Inspection on 12/01/07 for Parklands Nursing Home

This inspection was carried out on 12th January 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 Nursing Home 11/06/07

Parklands Nursing Home 10/05/06

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 Schwarz Unannounced Inspection 12th & 17th January 2007 10:00 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.V320582.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 Nursing Home DS0000019248.V320582.R01.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.V320582.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2006 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 Woolstone 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 £541 and £684 per week depending on the room available and residents’ care needs. Information about the home can be obtained by telephoning or visiting the home. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of two days and covered all of the key standards for older people’s services. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received about the home since the last inspection was also taken into account in the planning of the visit. Discussions took place with the manager, administration manager, financial manager and one of the nurses in charge. Observation of care practice was undertaken and there was opportunity to speak with staff on duty to gain their views and to speak with service users. A tour of the premises and examination of some of the required records was also undertaken. A key theme of the inspection was assessment of how the home meets needs arising from equality and diversity. At the end of the inspection feedback was given to the manager and the financial manager. Some requirements from previous inspections have not been addressed, causing concern about how the home is run and overseen. Revised timescales are given within the report. In addition the Commission will look at whether further action is necessary, such as enforcement action, to ensure that regulations are complied with. The home is thanked for co-operating with the inspection and for its hospitality. What the service does well: Information about the service is contained within a statement of purpose and service users guide so that prospective service users and their families have the necessary information to help make a decision about moving into the home. Contracts are in place, setting out the terms and conditions of residency so that service users know what to expect and their rights. Assessment is undertaken of prospective service users to ensure that needs are identified and that the home is able to meet these needs. Health care needs are largely met and medication is well managed, to ensure that service users stay well and receive the medicines they require as prescribed. There is regard for service users’ privacy and dignity and they are treated with respect, ensuring that care is provided sensitively and appropriately. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 6 Social, religious, cultural and recreational needs are partly met, providing service users with some continuity and varied stimulation. Contact with family, friends and the local community is enabled, maintaining important social links. Service users have opportunities to exercise choice and control over their lives, where able, to retain independence. Meals and mealtimes are well managed, ensuring that service users’ nutritional needs are met. A complaints procedure is in place, to ensure that views of service users and their representatives are listened to. The environment has an overall homely and personalised ambience. Heating, lighting and space requirements of the environment are met, to provide comfortable accommodation, and there is good regard for cleanliness, to prevent the spread of infection at the home. Good progress has been made with National Vocational Qualification training, ensuring that staff have the skills and competencies to meet the needs of service users. There is effective management at the home, ensuring continuity and that the home is run in the best interests of service users. Quality assurance measures are sufficient to monitor standards of care, ensuring that service users receive the support they require. What has improved since the last inspection? Prospective service users are assessed by the nurse manager, to ensure that a suitably qualified person ascertains care needs and is able to determine whether the home is in a position to meet these needs. Care plans are being reviewed regularly, to ensure that changing needs are documented. Nutritional assessments have been put in place to ensure that service users receive an appropriate diet and any assistance they require. Changes to medication regimes have ceased to be taken verbally by unqualified staff, reducing the risk of error. There is better regard for service users’ dignity, promoting their self-worth. The complaints policy has been reviewed and a complaints log established, providing more appropriate systems for airing views and documenting these. There has been some adult protection training, ensuring that staff understand and recognise different types of abuse and how to protect service users. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 7 Some improvement has been made to en-suite bathrooms and showers to ensure that service users have facilities that met their needs. Some new beds have been purchased, to ensure that service users are comfortable and can be nursed appropriately. A quality assurance questionnaire had been undertaken, to seek views on standards of practice within the home. The number of care staff on duty has been increased to five and there is a qualified nurse on duty in addition to the nurse manager between 9 am and 5 pm. The target of fifty percent of care staff holding National Vocational Qualifications has been reached, to ensure that service users are cared for by staff with the necessary competencies and skills to meet their needs. Evidence of suitable training was in place for staff who handle food, ensuring that the correct hygiene measures are in place. Water is being stored above 60°Celsius to safeguard against the risk of Legionella species growing. What they could do better: Completion of all sections of the pre-admission assessment format is needed, to make sure that important details are not missed out. Care plans are in place for each service user but need some further details, to ensure that needs are identified and can be met by staff. Some attention is needed where service users are nursed in bed, to ensure they are turned as frequently as their care plan states, to prevent pressure damage. The adult protection procedures need some revision to ensure that current and best practice is followed and some staff need to complete their Protection of Vulnerable Adults training to make sure that service users are protected from the risk of harm. The home’s recruitment practice and management of service users’ money places service users at potential risk of abuse. The environment needs improving to ensure that en-suite facilities are in good working order and that appropriate beds are provided for all service users, to best meet their needs. The number and skills mix of staff may not be sufficient to meet the needs of service users, resulting in restricted choice of times to get up and go to bed. Recruitment of staff is not robust enough, placing service users at potential risk of harm. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 8 Mandatory training needs completing by some staff, to ensure that staff have the necessary skills and knowledge to meet care needs. Those left in charge of the building are not always fully trained, potentially placing service users at risk of harm. Service users’ money is inappropriately handled, increasing the risk of financial abuse. Higher regard toward health and safety is needed, to ensure that the risk of accidental injury to staff, service users and visitors is minimised. 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 Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the service is contained within a statement of purpose and service users guide so that prospective service users and their families have the necessary information to help make a decision about moving into the home. Contracts are in place, setting out the terms and conditions of residency so that service users know what to expect and their rights. Assessment is undertaken of prospective service users to ensure that needs are identified and that the home is able to meet these needs. Completion of all sections of the assessment format is needed, to make sure that important details are not missed out. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home’s statement of purpose and service users guide had been updated since the last inspection and provided useful information about the home and what service users may expect. A recommendation to make these available in other formats, such as large print, had not been put into practice yet although ideas of the types of format were discussed. Contracts and copies of local authority care service orders, where applicable, were in place on the files examined, setting out the terms and conditions of residency and important information such as how to make complaints and the contact details of the Commission for Social Care Inspection. Pre-admission information of three service users was examined. The nurse manager had undertaken and written each of these and a useful format had been used covering a range of personal and health care needs. Some sections of the format had not been completed in a couple of files, or required further details such as the type of pressure relieving device required. A requirement is made to address this to ensure that key information about personal and health care needs is not overlooked. Information was also available from other agencies, such as the hospital where one service user had been admitted straight from a ward. The pre-admission information had been used as a basis for each person’s care plan. Intermediate care (standard 6) is not provided by the home therefore this standard was not applicable. Parklands Nursing Home DS0000019248.V320582.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. This judgement has been made using available evidence including a visit to this service. Care plans are in place for each service user but need some further details, to ensure that needs are identified and can be met by staff. Health care needs are largely met and medication is well managed, to ensure that service users stay well and receive the medicines they require as prescribed. Some attention is needed where a service user is nursed in bed, to ensure they are turned as frequently as their care plan states to prevent pressure damage. There is regard for service users’ privacy and dignity and they are treated with respect, ensuring that care is provided sensitively and appropriately. EVIDENCE: A care plan was in place for each person living at the home and improvement noted since the last inspection. The plans did not contain evidence of service user involvement, for