Inspection on 25/04/06 for Parklands Court Nursing Home

This inspection was carried out on 25th April 2006.

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

The inspector 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 18/05/07

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 Richard Eaves Key Unannounced Inspection 25th April 2006 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.V287504.R01.S.doc Version 5.1 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.V287504.R01.S.doc Version 5.1 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 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) www.bupa.com BUPA Care Homes (CFHCare) Limited 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.V287504.R01.S.doc Version 5.1 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. 30th January 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.V287504.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was undertaken by 3 Inspectors from the Commission for Social Care Inspection using the following information: the action plan submitted by the home to the unannounced inspection during January 2006, reports from the organisation relating to the conduct of the home, the pre-inspection questionnaire, survey responses and records held at the home. The inspection involved a full tour of each of the bungalow units including, bedrooms, communal rooms, service areas and provided an opportunity to speak with many service users, visitors and staff. What the service does well: What has improved since the last inspection? Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 6 Good progress has been made in implementing the homes decoration and refurbishment programme with a number of areas completed and carpets replaced where required. The modifications to Samuel house will aid in the delivery of the rehabilitation programmes for the service users. The assessment processes are reviewed to identifying changes of condition overtime and the care plans expanded to take account of potential complications to certain health conditions giving detailed direction to staff of appropriate responses. What they could do better: The involvement of the service user and or their relative in the assessment and care planning processes and reviews should be documented in the case file and rehabilitation goals included in the care plans for intermediate care service users. With the introduction of intermediate care it is necessary to provide a means of checking and booking in of medicines received and staff would benefit from training in this specialist area of work. Staff must be supervised to ensure routines are not implemented in an institutional way and receive training and regular updates in adult protection procedures. Personal clothing is an issue for service users and relatives with labels either lost or faded and clothing being issued to the wrong persons, “I do get fed up with the clothes thing sometimes, my wife never wears trousers but I keep finding them in her wardrobe”. While meals are good at the home there are weaknesses in the service due to the pressures of assisting a large number of service users. Some views expressed include, “if relatives didn’t visit we would never feed everybody on time”, “I’m here everyday I see the girls struggle, I don’t mind helping feed my wife”. Continued progress is required to fitting of door locks to bedroom doors to provide all service users the choice of added privacy and security in their rooms. Environmental monitoring must be thorough to identify actual and potential safety hazards and ensure aids to security such as streetlights and gates are in working order. The process of decoration refurbishment and replacement of furniture must be undertaken in such a way as to not leave areas with insufficient furniture to meet all service users needs at all times, such items as easy chairs in communal areas and dining places for the full number of people who could possibly make use of them. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 7 The levels of staff numbers and skill mix for nights requires to be reviewed to ensure that all aspects of the roles and responsibilities of staff can be met safely. The numbers of staff trained in NVQ level 2 requires to be in sufficient numbers to ensure the standard can be maintained at all times. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 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.V287504.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 The home provides good sources of information about the home and invites prospective service users to visit and spend time at the home prior to admission to enable them to make an informed decision about entering the home and receive a contract confirming the terms and conditions agreed for their stay at the home. The home uses comprehensive assessment tools, which means that residents’ needs can be thoroughly assessed but does not demonstrate their involvement to ensure that care needs will be identified and met. A dedicated team provide intermediate care that prepares service users to return home there remains scope to maximise this through ongoing staff training. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 10 EVIDENCE: Each unit has a copy of the homes statement of purpose available and each includes the unit’s own philosophy, a copy of the service user guide was seen to be issued to each bedroom, Samuel unit requires to develop an intermediate care specific section. All units use the comprehensive assessment tool, the BUPA Minimum Data Set (MDS) and supplemented with a range of risk assessments that identify needs and interventions required to address and minimise risks. Each of the assessments are subject to regular review. Other assessments seen within the case files were those raised by the care managers at the point of admission and subsequent reviews. Service users all had a thorough assessment document, the BUPA Minimum Data Set (MDS) but this had not been completed in all cases. The information contained within the MDS is comprehensive but confusing to read at times. There was no evidence to demonstrate the involvement of service users or their representatives during the assessment process or subsequent reviews; exceptionally risk assessment for use of bedrails did include consents. Samuel unit now provides intermediate care and shortly the entire unit will be dedicated entirely to providing intermediate care. Intermediate care is in its infancy, staff have identified that some service users have been admitted outside the initial guidelines. Staff must be more proactively involved in agreeing that service users are admitted to Samuel within the current category of registration and strictly within agreed protocols. Staff spoken to have had limited training about what is intermediate care but training will continue to be provided on an ongoing basis and this must address current gaps in understanding in intermediate care. Medical cover is provided by a local GP although information systems need to be improved to ensure that a full medical history is available. The service user guide describes services that are available, but does not include services provided for service users who are admitted for intermediate care. Information must be available that explains the ethos of intermediate care, services available and all multi disciplinary staff who are available to assist service users requiring intermediate care for Samuel unit. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Health care needs of service uses are generally well met and care planning in the home is overall of a good standard but in some instances requires to be more detailed if omissions of care are to be avoided. Medications are well managed at the home, facilitating the promotion of service users health. Personal support in some units is not offered in such a way as to promote and protect service users’ dignity. EVIDENCE: Case files were available for all service users across the home and a sample randomly inspected in each of the units and included a sample of those admitted under the intermediate care arrangements. Overall the care plans were derived from extensive assessments of needs and individually assessed risks were completed well and provided good direction for the delivery of care. Care plans are subject to daily assessment and fully reviewed at least monthly. Samples of service users files were seen on each of the homes units, in all cases service users had care plans that detailed their needs and the care that had been planned for them. The system used does not readily demonstrate Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 12 how service users are involved in this process or to show their agreement with the care planned for them. Some care plans were well written and had a very individualised feel to them. Other plans require more in depth information such as how to deal with conditions such as diabetes, epilepsy and pressure care. Contingency plans for these conditions were patchy some included detailed guidance while one example was seen of no plan for epilepsy. On one unit it was noted that nursing staff were omitting doses of insulin prescribed for residents with diabetes this is concerning because there is no documented evidence that this was supervised and authorised by the doctors. Residents with unstable diabetes had not been referred for specialist advice on how to manage their condition. On Samuel unit a plan of care is available for all service users, these need to be developed to ensure that intermediate care goals are included and demonstrate that service users are involved in planning and evaluating their care. Administration of medication across the home is by trained nursing staff only and is undertaken safely. There were some gaps in recording whether medicines have been administered particularly for the administration of creams and lotions. Staff need to ensure that all medicines and particularly service users who are admitted for intermediate have receipt of their medicines recorded. Care plans need to be drawn up that demonstrate when “as required” or PRN medication is to be administered and how its effectiveness is monitored. The date of opening of “short life” medicines such as liquid antibiotics and calogen is not recorded in all cases. The treatment room on Samuel was warm on the day of the visit as were others on site, room thermometers were available though not all units are routinely monitoring the treatment room to ensure that medicines are stored within required temperatures. Drug fridge temperatures are recorded daily on all units, the record on Samuel showed temperatures considerably outside “safe” temperatures and this required immediate attention, it was not certain if the problem was with the electronic thermometer or the fridge. An audit is undertaken quarterly of medication arrangements on all units. Interaction between service users and staff were generally observed to be positive, which was confirmed by service users spoken with comments such as “staff are very good”. The survey responses were all positive about the relationship with staff and of the nine who made comments they were positive other than a general view that there were insufficient staff numbers, particularly during the evenings. Staff were observed to switch off the television without asking service users and also putting protective covering over their clothes without first asking if they would like a napkin to protect their clothes. Some relatives have made comments about clothing going missing or other people’s clothing in their relatives’ wardrobes. “I do get fed up with the clothes thing sometimes, my wife never wears trousers but I keep finding them in her wardrobe”. Whilst touring one of the units it was noted that there were items Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 13 of underwear on a trolley, such a situation suggests that the poor practice of communal use is going on, one relative identified that her mother had been seen in an other persons clothing, this was discussed with the acting manager during the inspection and the matter will be addressed. