Inspection on 10/05/06 for Parklands Nursing Home

This inspection was carried out on 10th May 2006.

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

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

Other inspections for this house

Parklands Nursing Home 11/06/07

Parklands Nursing Home 12/01/07

Parklands Nursing Home 23/12/05

Parklands Nursing Home 04/07/05

Parklands Nursing Home 27/09/04

Parklands Nursing Home 05/05/04

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

CARE HOMES FOR OLDER PEOPLE Parklands Nursing Home 33 Newport Road Woolstone Milton Keynes Buckinghamshire MK15 0AA Lead Inspector Chris Sidwell Unannounced Inspection 10th May and1st June 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 Nursing Home DS0000019248.V296778.R02.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 Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parklands Nursing Home Address 33 Newport Road Woolstone Milton Keynes Buckinghamshire MK15 0AA 01908 692690 01908 231329 manager@pnh.demon.co.uk 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) Mr Vaz Mrs M Officer Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23/12/05 Brief Description of the Service: Parklands is a small privately owned care home, registered to provide nursing care and accommodation for thirty older people. The home is situated in the Woolstones area of Milton Keynes and is within a short journey of the town centre, where a varied range of amenities and facilities can be found. Parklands has twenty-two single bedrooms and four shared rooms. Some of these are being used as single rooms at the time of the inspection. All bedrooms are fitted with adjacent en-suite facilities and are on the ground floor. The lounge/dining room is fitted with four sets of French doors, which offer immediate access to the patio area and grounds beyond. Extensive welltended gardens surround the home. Fees range between £515 and £684 per week depending on the room available and resident’s care needs. Information about the home can be obtained by telephoning or visiting the home. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of four days. Prior to the fieldwork visit previous information about the home was reviewed and the outcome of previous inspections noted. Eighteen questionnaires were sent to service users families and eleven were returned. Six questionnaires were sent to professionals who visit the home and two were returned. Residents and those family members who were visiting on the days of the fieldwork were interviewed. A tour of the premises was undertaken and records held in the home were scrutinised. The care of a number of residents was ‘case tracked’ from their original contact with the home to the care that they are now receiving. Care practices and the home’s approach to quality and diversity issues were observed throughout. What the service does well: What has improved since the last inspection? What they could do better: A qualified nurse should always assess potential resident’s needs, before they move to the home, to ensure that they can be meet. Information for residents should be available in formats suitable for those with sensory deficits and systems should be in place to provide translated information for those whose first language is not English. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 6 Although the personal care of most residents had been met there is a need to ensure that personal hygiene needs are fully met for those who cannot manage themselves. The care plans should be reviewed monthly and all residents should have a nutritional assessment. A nurse must always take verbal messages regarding medication directly, in line with guidance from the Royal Pharmaceutical Society and the Nursing and Midwifery Council. There is also a need to ensure that there is sufficient staff available to meet residents needs in a timely way at busy periods of the day. Screens should be used when hoisting residents in the lounge. Everyday activities should be included in the daily programmes to provide stimulation and variety for residents during the day. The application of the home’s complaints policies and procedures must be improved. Written complaints should receive a written response, the complaints log should be maintained and themes from complaints should be analysed to make changes to improve the lives of service users. All staff should have training in the Protection of Vulnerable Adults. The lighting should be increased to ensure that it meets the needs of residents who are partially sighted and wish to read. The requirements of the environmental health officer should be implemented. The current height adjustable beds should be serviced and a plan agreed to replace the old beds and mattresses over a period of time. A programme with clear timescales to refurbish the bathrooms and ensuites should be agreed with The Commission for Social Care Inspection. Risk assessments must be completed for all those residents whose rooms do not have thermostatically controlled valves to water outlets in their rooms. The existing thermostatically controlled valves must be serviced and checked regularly. The staffing levels should be increased to meet at least the level described in the staffing notice issued by Buckinghamshire Area Health Authority in 2001, which stated that there should be five carers on duty in the mornings in order that residents needs are met in a timely way. A clear plan to ensure that 50 of staff hold the National Vocational Qualification in Care at Level 2 should be agreed with the Commission for Social Care Inspection. All staff must have basic mandatory training with annual updates. All staff who handle food must have food hygiene training. The recruitment processes must be improved as a matter of urgency to ensure that all staff have had the required Criminal Records Bureau disclosures and references taken up before they commence work. Their work history must be checked and references must be taken from the previous employer. The proprietor must also ensure that the residency status and work permit status is held on file for all staff. The annual development plan must be formalised and a copy sent to the Commission for Social Care Inspection. The planned quality assurance Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 7 programme must be implemented. The accounts, business and financial plans for the home must be sent to The Commission for Social Care Inspection. 