example signatures or personal contributions such as “I would like” or “I would prefer”. It is recommended that the plans be developed along the lines of person centred planning to ensure that service Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 13 users are able to contribute to how their care is delivered and to make sure that they have opportunities to be consulted about it. Each file was well presented with information easy to locate and a consistent format in use. There was evidence of regular reviewing where service users had been resident at the home long enough for this be to be relevant. Information on care plans was recorded in key areas such as medication regimes, hearing and communication, foot care, oral care, continence, personal care and pressure risks. Nutritional assessments were in place on each file examined and moving and handling assessments had been written by the physiotherapist. Some important details were missing in files, such as typical blood pressure readings, temperature and pulse rates and weight upon admission. Evidence of regular weighing was not consistent in each of the files examined and notably absent for a service user at high risk due to refusal to eat or drink. It is recommended that these measurements are taken and recorded on the care plan and repeated at regular intervals so that any deterioration in health is easily identifiable. Pressure area management plans were in place where needed and there was evidence of regular involvement of tissue viability nurses with detailed records maintained of pressure damage and treatment. It was observed that one service user being nurse in bed needed to be turned on a regular basis. Whilst records did provide evidence of regularity, they also showed large amounts of time in one position, for example from 5.30 am until 12.00 noon and the record sheet was dated 11th January even though it was the 12th. A requirement is made to ensure that turning regimes are adhered to and accurate records maintained of these. Pressure relieving devices were being used and the nurse manager said that the home’s physiotherapist provided guidance on the type required by each service user. Each service user had been registered with a surgery and records were available within the home to record when visits had been made and the outcomes. Involvement of a physiotherapist at the home is a positive aspect of promoting service users’ mobility and helping reduce the risk of falls. Medication was being managed using a monitored dose system. Accurate records were being maintained of medication administered to service users and all medicines were safely stored on the premises. Controlled drugs were appropriately stored and an accurate register maintained. A recommendation is made to ensure that staff wipe up drips of liquid medication, to prevent stickiness which is then transferred around the cabinet. There had been some issues with service users’ privacy and dignity being compromised at the last inspection, resulting in a requirement being made to Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 14 improve practice. This was largely due to service users being assisted through communal areas of the premises in night attire to use the shower or bathroom as their own were not working. Whilst some showers and bathrooms are still awaiting attention, there did not appear to be any issues of dignity and privacy being compromised on this occasion. Staff were observed knocking on doors before entering and all personal care was carried out in private. Service users looked well presented in clean clothing and were enabled to wear jewellery and look their best. Four relatives returned comment cards. Three said they were satisfied with overall standards of care and one said that they usually are satisfied. One relative said “The care given to my mum is excellent and she is very happy at Parklands.” The home is providing care to some service users with dementia. The current registration certificate does not include this category and the home’s link inspector will be advised of this, to consider whether a variation to the registration is necessary. Parklands Nursing Home DS0000019248.V320582.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. This judgement has been made using available evidence including a visit to this service. Social, religious, cultural and recreational needs are partly met, providing service users with some continuity and varied stimulation. Contact with family, friends and the local community is enabled, maintaining important social links. Service users have opportunities to exercise choice and control over their lives, where able, to retain independence. Meals and mealtimes are well managed, ensuring that service users’ nutritional needs are met. EVIDENCE: Some of the feedback from service users was that they would like more entertainment and opportunities for stimulation. This had also been one of the findings of the service user questionnaire which the home circulated as part of a quality assurance review. Effort had been made by the nurse manager and financial manager to put more on the programme and the January list included floor dominoes, cards, reminiscence, bingo, sing a longs, sweet making and a church service. Service users were seen enjoying watching a recording of The Sound of Music on the second day of the inspection and playing bingo on the afternoon of the first visit. A hairdresser had also visited as part of a weekly Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 16 arrangement with the home. Posters displayed in the home