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 The home provides a well-organised and appropriately varied social and recreational activity programme that provides interest and pleasure for the service users in each unit. An open visiting policy assists service users to maintain contact with their family and friends. Service users exercise choice and control over their lives but staff must guard against routines detracting from service users choices. Meals at the home are wholesome and meet the nutritional needs of service users while reflecting choice and taste. The service of meals is poorly organised and may detract from the pleasure to be derived from mealtimes. EVIDENCE: All case files include a “map of life” providing information about service users past life and interests. There was no evidence that this is developed into a plan of care for social activities. Intermediate care service users require a social care plan as part of their rehabilitation programme. There was little information in the care plans about service users choices in such areas as preferred rising and settling times, food likes and dislikes and where to spend their time. The homes Activity Organisers provide each unit with three half-day sessions a week with an activities programme displayed on the notice boards of each unit, this forms the basis of routine events which can be expanded by Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 15 more ad-hoc and spontaneous events such as exercises, music and movement, entertainers, individual shopping trips and other one to one sessions. Across the home meal times were observed and it was evident that staff struggle to assist all of the service users who needed help with eating and drinking. There are a high number of residents who need assistance during meal times. Some comments included “if relatives didn’t visit we would never feed everybody on time”, “I’m here everyday I see the girls struggle I don’t mind helping feed my wife”. Those residents who are capable of feeding themselves are sometimes left to wait a little longer for their meals whilst others receive assistance. Mealtimes appear to be a frantic affair as staff rush to ensure that all residents are given a meal. The registered provider must explore ways in which to make mealtimes a more relaxing and enjoyable experience for residents Residents were offered choices for breakfast of bacon, scrambled egg and tomatoes with toast. The home provides sandwiches at lunchtime for the majority of residents but there is always a “hot” option available. The main meal of the day is served at teatime. The food is delivered to each unit by trolley from the main kitchen and generally looks appetising, although for those residents who require a soft diet their meals looked unappetising and unappealing. On the first morning of this inspection those residents were offered liquidised bacon and sausage with scramble egg. On Samuel unit it was seen that tables were laid and the dining area is pleasant but there were insufficient tables and chairs for all service users. Observations made identified that service users were not all asked whether they would like to go to the table for their meals. Staff said that service users are asked for their choice of meal the previous day. Comments made by service users would suggest that they had either forgotten what was available or were just given sandwiches and soup without being offered choice. The Unit Manager said that they are producing written information on choices available, which service users can complete themselves and will ensure that if they would prefer a hot snack they know this option is available. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home complaints policy is robust providing a safe environment in which service users feel they can voice concerns and that these will be listened and responded to. Service users rights are protected and staff demonstrate an understanding of adult protection issues that contributes in providing an environment safe from abuse. EVIDENCE: The home has an appropriate complaints procedure and maintains a detailed record of the complaint, investigation and the outcome, since the previous inspection a number of concerns have been raised and responded to internally. Some relatives were spoken to and they indicated that they knew who to contact if they were unhappy. “I go straight to the matron, that way you know you will get things sorted out”. Of the survey returns 12 indicated they always knew how to make a complaint, 5 usually and 1 sometimes. Two added comments, “I usually ask my daughter to take up things on my behalf”, and “I have not needed to make a complaint but I feel I would know how”. A number of staff have not received recent protection of vulnerable adults training to increase their awareness of what is abuse although the training matrix identifies two sessions for up to 30 staff for May. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 Overall the home provides a good standard of décor, furnishings and managed services but a number of deficiencies detract from its safety and homeliness as a place to live. The home is clean, free from odours and hygienic. EVIDENCE: Each of the units except Harrison has been decorated and received some refurbishment and is continuing, with work on Samuel nearing completion and Harrison programmed for May. On Samuel the lounge was found to be sparsely furnished with insufficient lounge chairs for all service users giving it an unwelcome appearance. It was pleasing to note that on each of the dementia care units work has been undertaken to fill memory boxes for each resident. This work was very imaginative and done with the resident and their families. Each resident has their memory box fixed to the wall next to their bedroom door this helps them to recognise things familiar to them and to be able to find their bedrooms. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 18 One of the dementia care units has developed a sensory garden that residents are able to enjoy with their families and each other. There is a water feature and wind chimes and adequate seating for residents. A tour of the premises was undertaken and serious concerns were highlighted on one unit. The bathrooms and toilets on one of the units tiles had become loose some at a high level and presented a risk of falling off. A notice of immediate requirement was issued to address the problem, which was seen to be made safe the same day. Security on site is lax with street lights out of order, the front gates unsecured at night and the front door of Samuel unit found to be unlocked at 7.10a.m. and again during the late afternoon with the Inspector entering the home unchallenged this must be addressed to protect service users and their property. The premises overall are generally clean to a good standard, hygienic and free from odours, the need for more frequent high dusting was identified and that of a need to clean extractors on a more frequent basis. Infection control practices are generally satisfactory although a number of commode chairs require upholstering and the commode pot racks in the sluice areas are damaged and the metal is rusty requiring their replacement. Staff were observed to wear protective clothing during the course of their duties for personal care and handling food. Gloves and aprons were available for all staff to help reduce the spread of infection. Staff hand wash hot water remains uncontrolled in some areas and requires to be addressed to promote good hand washing practice. The centralised laundry meets all standards for cleaning, sluicing and disinfection by washing machine with facilities and policies to protect staff from infection. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 The home has a good mix of staff in sufficient numbers to provide consistency of care that meets service users needs. The home continues to make progress in developing a skilled staff group, although staff turnover has reduced the number of qualified staff and could affect the consistency of care to service users. Recruitment and selection processes are to a good standard protecting vulnerable people. EVIDENCE: Staff are appointed and allocated to each of the 5 units to provide consistency and in such numbers that reflect the dependency needs of the service users the details of daily allocations are shown under each unit heading. Marlborough staffs with 2 nurses and 4 care for the 18 bed unit and 2 care for the 8 bed unit with 1 nurse and 3 care overnight. Clarendon has 2 nurses by day with 5 or 4 carers and a nurse plus 2 care at night with a twilight shift. Collins has a 2 nurses plus 7 care a.m., a nurse plus 5 care p.m and a nurse plus 2 at night. Samuel staffs with 2 nurses plus 5 care morning and 4 afternoon and 1 nurse and 2 care at night. Harrison 2 nurses and 4 care by day with 1 nurse and 2 care at night. There is a proposal for Samuel unit to increase staffing levels by one member of staff when all 29 beds are occupied by service users requiring intermediate Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 20 care. Staff confirmed that day staffing levels currently meet service users needs although there is concern about the sufficiency of staff on night duty. Night staffing levels can be compromised when the trained nurse has the responsibility as site cover. The role and responsibilities of the night manager and deputy requires them have to leave their unit leaving just two care staff on the unit, this should be reviewed. Due to staff turnover the previously achieved standard of 50 care staff with NVQ at level 2 is not now achieved with the number dropped to 33 . A number of staff are enrolled or due to be enrolled which will enable the standard to be met on completion of the training. Staff spoken to said that training opportunities are good. All new staff receive induction and foundation to National Training Organisation standards and have an identified mentor who is an experienced carer to give them help and support. Recruitment and selection is completed to a good standard and includes all necessary checks such as CRB, POVA and nursing registration. Staff files also show that two references are obtained and records kept of interviews. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 In the absence of a registered manager leadership at the home remains good and staff demonstrate an awareness of their roles and responsibilities to service users benefit. The sound financial management of the home and arrangements for safekeeping of their money safeguards service users interests personal and financial. Staff receive supervision and direction to ensure that the service users receive consistent quality care. Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. EVIDENCE: The Registered manager has left the post and the deputy has been appointed to the post, the process of registration has commenced. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 22 The home has a quality plan, with a review of all areas of the home at least annually. The home manager conducts monthly audits of the incidence of pressure sores and care plans and quarterly audits of accidents and complaints. A service user survey was undertaken in Autumn 2005. A report is available of the findings, which also compared findings identified when a survey was undertaken in the Spring 2005. Staff can be rewarded customer service awards with “Personal best awards” which are nominated by services users or relatives for care beyond expectations. Secure facilities are available for the safe keeping of service users personal money and valuables. Written records are available for all transactions and detail the reason for the withdrawal and two signatures. Regular external audits of service users personal money are undertaken. Services users are able to control their own finances if they want and are able, the majority have their finances managed by their families or by a Guardianship Order. There are currently 8 long standing service users who have their financial affairs managed by the home, this should be reviewed to see if alternative arrangements can be made as far as is reasonably practical. Services users can choose whether they opt in to an additional package of services, which includes the provision of toiletries, chiropody and hairdressing which are charged separately. Consideration should be made about this ongoing arrangement to include the key worker and service users preferred choice of toiletries. Staff receive regular supervision where they are able to discuss their progress and identify training needs. “I see the manager she tells me if I’m doing well, they usually tell us what training we need to do”. All staff have recently received an annual appraisal and have received at least 1 supervision this year. There is a need to ensure that supervision records are comprehensive and include all areas discussed and agreed. It was pleasing to see that following a random inspection of service users files all residents who require bed rails have a completed comprehensive bed rail risk assessment in place. The home has good statutory training opportunities for fire safety training and moving and handling but further training is required in infection control, protection of vulnerable adults and health and safety. Accident records are not reviewed centrally however two accident records seen required further investigation to ensure that service users are fully protected from harm. Accidents require to be analysed on a monthly basis and action plans developed as required. The separation of incidents from accidents would assist in this analysis. Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 24 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 OP24 Regulation 23(2)(e) Requirement The responsible person will complete the process of fitting suited locks to bedroom doors. Timescale of 2.9.04 not met. The registered person must ensure the redecoration programme continues and includes Harrison House. The registered person must make safe all of the loose tiles in all bathrooms and toilets in Clarendon House The registered person must ensure that the microwave in Clarendon House is replaced because it is rusty and has peeling paint internally and places service users at risk. (immediate requirement) All rusty or damaged sluice racks are repaired or replaced. Damaged commodes must be repaired or replaced. The home must only accommodate service users within the categories of care for which the home is registered. The home must demonstrate the Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 25 Timescale for action 30/06/06 2 OP19 23(2)(d) 30/06/06 3 OP19 23 (2) (b)(c) 26/04/06 4 OP26 23 (2) (k) 31/07/06 5 OP3 14 & 15 31/07/06 6 OP7 15 7 OP9 13(2) 8 9 OP6 OP10 18 16(2)(f) 10 11 12 13 OP18 OP20 OP27 OP28 13(6) 23(2)(g) 18(1)(a) 18(1)(c)i 14 OP38 13(6) involvement of service users or their representatives in the assessment process. The plan of care for service users requiring intermediate care must include goals for their rehabilitation. Staff must record the receipt of all medicines including medicines that service users bring in with them. The date of opening of short life medicines must be recorded. Medicines must be stored safely within required temperatures. No gaps are to be left on the medication administration record. A record must be made of the administration of creams and lotions. All staff (Samuel) involved in intermediate care must undertake training. Services users choices are respected and dignity upheld. The registered provider must ensure that the practice of “communal” underwear stops and each service user has their own clothing. All staff must receive training in the awareness of what is abuse. A sufficient number of easy chairs must be provided to meet the needs of all service users. The responsible person must ensure that sufficient numbers of staff are deployed at night time. The responsible person must ensure that staff are trained to NVQ level 2 in sufficient numbers to maintain a minimum number of 50 at all times. All accident reports must be reviewed by a senior member of staff to ensure that all required actions have been undertaken, DS0000020791.V287504.R01.S.doc 31/05/06 31/05/06 31/10/06 25/04/06 31/10/06 31/05/06 31/05/06 31/10/06 31/05/06 Parklands Court Nursing Home Version 5.1 Page 26 15 OP38 23(2)(o) and this must be recorded. The grounds require to be well lit at night and kept secure. 05/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations The registered person must continue the process of providing a safe supply of hot water at staff hand wash points of sluice and laundry to promote good hand washing practice. Care plans for the care of diabetes and the management of pressure sores must be more detailed and include contingency planning. Service users have a social plan of care that identifies their interests and capabilities referred to in the case file. The responsible person shall ensure as far as practical that persons working at the care home do not act as the agent of a service user. The service users guide must be reviewed to reflect the changes in service in a timely way. 2 3 4 5 OP8 OP12 OP35 OP1 Parklands Court Nursing Home DS0000020791.V287504.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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