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 Nursing Home DS0000019248.V296778.R02.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 Nursing Home DS0000019248.V296778.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence, including an unannounced visit to this service. Overall potential residents have the information that they need to decide whether the home can meet their needs and they have a contract, which tells them about the service they will receive. The information is not available in other formats to help those with sensory deficits or whose first language is not English. Their needs are not always assessed fully prior to moving to the home nor are they reviewed in a timely way. EVIDENCE: There is a statement of purpose and service user’s guide, both of which have been updated in the last year. The manager stated that these are given to residents on request. They are not available in formats specific to those with impaired hearing or sight. One relative was spoken to and although uncertain he thought he or his wife had seen these documents. The resident’s files seen had copies of their contract, which were explicit as to the service they should receive and the terms and conditions of occupancy. The care plans of the last three residents to be admitted were seen. All had had a pre assessment Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 10 although the general manager had undertaken one and not the qualified nurse in charge. They were not always fully complete. A copy of the care manager’s assessment, the referral letter from the Primary Care Trust and discharge letters from the local hospital were on file as appropriate. There was evidence on file that an initial care plan had been drawn up following the assessment. The manager stated that residents are admitted for a trial period. There was evidence that some, but not all, residents had been reviewed at the end of the initial four weeks in the home. The general manager described an assessment of a gentleman with complex needs, which she was currently undertaking with the newly appointed nurse manager. She described an approach, which was sensitive to both the potential resident’s physical and emotional needs but also the effect that the admission might have on the residents living in the home. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including an unannounced visit to this service. In general resident’s personal and healthcare needs are met, although not always in a timely way. The staff were conscious of the residents right to privacy and to maintain their dignity but were not always able to put this into practice. EVIDENCE: The care of four residents was ‘case tracked’. All had care plans although the extent to which these were fully completed and updated on a regular basis varied. The nurses spoken to were knowledgeable about the Nursing and Midwifery Council’s role in setting standards of nursing care and were aware of its guidance on medication. There was evidence in some files that residents had been involved in agreeing their care plans. All residents were seen and most had been assisted with their personal hygiene needs, where they were unable to meet these themselves. Some residents had dirty fingernails and this aspect of care needs to be monitored regularly. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 12 The care plans of the residents who were case tracked contained evidence that their risk of developing pressure damage had been assessed. Only one resident had pressure damage, which had developed in hospital. This was almost healed. The home has a number of pressure relieving mattresses, which the general manager had listed. There is a need to ensure that these are maintained on a regular basis. A number of the beds were very old. There is a need to gradually replace the beds and base mattresses over a period of time and to ensure that the home has a range of pressure relieving mattresses, appropriate to a resident’s risk of developing pressure damage. The advice of the tissue viability nurse should be sought as to the most appropriate purchases. There was evidence in the care plans seen that residents had been assessed as to their continence needs and that incontinence aids are provided, as appropriate, by the Primary Care Trust. There were no offensive odours in the home although on two occasions the inspectors observed residents who clearly wished to go to the toilet who had to wait until a carer was available. There were nutritional assessments in some of the records seen but not all. Resident’s weight is monitored regularly. A local general practitioner supports the home. There was evidence in the care plans that residents have access to chiropody, optical assessment and had been supported to attend the