advertised forthcoming events. Details of particular interests, hobbies and pastimes were not included in the sample of care plans that were read. This information needs to be ascertained to ensure that activities are appropriate to the needs of service users and that they have opportunity to pursue leisure interests. A requirement is made to address this. There was positive feedback from service users about meal provision at the home and they said they are given enough to eat. Menus submitted with the pre-inspection questionnaire showed variety and the food served during the inspection looked appetising and was nicely presented. Those service users who needed assistance to eat were enabled by staff. Several visitors came to the home and were made to feel welcome by staff. Service users said that their friends and relatives can come and see them as they wish and that no restrictions were placed upon this. There is a room adjacent to the lounge that can be used by service users and their visitors if they wish. One relative commented that staff make her feel very welcome when she visits. Service users had been encouraged to bring in personal belongings to maximise personal autonomy and choice. No one who participated in the inspection was still managing their own finances, either due to choice or infirmity. Parklands Nursing Home DS0000019248.V320582.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 poor. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place, to ensure that views of service users and their representatives are listened to. There are adult protection procedures and training in place to ensure that the risk of harm to service users is reduced. The procedures need some revision to ensure that current and best practice is followed and some staff need to complete their training to make sure that service users are protected from the risk of harm. The home’s recruitment practice and management of service users’ money places service users at potential risk of abuse. EVIDENCE: The home’s complaints procedure covers all required areas and a log book has been set up to file any complaints. No complaints had been received at the home since the last inspection. The Commission had been contacted by a relative regarding reimbursement of fees which has since been resolved and an anonymous complaint about showers not working; this prompted an unannounced visit by the Commission to review the environment at the home and resulted in requirements being made for improvement. Relatives who completed comment cards were aware of the home’s complaints procedure and one person added “Any complaints I have made have only been minor incidents.” Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 18 Adult protection procedures are in place at the home. The home’s policy needs to be revised to include a statement that staff are to report any suspicions, allegations or incidents of abuse to the Commission within 24 hours, so that these important notifications are not missed. A requirement is made to attend to this. The local authority inter-agency procedures in the home were dated 2004; it is recommended that contact is made with the local authority to ensure that the home has the most up-to-date version available. The Commission is not aware of any current adult protection concerns regarding service users at Parklands. Some training on adult protection had taken place at the home but some staff, mainly those who work on an occasional basis at the home, did not attend this. A requirement is made to ensure that they complete adult protection training as part of their mandatory training. The continued lack of robust recruitment practice at the home, despite previous requirements to comply with regulations, is of particular concern due to the possible repercussions for service users. This is covered later on in the report under the staffing section. Management of service users’ money is poorly handled at the home and has not been effectively overseen. This is detailed under the section looking at management and administration. Parklands Nursing Home DS0000019248.V320582.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, 21, 23, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment has an overall homely and personalised ambience but needs improving to ensure that en-suite facilities are in good working order and that appropriate beds are provided for service users, to best meet their needs. Heating, lighting and space requirements are met to provide comfortable accommodation and there is good regard for cleanliness, to prevent the spread of infection at the home. EVIDENCE: Parklands is situated in a quiet location to the east of Milton Keynes. The premises are close to open space and the home provides accommodation on ground floor level with all single bedrooms. Four of the bedrooms were previously used for double occupancy and provide increased space for service users; this was put to good use for one person who relies on a wheelchair to get around. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 20 She pointed out that the door way had been adapted to enable easy access into the room. Bedrooms fulfilled space requirements and were personalised with items such as furniture, ornaments, pictures, television and music equipment. Each room had a good sized window and appeared suitably ventilated and appropriately lit. The home was heated throughout and service users were warm to touch. All of the bedrooms have en-suite showers or baths. The baths are unadapted and hence not suitable for the needs of the people living at the home. There had been a concern that several of the en-suite rooms were insufficient to meet needs, resulting in occasion when other service users’ showers were used. Additionally, service users had been taken round to communal bath and shower facilities in their night wear, compromising their dignity and privacy when wheeled through the lounge to get to these facilities. Some improvement was noted to en-suite provision at this inspection. Three new showers had been installed and were working, with a fourth waiting to be fitted. One of the baths had been removed and replaced with a shower in a refurbished en-suite. This room was vacant at the time of the visit but due to be filled imminently. The financial manager described the plan to improve facilities by focusing first on the showers that are not effective, and replacing the wall tiles, and aiming to have this completed by the end of February this year. In time, these will be completely refurbished to provide more of a wet room facility. Eleven rooms had baths that need to be taken out and replaced with a shower and it is envisaged that one a month will be upgraded. Overall, the number of service users relying on using the communal shower or the Parker bath was reduced, according to information supplied by the nurse manager and financial manager. Service users’ privacy and dignity was not observed to be compromised on this occasion. The home was complying with a requirement to write risk assessments for those service users whose rooms do not have thermostatic valves fitted and there was evidence of one round of hot water temperature checks since the last inspection. It would be advisable to increase the frequency of these checks to make sure that service users are not placed at risk of harm and a requirement is made to address this. A requirement was also made at the last inspection to maintain height adjustable beds and replace older ones and those with poor quality mattresses. Six new beds had been bought so far, to replace the worst, and then the aim is to replace one a month. Until planned remedial work is completed at the home, some of the standards in this section cannot be scored as fully met and will be part of the focus of future visits to Parklands. It is suggested that any obstacles that prevent the plans from progressing be communicated to the Commission promptly and a recommendation is made to this effect. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 21 Good standards of cleanliness were being maintained at the home. Catering staff were suitably attired for food handling and care staff made use of gloves and aprons for personal care. There were no unpleasant odours at the home and laundry was being managed well. Hand wash and disposable towels were provided and kept well stocked. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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 a visit to this service. The number and skills mix of staff may not be sufficient to meet the needs of service users, resulting in restricted choice of times to get up and go to bed. Recruitment of staff is not robust enough, placing service users at potential risk of harm. Good progress has been made with National Vocational Qualification training although mandatory training needs completing by some staff, to ensure that staff have the necessary skills and knowledge to meet care needs. Those left in charge of the building are not always fully trained, potentially placing service users at risk of harm. EVIDENCE: Staff rotas are being maintained at the home, with a mix of qualified nurses, carers, catering and domestic staff on duty. The nurse manager’s hours are in addition to the planned rota and a requirement to ensure five carers are on duty between 9 am and 5 pm was being complied with. At the last inspection it was observed that service users were still being helped up at 12.00 noon. On the first day of this inspection, the last service user had been helped up at 12.30 pm. Some of the feedback from service users was that they would like more flexibility in when they get up and go to bed. It was not clear whether staff numbers were not sufficient to meet the current care Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 23 needs of the home or if there was an issue with how staff on duty were being deployed. Discussion took place with the nurse manager and financial manager about this issue and this is something that they will need to monitor. One relative commented that there is not always a member of staff available in the lounge to assist service users, such as taking them to the toilet. The home needs to have in place sufficient staff to meet the needs of service users and to offer some flexibility in times of getting up and going to bed, so that service users are not being left in bed for excessive periods of time. A requirement is made to address this. Service users said that call bells are answered promptly and this was observed to be the case whilst present at the home. One person said that staff were “generally good but busy, and this affects when I get up and go to bed.” One service user felt that newer staff did not seem appropriately trained, which affected confidence. The nurse manager said that new staff undertake a week long induction with an external agency, which is of the required standard for carers in social care settings. Evidence of such a completed induction was seen in one of the files examined. This induction then leads carers into National Vocational Qualification level 2. Seven carers had already completed National Vocational Qualification at level 