. Inspectors spent time speaking with staff, people living at the home and their visitors, as well as looking at records and observing staff in their work. Comments and views were collated from people living at the home, staff on duty and visitors, and the content of these is reflected within the individual outcome groups in the report. It became apparent during the inspection that the home is not functioning well and people living, visiting and working at the home do not feel that the staffing levels are sufficient to enable high quality care to be given - these comments were fedback to the Senior Management team at the end of the inspection who recognised that work is needed to improve the home. Management and staff were wholly co-operative throughout the day and assisted inspectors in their task, for which CSCI extends its thanks. What the service does well: People living at the home are cared for by a staff group who are enthusiastic in ensuring people receive good care-frequent comments of ‘the staff are very good’ were made by visitors and people living at the home. People who were unable to communicate their views appeared well-cared for and staff responded sensitively and appropriately to requests. Staff assess and plan care to take account of peoples’ likes/dislikes and preferences. Staff recognise diversity and cultural needs when planning care. The home provides an intermediate care service, which promotes rehabilitation with the aim of maximising people’s independence to enable a planned discharge to take place. The home provides a range of activities and meals offer choice and variety. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: It is acknowledged that changes within the management structure can create instability within a home, however it is generally expected that senior management oversee operations to ensure that processes within the home remain stable. From observations made at this inspection it appears that for a period of time prior to the current acting manager taking up post, lapses have occurred with how this home has been led and managed. In summary areas identified as needing improvement include:It was reported to inspectors that basic care tasks cannot always be undertaken at the appropriate time or frequency - and staff reported having limited “quality time” to spend with people living at the home. Staffing levels must be reviewed and sufficient staff provided on all shifts and on all units to meet the needs and dependency of people living at the home-this requires prompt action on the part of the provider to ensure this is achieved. The supervision process needs to be reviewed to ensure that staff are competent to do their job and that this competency is maintained through a process of monitoring and reflecting on practice. Staff who are designated as ‘supervisors’ need to be equipped with the skills to perform this role. Staff need to be provided with training to ensure they are equipped with the skills and knowledge relevant to their role and to meet the needs of people living at the home. Training records need to be improved to show when staff have received training and to enable closer monitoring of individual training needs. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Parklands Court Nursing Home DS0000020791.V339308.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 Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is good. The home has a satisfactory admissions procedure that provides for an effective needs assessment for each resident. The sources of information about the home need updating to ensure people are provided with accurate information. The home provides an intermediate care service, which promotes rehabilitation with the aim of maximising people’s independence to enable a planned discharge to take place. This judgement has been made using available evidence including a visit to this service. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has recently reviewed the documentation used to assist with the assessment process at the time of a person’s admission to the home. Care files were examined in four of the units, which showed that the new documentation provides for comprehensive assessments to be made and prompts staff to initiate care plans when particular problems are identified. Scrutiny of eight people’s care files showed that staff had conducted detailed assessments involving the individual and/or their significant other, these included recognition of communication restrictions such as when a person’s first language is not English, safety needs, assessments of mental health, nutritional and personal care needs. Staff had recognised individual likes/dislikes and personal preferences, which were clearly identified in peoples care plans One relative on Collin’s Unit confirmed how they had been able to look around the home to determine whether the home was able to meet their relative’s needs and they confirmed their satisfaction with the admission process. Since the last inspection the home has moved forward in its provision of intermediate care and now provides one 29 bedded unit solely for this purpose. This intermediate care service is provided in partnership with the local PCT. The processes of admission to this unit differ from the other units in that initial assessments are undertaken by a social/health care professional either in a hospital setting or in the person’s own home and the person is then admitted to the unit for a short stay with the aim of maximising independence. On admission to the home staff then complete their own assessment and plan care in conjunction with the multi-professional team, which includes physiotherapists, occupational therapists, social workers and the medical services of a local GP practice. Two care files that were seen showed that staff on Samuel Unit