outpatient department where necessary. The residents spoken to confirmed that they had seen a chiropodist. One resident who is partially sighted said that she could not see well because of the low levels of lighting offered by the low energy light bulbs. This should be addressed by supplementary lighting where appropriate. A nurse from the local Primary Care Trust visits the home regularly to assess resident’s entitlement to financial support towards the fees in respect of their nursing care. She returned the comment card sent out as part of this inspection and confirmed that the home gave her the necessary support to do this. There are medication policies and procedures in place. The nurse in charge described the system that is in place to record medication entering and leaving the home although the general manager had inadvertently destroyed some of the paperwork. Controlled drugs are stored appropriately and the records seen were completed accurately. There was evidence in the records that a general practitioner had reviewed resident’s medication. Medication is supplied by a local chemist who offers advice and undertakes regular audits. There were issues about verbal messages phoned to the home regarding medication changes, which are not always received directly by the qualified nurse. This must not happen and nurses must take verbal messages regarding medication directly, in line with the guidance issued by the Nursing and Midwifery Council and the Royal Pharmaceutical Society. In general resident’s dignity and privacy is observed and all personal care was observed to be given in residents rooms. One lady was observed to be hoisted from her wheelchair to an armchair in full view of all residents and visitors in Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 13 the lounge. It is recommended that screens be used in these instances to protect resident’s dignity. The home works with the Willen Hospice to care for residents who are reaching the end of their life. There were many examples of thank you letters from relatives who valued the care and support that had been offered. Although the care needs of residents are generally met there are difficulties in meeting them in a timely way. On the day of the first visit to the home, four residents were still in bed at 12.00 noon. The staff spoken to said that they had not had time as yet to get to these residents. The inspector had to intervene to ask that a resident who was lying flat be sat up in bed before he was assisted out of bed, as he clearly had a chesty cough. On the second visit to the home, five residents were in still in bed at 11.30am. The staff spoken to said that this was because they had not had time as yet to help these residents. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence, including an unannounced visit to this service. The home welcomes friends and families although resident’s choices as to how they spend their day are constrained by staffing levels. Residents receive a healthy and balanced diet and mealtimes are a sociable occasion. EVIDENCE: There is a published activity programme and on one day of the unannounced visit the residents were enjoying reminiscence therapy. There was little evidence however of activities that are built into the day or of a full social history in the care plans which describes the activities that individuals would like to participate in. The daily routines are constrained by staffing levels. One resident said that she knew she would have to wait, as they are ‘very busy in the mornings’. All family members who returned the comment cards said that the staff welcomed them to the home at any time and that they could visit their relative in private if they wished. This was observed to be the case at the inspection, with family members arriving throughout the day. Details of local advocacy services are posted in the entrance to the home and there was evidence in many of the rooms that residents are encouraged to bring their personal possessions with them. Church representatives visit the home regularly. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 15 The chef was interviewed. She shared the menu plans, which were varied. The menu on the day of the unannounced inspection reflected the menu plans. Lunch was observed. The tables were laid well and the food presented attractively. The residents spoken to said that they enjoyed their meals. The food was mostly ‘home cooked’ and one resident said that he particularly enjoyed ‘crumble and custard’. The chef said that she was able to provide special diabetic diets if necessary and that special diet for those who had religious or cultural needs could be provided. Meal times were unhurried and staff were seen to assist residents sensitively. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 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 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence, including an unannounced visit to this service. Not all family members have the confidence that their concerns will be addressed and action taken to deal with them and neither are the Protection of Vulnerable Adult policies and procedures understood sufficiently by all levels of staff to protect residents. EVIDENCE: There is a complaints procedure and a record of complaints is kept although this was not complete. Of the eleven family members who returned the comment cards, nine said that they were aware of the homes complaint procedure and six said that they had had to make a complaint. One stated that a response had not been received. The complaints log showed that most complaints had been addressed but not all. The home has a copy of the Milton Keynes multi agency strategy for the protection of Vulnerable People. The staff spoken to were clear that they would report any concerns but some were not clear as to what constitutes abuse. The training records showed that not all staff have had training in protection issues. This must be addressed. It is of major concern that not all staff have had a Criminal Records Bureau check prior to commencing work at the home. The home’s recruitment practices are described more fully in the staffing section of this report. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 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, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including an unannounced visit to this service. Overall the home provides a comfortable environment for residents but is in need of refurbishment. EVIDENCE: Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 18 The home is located in a quiet residential area, in the centre of Woolstone, just over two miles from the centre of Milton Keynes. The home is readily accessible by car and has a car park for visitor and staff cars. There is a moderately large sized garden to the rear and a smaller garden to the front of the building. A wheelchair user would probably require assistance to enter the building in negotiating raised steps and doorsills. A temporary wooden ramp had been constructed to facilitate access from the garden but this needs replacing because the wood is starting to split, apparently due to weather exposure. The path to the rear and side of the house is uneven in places. All interior areas used by service users are accessible by wheelchair. The accommodation consists of the original house which, over two floors, houses the kitchen, an office, store rooms and staff changing rooms, and an extension, built about 17 years ago, in which the resident accommodation is located. The overall standard of accommodation is variable and work on modernising the hot water and heating systems had recently taken place. Many areas require refurbishment. Standards of cleanliness were generally good. The home is maintained by a gardener who also helps more generally (e.g. moving objects), and by regular contractors who carry out general maintenance duties. Other maintenance services (pest control, heating, fire safety, electrical etc.) are engaged on contract as required. Security includes alarms on doors and metal grills on some windows. The entrance lobby and reception area lead to communal living and dining areas and to offices and other accommodation used by staff. Resident’s bedrooms are located off corridors in the north and south wings of the building. At the time of the inspection there were 26 single bedrooms. Some bedrooms are larger than others having being converted from double bedrooms. 24 of the 26 bedrooms have en-suite facilities. The remaining two bedrooms have washbasins only. Bedrooms met the standards, which applied when the home opened and all have doors opening directly onto the rear gardens. Shared facilities comprise the dining room, living room, a smaller activities room and the assisted bathroom. Much of the lighting is provided by energy saving lights. It was reported that some dissatisfaction has been expressed about the level of illumination provided by these lights. The quality of the furnishings in the dining room and living room was satisfactory. Bedrooms are comfortable and those occupied have been personalised by residents. One bedroom door has been modified to facilitate access by an electric wheelchair and the fire authority has given advice on the fire safety aspects of this. Bedrooms do not have lockable storage space. Residents do not have keys to their bedrooms. A number of rooms are registered to provide double accommodation, although these are currently offered as single rooms. Most rooms have en-suite facilities. The home plans to replace en-suite baths with shower facilities in the near future. Some, but not all, of the hot water outlets in areas to which residents have access have been fitted with temperature regulating valves. It is expected that all will be so fitted “by the end of the summer”. Staff call points are fixed to the wall with leads provided where needed. Aids such as rails around toilets have been fitted where required. The home does not have grab rails in corridors. Portable hoists are available when required. The Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 19 assisted bathroom has a Parker bath. The heating system was in the process of being replaced at the time of the inspection. Some radiators had been covered. Some new radiators are being fitted at high level and are considered not to pose a risk to residents. The acting manager said that exposed pipe work associated with the work on the heating system would be covered on its conclusion. The digital display in the hot water boiler indicated that the water was at 59 degrees Celsius. Legionella is checked through an annual bacteriological analysis of the water. Not all water outlets have thermostatically controlled valves, although none tested had water higher than 44C. There seemed to be pressure on storage space. Hoists were stored in an empty bathroom. A trolley and commode were stored in the assisted bathroom. Surplus stock medicines, external preparations, syringes, dressing and catheters were stored together on open shelves in an upstairs storeroom. Some housekeeping issues were noted: a bin without a lid in the assisted bathroom, used disposable gloves in the bin in an empty room, a brick on the floor in the laundry, and untidy storage in some areas. The laundry room on the ground floor has two washing machines, a tumble dryer and a hand basin. There was clear separation between clean and dirty laundry. Clinical waste is disposed of in two large (unlocked) bins. The home has a contract with a company in Essex for the removal of such material. The proprietor stated that he has plans for an extension to the front of the home although these have not yet been submitted to the Commission for Social Care Inspection. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including an unannounced visit to this service. There is insufficient staff in the home at times of peak activity to fully meet the needs of residents. The recruitment procedures do not ensure that residents are protected from potentially unsuitable workers. EVIDENCE: There is a staff record. The record shows that the home plans to have 1 qualified nurse and four carers on duty between 08:00 and 14:00. This is below the staffing notice issued by Buckinghamshire Area Health Authority in 2001, which stated that five carers should be on duty during the morning. There was evidence that resident’s needs cannot be met in a timely way during the mornings. These are described in the Health and Personal Care section of this report. There are domestic and catering staff in post. Two of the fifteen care staff hold the National Vocational Qualifications in Care at Level 2. A number of staff are completing an accredited Skills for Care Induction programme, which is the foundation for entry to National Vocational Qualifications in Care. Eight carers are enrolled on the National Vocational Qualifications in Care at levels 2 and 3. The home does not yet meet the standard that 50 of care staff hold National Vocational Qualifications, although a plan is in place to achieve this. The recruitment records were found to be incomplete at the last inspection undertaken on 23/12/05. The administration manager had prepared a Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 21 spreadsheet showing which staff had the required documents. The spreadsheet showed that 11 of the 32 members of staff did not have 2 references on file and of those 6 had no references. Some staff had been employed for many years. In one record it was not clear whether the references were from the staff members previous employer. 10 members of staff did not have Criminal Records Bureau checks. One had been applied for on the 20.09.06 and had not yet been received and 9 were applied for on the 22/05/06. The POVA first clearance had been received for seven of these applicants. The application form does not state start and finish dates for previous employment and it was not possible to say whether there had been any gaps in employment history. The residency status and work permit status, where appropriate, of non-European passport holders were not clear. A requirement was made following the inspection undertaken on 31/12/05 that the proprietor must ensure that the recruitment files contain all the information required by Regulation 19 of the Care Homes Regulations 2001 and that the proprietor must have a copy of the relevant work permits on file. These requirements have not yet been met and must be addressed and followed up urgently. The requirement will be repeated in this report and continued noncompliance may result in the matter being referred to The Commission for Social Care Inspection’s legal department for consideration as to whether enforcement action is necessary. There is an active training programme although the training matrix requires updating to ensure that all staff have the required training with annual updates. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence, including an unannounced visit to this service. The acting management arrangements have protected residents although the development and implementation of the home’s management systems and quality assurance programmes has been hindered. EVIDENCE: The home has been without a registered nurse manager since September 2005. An administrative manager has been appointed who has taken overall responsibility for the home assisted by an experienced nurse who has acted as the acting nurse manager. A permanent appointment has now been made and a nurse manager comes into post on the 3rd July 2006. Both the administrative manager and the nurse manager have clear job descriptions. Their respective responsibilities have been mapped out. Three of the relatives Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 23 who returned the questionnaire commented on the lack of registered nurse manager. A number of staff members were interviewed and some concern was expressed that they were not always aware of changes and that the atmosphere was not always inclusive. There is an equal opportunities policy. Staff meetings are held informally. There is no formal residents or family members group established to enable them to influence the way in which the service is run. There is no formal annual development plan although the proprietor is planning to upgrade the facilities and to build an extension, to improve the administrative areas and to increase the number of single rooms within the current registration numbers. A service user survey has not been undertaken this year. The home has purchased a bespoke quality assurance manual, which the proprietor states will provide the basis of the home’s quality assurance procedures. The home does not manage any money on behalf of residents. A small amount of personal allowance is kept on behalf of residents and this was found to be managed correctly. The accounts for the home, the