2 or above with five more enrolled. Two staff were undertaking level 4 and the nurse manager had just started the Registered Managers Award. A sample of staff files was looked at. Records of mandatory training showed a mixed picture. Some newer staff had made steady progress in attending mandatory training. For longer serving staff, courses were largely up-to-date on the whole but some staff records had significant gaps. Two of these were of staff employed as nurses and subsequently left in charge of the premises. One had not been used to work at the home for some time, and therefore presented no current risk to service users but the other had been working throughout December 2006 and January this year. The nurse manager and provider must ensure that only fully inducted and trained staff are left in charge of the home, to reduce the potential for risk of harm to service users. Previous requirements regarding mandatory training have not been complied with. A requirement with a revised timescale is made to address this. Recruitment files for a sample of staff were examined. Previously, requirements have been made to ensure that work permits are in place, where applicable, and that the full range of required checks are in place for each person working at the home. Of four files, only one had evidence of all necessary checks being completed. One file required a second reference and the provider had not checked with the Home Office whether a work permit was needed to work specifically at Parklands, in addition to the permit to work for another provider. A second file contained evidence of a work permit for Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 24 another organisation, not Parklands. This also had not been checked with the Home Office. The remaining file required a second reference and evidence of complying with “visa work permit dependant” status. Overall, the recruitment files were not of a satisfactory standard and the provider is not complying with previously made requirements. These requirements are repeated. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is effective management at the home, ensuring continuity and that the home is run in the best interests of service users. Quality assurance measures are sufficient to monitor standards of care, ensuring that service users receive the support they require. Service users’ money is inappropriately handled, increasing the risk of financial abuse. Higher regard toward health and safety is needed, to ensure that the risk of accidental injury to staff, service users and visitors is minimised. EVIDENCE: The home has a nurse manager who has been in post since last summer. She has experience of nursing older people and has commenced the Registered Managers Award. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 26 There was positive feedback on changes that she has been able to implement at the home such as revising care plans and refining care practice. She will need to apply for registration with the Commission and was asked to contact the local office for the necessary forms. Until the home has a registered manager, standard 31 cannot be scored as fully met. This should not be seen as a reflection of the manager’s abilities. A quality assurance exercise had been undertaken at the home with service user questionnaires distributed and a good return rate. A detailed report had then been compiled by the financial manager of the findings and effort was being made to strengthen areas of weakness, such as comments on a need for more activities. Reports were available within the home of monitoring visits carried out on behalf of the provider to ensure that care standards are being met. These were detailed and covered a range of areas. A requirement to produce an annual development plan for the home had not been met although, from discussions, there are various plans that are already in the pipeline and just need committing to paper. The requirement is repeated. A requirement had been made previously for the accounts, business and financial plan for the home to be sent to the Commission by 30/09/06. This had not been complied by the provider and is repeated with a revised timescale. It was of concern that service users’ money and the records of deposits and transactions were not kept at the home. This arrangement appeared unknown to the manager and financial manager. Following a burglary at Parklands in 2005, one of the senior team had decided to keep service users’ money at her home where it has remained. It was explained during the inspection that this is unacceptable practice and the money and records needed to be returned the following day, with an audit undertaken to make sure that there are no irregularities. A requirement is made to ensure that this takes place. There was a certificate of satisfactory water analysis for the home. Electrical appliances had been tested in November 2006 and there was a valid certificate of satisfactory electrical installation for the premises. Following an environmental health visit last year, some actions were highlighted for attention which seemed to be in order now. A call was made to the environmental health department to check that they will be returning to reinspect the premises, which is indeed planned to take place this year. Most of the staff had undertaken fire safety training. The fire log showed that regular weekly tests take place of the alarm system although the call points being tested need to be varied. A recommendation is made to this effect, to make sure that each is in good working order. The home’s fire based risk assessment had been produced in 2001 and updated in July 2005. This should be reviewed annually to make sure that risks are not left undetected. A requirement is made to address this. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 27 A fire drill had taken place in September 2006 and a detailed report written of how it could have been handled more safely. The records showed that the previous drill took place in June 2005. Drills were therefore not happening at least every six months, as necessary. A requirement is made to address this, to ensure that staff are adequately rehearsed in evacuation procedures. The means of escape from the building were being checked frequently and emergency lighting was being checked regularly. Actions raised as a result of the fire officer’s visit in March 2006 had been attended to. There were servicing records for equipment such as the carpet shampooer, hoists and laundry equipment. Training on manual handling had been updated and staff who handle food had the necessary food handling and hygiene certificates. Accident records were being completed by staff. A requirement to fit a larger air vent to the boiler room had not been met, preventing the home from obtaining a gas safety certificate. The vent must be obtained and fitted without further delay and the safety certificate obtained. The requirement is repeated. Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 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 3 17 X 18 1 2 X 2 X 3 X 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 1 X X 1 Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP3 OP8 Regulation 14 12 Timescale for action The pre-admission assessment 01/03/07 tool is to be completed in full for each service user. Turning regimes are to be 01/03/07 adhered to where service users are nursed in bed and accurate records maintained. Details of particular interests, 01/04/07 hobbies and pastimes need to be recorded in care plans. The adult protection policy needs 01/03/07 to state that any suspicions, allegations or incidents of abuse are to be reported to the Commission within 24 hours. All staff are to have attended up- 01/05/07 to-date training on adult protection. Frequent testing of hot water 01/03/07 temperatures in service users’ bedrooms is to take place, to ensure that service users are not at risk of harm. Staff numbers are to be 01/03/07 sufficient to afford flexibility in times of getting up and going to bed, so that service users are not being left in bed for excessive periods of time. The provider is to ensure that 01/03/07 the recruitment files of all DS0000019248.V320582.R01.S.doc Version 5.2 Page 30 Requirement 3 4 OP12 OP18 16(2)m 37 5 6 OP18 OP21 18(1)c(1) 13(4) 7 OP27 18(1)a 8 OP29 19 Parklands Nursing Home 9 OP29 19 10 OP30 18(1)c (1) 11 OP30 18 12 OP33 24 13 OP34 25 14 OP35 13(6) 15 16 17 OP38 OP38 OP38 13(4) 23(4) 23(2) employees contain the information specified in Regulation 19 and schedule 2 and 4 of the Care Homes Regulations 2001. This is an unmet requirement of previous inspections and the revised timescale of 31/7/06 is not met. The provider must ensure that there is a copy of the residency status and a valid work permit on file for all relevant staff. Previous timescale of 31/07 06 not met. Staff left in charge of the premises are to have been fully inducted and up–to-date with mandatory training. All staff must have the basic mandatory training, thereafter annual updates. Previous timescale of 30/09/06 not met. The annual development plan must be formalised and a copy sent to the Commission. Previous timescale of 30/09/06 not met. The accounts, business and financial plan for the home to be sent to the Commission. Previous timescale of 30/09/06 not met. Service users’ money and transaction records are to be kept on the premises. An audit is to be undertaken to ensure that there are no discrepancies. The fire based risk assessment is to be updated and thereafter annually. Fire drills are to be carried out at least every six months. The air vent to the boiler room must be fitted and an up to date maintenance and safety certificate obtained. Previous DS0000019248.V320582.R01.S.doc 01/03/07 01/03/07 01/06/07 01/04/07 01/03/07 01/03/07 01/03/07 01/03/07 01/04/07 Parklands Nursing Home Version 5.2 Page 31 timescale of 31/12/06 not met. 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 service user guide be available in other formats to assist those with sensory deficit and those whose first language is not English. Care plans are to be developed so that they are personcentred, providing service users with opportunities to contribute to how their care is delivered. Typical blood pressure readings, temperature and pulse rates and weight upon admission are to be noted and repeated at regular intervals so that any deterioration in health is identifiable. Bottles of liquid medicines are to be wiped after use to prevent the spread of stickiness in the cabinet. A check is to be made to ensure that the most up-to-date version of the local authority inter-agency adult protection policy is available at the home. Any obstacles that prevent the plans to improve the environment from progressing are to be communicated to the Commission promptly. Call points are to be varied when testing the alarm system each week to make sure that each is working satisfactorily. 2 3 OP7 OP8 4 5 6 7 OP9 OP18 OP19 OP38 Parklands Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Nursing Home DS0000019248.V320582.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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