had completed assessments, which were individualised and recognised people’s motivation, attitude to rehabilitation and personal goals. Observations confirmed that Samuel Unit provides a full range of equipment to enable rehabilitation and assist staff to move people safely. Training records show that staff have received moving and handling training. The last inspection report makes reference to people being admitted to Samuel unit outside of the category of registration, a discussion with the unit manager at this inspection confirmed that this situation had improved although occasionally people are admitted to the unit who require more general nursing care instead of the rehabilitative approach of intermediate care. Three people staying on Samuel Unit spoke of their satisfaction with the facilities, equipment and the staff assisting with care on this unit. It was observed that the statement of purpose and service user guide require amending and updating to include reference to the fees charged by the home. A discussion with two individuals on Samuel Unit identified that they were not Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 11 aware of where they could locate information on the home and although the Regional manager confirmed that Service User Guides should be available in each bedroom, these people had not been informed of this. People in other parts of the home confirmed access to this guide. The regional manager provided verbal confirmation that the Service User guide is in the process of being updated. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. Changes to the assessment and care planning process has led to improvements in how care is planned for people and generally provides staff with all the information they need to meet people’s needs. Evidence of regular review and good multidisciplinary working ensures that the health and personal needs of residents are met. The administration of medication is generally good, however the storage of medication is not satisfactory and this could impact on the effectiveness of the drugs and put service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care files were observed on each of the four units inspected which show that staff plan care on an individualised basis, taking into account Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 13 peoples differing care needs. All of the files contained care plans, which had been derived from the initial assessment of needs and reviewed on an ongoing basis or when needs changed. Care plans were individualised and in most cases provided documentary evidence to confirm the involvement of the person living at the home and/or their significant other in the care planning process-this should be further enhanced through the phased introduction of new documentation. Care plans for two individuals case tracked on Marlborough unit were seen to provide specific guidance for staff to follow in the event of episodes of challenging behaviour and a discussion with staff showed that they had good awareness of the management of this behaviour. It was felt and discussed with the Regional Manager that the process of identifying trigger factors which may give rise to challenging behaviour could be more detailed-the Regional Manager confirmed that development within this area is in hand, which will also take account of changes to mental health legislation. Some inconsistencies were noted whilst observing care documentation, for example a care plan for one person with diabetes did not contain specific instruction on the frequency of recording the person’s blood sugars and yet another person, also with diabetes had good information provided in their care plan for the care of their diabetes. Bed rail risk assessments were available on the files of the people case tracked although for one individual documented as needing bed rails it was observed that bed rails were not in place on this person’s bed. Risk assessments for pressure area care, moving and handling and nutrition were comprehensive and regularly reviewed. Sufficient and appropriate equipment was seen available throughout the home to promote tissue viability and to move people safely. People on Samuel and Collins Unit who were spoken with described staff as ‘very good’; visitors to the home also supported this view. One visitor spoke of how their relative had improved since being admitted to the home, and also commented on how staff paid attention to their relative’s appearance and general well being. People who were unable to communicate their views due to the nature of their illness appeared well cared for and staff were seen to treat people with dignity and respect. One area which would benefit from a more sensitive approach is in the labelling of clothes as one person was seen to have name labels secured to the outside of his clothing. The four units inspected showed that the home is failing to ensure that medication is stored at the correct temperature. Observation of the drugs fridge temperature records on Samuel and Collins unit showed that the temperature of the fridge was considerably outside of the required range of 2°C to 8°C, for example on Collins Unit staff had recorded fridge temperatures as low as –39°C and as high as 32°C, which suggests that staff recording the temperature are not aware of the required ‘safe’ temperature range. It was seen that insulin was not being stored according to manufacturers instructions on three of the units inspected. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 14 The home has not yet implemented a process to ensure that the temperature of all the medication storage rooms within the home are monitored and maintained below 25°C. The Regional Manager provided verbal confirmation that prompt action would be taken to address the deficits described above. It is disappointing that concerns regarding medication storage were identified at the inspection in April 2006 and little action appears to have been taken by the home. Medication administration record charts appear to have been completed accurately by staff to confirm that people had received their medication as prescribed None of the people currently staying on Samuel Unit self-administer their medication, although the unit manager confirmed that guidance on taking medication is given prior to a person’s discharge home to ensure that people are able to take medication correctly. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. The home provides a range of social and recreational activities that provides interest and enhances the social well being of people living at the home. The meals at the home offer choice, variety and cater for different nutritional needs, however mealtimes remain poorly organised and require the interventions of visitors to ensure people receive their meal. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation of care records and a discussion with people living at the home provides confirmation that a range of activities and entertainment is provided by the home. These activities are provided by the home’s designated activities organisers and by staff working on the Units. For example staff on Clarendon discussed how people are enabled to access the local park and on Marlborough unit staff described how activities are organised dependant on individual capabilities such as walks in the garden or a game of skittles. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 16 People on Samuel Unit are provided with activities, which support their rehabilitative programme such as development of daily living skills, visits to Day Centres and attendance at a ‘Falls Clinic’. People who were spoken with on Samuel Unit felt that the level of activities was sufficient, also commenting that they enjoyed spending time resting in their own rooms watching television. People living at the home commented that the meals provided by the home are good, with a wide variety of choice. Menu cards showing meal choices for the following day were available in people’s rooms and staff were seen providing assistance to people who were unable to complete the cards independently. The last inspection described how staff had to rush to ensure that all people were given a meal. At this inspection staff and visitors on Marlborough and Clarendon described how relatives attend these units at mealtimes to ‘help the staff out’ and on Collins unit staff were observed providing sensitive assistance but were struggling to assist all people who needed help with eating and drinking. A concern about staffing levels within the home was raised with he Regional Manager during this inspection and this is covered in the Staffing section of this report. People visiting the home spoke of how staff are friendly in their approach and welcome people visiting the home. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. The home has a complaints procedure that ensures that people’s concerns are listened to and acted upon. Staff have not been provided with training to equip them with the knowledge and skills to safeguard adults from the risk of abuse or neglect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure with copies available on Notice Boards throughout the home and in the Service User Guide. Most people spoken with knew how to make a complaint if they had any concerns, although two people spoken with on Samuel Unit were not aware of where they could find the home’s complaints procedure and this was raised with the unit and Regional Manager to ensure people are informed of procedures on admission. Observation of the complaints file showed that complaints have been responded to. There were no records available within the home to show that staff have been provided with adult protection training and a lack of clarity in response from the management team meant that it could not be established what training, if any, had been provided in adult protection/abuse awareness. Two members of staff who have worked at the home for sometime spoke with the inspector, Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 18 and confirmed that they had never received adult protection/abuse awareness training. A requirement was made at the last inspection for all staff to receive training in abuse awareness-prompt action needs to be taken by the home to ensure this outstanding requirement is achieved. It was also felt that the home should have sought guidance from the multi-agency safeguarding adults team regarding the management of two people living on Marlborough Unit, following regular reported incidents of physical assault between these two individuals. An incident that involved a person living at the home is currently being investigated by the Health and safety Executive. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. Quality in this outcome area is adequate. The home is generally well provisioned and well maintained and provides a comfortable environment for people living at the home. The home does not have all systems in place to promote effective infection control and hand hygiene, although planned improvements within this area should ensure people are protected by the home’s infection control procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of a selection of bedrooms and communal areas on four of the units showed that the home is generally clean and meets the needs of the people currently living at the home. Sufficient chairs were available in dining and lounge areas, although it was noted that chairs on Clarendon Unit needed Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 20 cleaning and some parts of Marlborough needed redecorating and the flooring in some areas was stained. People are able to bring in personal possessions to decorate their rooms to promote a more homely feel. The majority of bedrooms have hard floor coverings although the Regional Manager verified that carpets can be provided if people wish. Staff were seen during the inspection using appropriate protective clothing for care activities and food handling. It was seen that not all units have handwashing facilities available for staff to use at the point of delivery of care, such as in people’s bedrooms-the Regional Manager provided confirmation that an audit had been undertaken of the whole home and provision of such facilities is planned. It could not be established whether infection control training had been provided for all staff due to a lack of robust recording of attendance at training-however notices were seen throughout the home, which showed planned training dates for staff. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. The home is failing to ensure that sufficient numbers of staff are available to meet the needs and dependency of people living at the home. Although it is recognised that this is work in progress, staff have not yet had access to all the training considered necessary to equip them with the skills to carry out their responsibilities. The home has a robust recruitment procedure in place that protects people from the employment of inappropriate staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Concerns about staffing levels were raised on three of the four units inspected. On Samuel Unit levels seemed sufficient to meet the needs of people accommodated, discussion with the manager on this unit established that allocated supernumerary time for administrative duties is not currently provided, this is considered necessary for the ongoing development of this unit. Staff who were spoken with on Collin’s Unit felt that the levels are consistently too low to enable them to respond promptly to peoples’ care needs. One Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 22 person living on this unit described staff as good but spoke of concerns about shortages of staff, describing several occasions recently where staff had been unable to attend to hygiene needs promptly and this had resulted in a direct impact on her well-being. Staff and visitors on Marlborough and Clarendon discussed insufficient staffing levels to ensure the care needs of people are fully met. Staff described and observations confirmed that people living on these units require many interventions and assistance. Staff spoke of how the home prefers not to use agency staff to cover shifts, instead staff are moved to another unit to provide staff cover which results in their own unit being short of staff and possibly ‘unsafe’. Staffing rotas for the week prior to the inspection showed that the amount of staff for each unit was not consistent and Registered Nurse cover for four units at night is not recorded. Staffing levels for all Units apart from Samuel appear to have reduced from those documented within the last inspection report. The last inspection identified a staffing concern with the trained nurse at night having responsibility for site cover, it was confirmed at this inspection that this practice is continuing with staff also having to leave their unit to lock the entrance gates. The unit managers have good ideas in how to develop the units and improve outcomes for people living at the home, but a lack of allocated time appears to be restricting these developments. All concerns regarding staffing levels were discussed with the Regional Manager at the end of the inspection and this issue requires prompt action to ensure staff are provided in sufficient numbers to meet the needs and dependency of people living at the home. Staff files, which were examined, show that all pre-employment checks are undertaken and induction provided, although one staff member appointed last year commented that they did not receive an induction programme at the time of their appointment. Records showed that some staff have achieved NVQ 2 and the Regional Support Manager believes there are now 60 of staff with this qualification. A member of care staff confirmed attainment of NVQ 2 during a discussion with one of the inspectors. Notice boards that were observed in staff areas showed planned dates for training in wound care, first aid, catheter care, infection control and training in the Management of Violence and Aggression is also planned for June. A member of staff commented that training opportunities have begun to improve since the appointment of the current acting manager. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. Development systems have lapsed with staff not receiving adequate training or supervision and, although there is evidence to suggest that these deficits have now been recognised, this has had a detrimental impact on the quality of care provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has operated without a Registered Manager for some time, although an acting manager appointed in February 2007 has provided managerial input with support from a regional team. The current acting manager appears to have worked hard to try and improve training opportunities within the home Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 24 and also ‘tighten up’ on processes such as monitoring accidents and incidents. The Regional Manager provided confirmation that a person has now been appointed as ‘Home Manager’ and is due to commence employment soon-an application for this person will need to be submitted to CSCI in due course. The home has various methods to monitor quality within the home. The Regional Manager attends the home on at least a monthly basis to conduct monitoring visits. Questionnaires are sent to people living at the home and/or their significant others on at least an annual