business plan and the financial plan for the home were not available at the inspection and must be sent to the Commission for Social Care Inspection. There are supervision policies and procedures in place although the absence of the registered manager has meant that these have not been fully implemented and some of the staff spoken to said that they did not receive supervision. There are health and safety policies and procedures in place. With the exception of the emergency lighting all regular servicing had taken place during the last year. There are manual handling policies and procedures in place and the training records showed that staff had received basic training although not all had had the required annual update. Eight staff members hold first aid certificates. Not all staff who handle food had had food hygiene training and the carers who serve the food in the evening did not know that they should probe the temperature of food at the time of its serving. There are infection control policies in place and the nurses were aware of how to control infection. The central heating systems have recently been replaced. Accidents are recorded in the accident record. The fire safety procedures have been improved since the last inspection and fire drills are now recorded. Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 24 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 3 2 X X N/A 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 2 X X X 2 2 3 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 2 Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 2 3 4 Standard OP3 OP7 OP8 OP9 Regulation 14 15 12 13 Timescale for action Service users should be assessed 31/07/06 by a suitably qualified person before they move to the home. The care plans should be 30/09/06 reviewed monthly and when a residents needs change. All residents should have a 30/09/06 nutritional assessment The general manager must not 30/06/06 take verbal messages regarding changes in medication. The qualified nurses must take these messages, only when absolutely necessary, in line with the guidance of the Royal Pharmaceutical Society and the Nursing and Midwifery Council. Resident’s dignity should be 31/07/06 protected at all times 30/09/06 The implementation of the complaints policies must be reviewed. All written complaints should receive a written response. A complaints log should be kept and analysed for themes, which could be used to improve the care and facilities for residents. All staff including the 31/12/06 DS0000019248.V296778.R02.S.doc Version 5.2 Page 26 Requirement 5 6 OP10 OP16 12 22 7 OP18 13 Parklands Nursing Home 8 9 10 OP19 OP20 OP24 16 23 13 11 OP25 23 12 OP27 18 13 OP28 18 14 OP29 19 administrative and nurse manager should have training in the protection of vulnerable adults. The requirements of the environmental health officer must be implemented. The lighting must be improved to enable residents to read. The current height adjustable beds must be maintained and programme agreed to replace old beds and those which have poor quality mattresses. A programme with clear timescales to refurbish the bathrooms and ensuites should be agreed with The Commission for Social Care Inspection. Risk assessments must be completed for all those residents whose rooms do not have thermostatically controlled valves to water outlets in their rooms. The existing thermostatically controlled valves must be serviced and checked regularly. The number of care staff on duty in the mornings must be increased to five. There must be one qualified nurse on duty between 09:00 and 17:00 hrs in addition to the nurse manager. The proprietor should develop a plan to ensure that 50 of care staff hold the National Vocational Qualification in Care at level 2 or above by 31.03.07. This plan should be sent to the Commission for Social Care Inspection. The proprietor must ensure that the recruitment files of all employees contain the information specified in Regulation 19 and schedule 2 and 4 of the Care Homes DS0000019248.V296778.R02.S.doc 31/07/06 31/10/06 31/10/06 30/09/06 31/07/06 30/09/06 31/07/06 Parklands Nursing Home Version 5.2 Page 27 15 OP29 19 16 17 OP30 OP33 18 24 18 19 OP33 OP34 24 25 20 OP38 13 Regulations 2001. This is an unmet requirement of previous inspections and a new timescale has been set. The proprietor must ensure that there is a copy of the residency status and a valid work permit on file for all relevant staff. All staff must have the basic mandatory training with annual updates. The annual development plan must be formalised and a copy sent to the Commission for Social Care Inspection The planned quality assurance programme must be implemented. The accounts, business and financial plan for the home must be sent to The Commission for Social Care Inspection All staff who handle food must have food hygiene training 31/07/06 30/09/06 30/09/06 31/10/06 30/09/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended that the statement of purpose and resident’s guide be available in other formats to assist those with sensory deficit and those whose first language is not English. It is recommended that every day activities be built into the daily programme. 2 OP12 Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aylesbury Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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. Extracts may not be used or reproduced without the express permission of CSCI Parklands Nursing Home DS0000019248.V296778.R02.S.doc Version 5.2 Page 29 - 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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