basis. Results are then collated to enable a report to be drawn up from the findings. Observation of this report showed that there had been a considerable reduction in the satisfaction in the services provided by the home. Staff feedback is also sought on how the service is managed-it was suggested that staff views are also sought on other areas pertinent to the home, such as views on training, staffing levels and care practice. Secure facilities are available for the safekeeping of peoples’ personal money and valuables, supported by written records of all transactions. A process has been implemented for staff to have access to formal supervision, however observation of these records shows that the focus of these sessions appears to be on practical observation, rather than reflection on practice and staff feedback described the sessions as an ‘ad-hoc’ affair, giving staff little time to prepare. Staff that are allocated to be ‘supervisors’ confirmed that training in conducting appraisals has been provided but not in the supervision process. Observation of training records show that the home has good statutory training opportunities for fire safety and moving and handling training, which is a similar finding to the inspection conducted in April 2006, where it was identified that training in infection control and the protection of vulnerable adults was required. The home does not appear to have moved forward in the provision of this training as records and discussion with staff do not provide confirmation that training has been provided. Records show that training in the safe use of bed rails has been provided and the home has a good process of monitoring to ensure correct fitting. Observation of maintenance and servicing records show a well-organised process with all necessary checks being undertaken. The Regional Manager confirmed that improvements in the lighting and security of the home at night have now occurred. Observations of the accident books showed that residents had sustained injuries during incidents of physical aggression but there was little evidence of follow up action taken, prior to the new acting manager starting in February 2007. It was also noted that the registered provider was not complying with Regulation 37 before this date, which requires that CSCI is notified of serious injuries, illnesses and events in the home which adversely affect the well-being Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 25 or safety of service users. There has now been an improvement in notifying CSCI of such events, with most significant events now being reported. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 26 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13 (2) Requirement Timescale for action 15/06/07 2 OP18 13(6) 3 OP27 18 (1)(a) 4 OP38 18 (1)(b) Medication must be stored in accordance with manufacturers’ instructions This is to ensure that medication is stored correctly to prevent people being placed at risk of harm and from receiving ineffective medication. (Previous timescale of 31/05/06 not achieved) Arrangements must be made to 15/07/07 ensure that all staff have a clear understanding of adult protection and whistleblowing procedures. This is to ensure that people living at the home are protected from harm or abuse. (Previous timescale of 31/10/06 not achieved) Staffing levels in all areas of the 01/07/07 home and for all shifts must be reviewed to take account of peoples’ needs and dependency. This is to ensure people’s needs are met safely and promptly. (Previous timescale of 31/05/06 not achieved) Staff must be provided with 01/08/07 training appropriate to the work they are required to perform. DS0000020791.V339308.R01.S.doc Version 5.2 Parklands Court Nursing Home Page 28 This will ensure that staff have the skills and knowledge to meet the needs of the people living at the home. 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 and service user guide should be reviewed and amended. This will ensure that people admitted to the home are provided with up to date information on the fees charged and the services offered by the home. Improvements are needed with the labelling of clothes. This will ensure that people’s dignity is not compromised. The registered person must continue the process of providing a safe supply of hot water at staff hand wash points of sluice and laundry. This is to promote good hand washing practice. (18/05/07-not assessed at this inspection) The process of fitting suited locks to bedroom doors should be completed. This is to ensure that people are provided with choice and privacy. (Previous timescale of 2/9/04 and 30/06/06 not achieved). Staff should be provided with training in infection control and improvements are needed in the promotion of hand hygiene. This is to reduce the risk of infection and to ensure people are protected by the home’s infection control systems. All parts of the home, including chairs must be kept clean and in a good state of décor. This is to ensure people are provided with a clean and homely place to live. Records to show that staff have attended training should be fully completed. This is good practice to enable training needs to be identified. The process of staff supervision should be reviewed. This will ensure that staff are competent to do their job and DS0000020791.V339308.R01.S.doc Version 5.2 Page 29 2 3. OP10 OP19 4. OP24 5 OP26 6 7 8 OP26 OP30 OP36 Parklands Court Nursing Home that this competency is maintained through a process of monitoring and reflecting on practice. Staff who are designated as ‘supervisors’ need to be equipped with the skills to perform this role. Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Parklands Court Nursing Home DS0000020791.V339308.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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