Inspection on 20/05/08 for Parkside

This inspection was carried out on 20th May 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Parkside 10/10/08

Parkside 22/05/07

Parkside 27/07/06

Parkside 06/03/06

Parkside 05/09/05

Parkside 04/03/05

Parkside 10/01/05

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Parkside 5 Park View Crescent Roundhay Leeds West Yorkshire LS8 2ES Lead Inspector Paul Newman Key Unannounced Inspection 20th May 2008 09:00 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 Parkside DS0000001490.V365421.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. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkside Address 5 Park View Crescent Roundhay Leeds West Yorkshire LS8 2ES 0113 2665584 0113 2663469 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) Parkside Residential Home Limited Mr Navtej Singh Lidhar Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2007 Brief Description of the Service: Parkside is a family run concern, providing a twenty beds for older people. It is situated in north Leeds. It consists of two Edwardian houses joined together and it still retains many of the original features. Over the years, various alterations have been made to make the home more accessible. All bedrooms are located on the first and second floors, with the floors being accessed via a passenger shaft lift, chair lift or staircase. There are 16 single bedrooms, 13 with en-suite facilities and 2 shared rooms. People living in the home may bring furniture and electrical items, though appliances are inspected for safety before use. All meals are prepared and cooked on the premises. In each service user’s room a plug point is available for a television and individual telephone lines can be arranged on request. Support services are in place with a choice of General Practitioners, and visiting district nurses, chiropodist, dentist and optician. Further information about the home and the services it provides can be found in the statement of purpose and service user guide. These documents are available at the home. Fees cover the costs of full accommodation, care and laundry facilities and range from £355.00 to £400.00. These figures were given at the time of the inspection visit but are subject to review. They does not include chiropody, hairdressing, and personal copies of newspapers, escorts to hospital and other personal requirements. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The accumulated evidence in this report has included: • • The previous key inspection. The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. Relevant information from other organisations. What other people have told us about the service. Information obtained from residents, relatives, staff and other health care professionals both in conversations and surveys that were completed and returned to us. • • • • One inspector made an unannounced visit to the home that lasted eight hours on 20 May 2008. During the visit, a number of documents were looked at and some areas of the home used by the people living there were checked. A proportion of time was spent speaking to the manager, supervisor, other staff, people who live at the home and visitors. Time was also spent in communal areas and the dining room, watching what was going on with people and whether they seemed comfortable and cared for. The AQAA that was returned was poorly completed and gave us little information about how the service is meeting National Minimum Standards, what it has improved during the last year and improvements it plans to make. Five people using the service, together with four relatives completed surveys and these reflected positive views about the care provided. However, other evidence seen during the inspection across a range of issues gave rise for great concern and these place people at risk that people would not necessarily be aware of. Feedback was provided at the end of the inspection to the manager and supervisor. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 6 The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. What the service does well: What has improved since the last inspection? What they could do better: There are a significant number of poor outcomes across the range of outcome groups, some of which were raised in previous inspection reports. Choice of home – poor. • Lack of pre admission assessments and lack of detail in assessments – this means people cannot be assured that the home can meet their needs. Health and Personal care – poor. • The care plans need more organisation and need to clearly set out in detail how the personal, health and social care needs of people will be met. If the care plans are like this with clear and organised guidance to staff that will help make sure that peoples needs are met, at the moment there is a risk that things will be missed. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 7 The home must make sure that the there is sufficient staff training to provide the skill and knowledge, together with professional healthcare support and backup to fully meet the specialised needs of people with dementia and challenging behaviour. Without this peoples specialist care needs like dementia and challenging behaviour are less likely to be met. • When the medication systems, storage and records were checked problems were found. There were general omissions in the recording of the administration of medication and no explanations for these. So we cannot be sure that people have received their prescribed medication. This included problems with the stock control, storage and recording of administration of controlled drugs. Daily Life and Social Activities – adequate • Due to financial constraints the number and range of activities offered has been reduced. Complaints and safeguarding – poor. • There is a lack of staff training in adult protection and lack of awareness of what to do if abuse is suspected or identified. This combined with poor recruitment practices and poor practices for holding peoples personal money mean that people are not protected from abuse or exploitation as they must be. Environment – adequate. • There are problems with the hot water system in part of the building and people are not able to live privately if they choose to do so because not all have locks to their bedrooms and some are not able to lock things securely in their rooms for safekeeping. Staffing – poor. • There are serious failures in following proper recruitment policies and staff have not been checked and referenced, as they should be. We cannot be sure that staff are suitable to work in a care setting. In addition there has been no staff training since early in 2007 so people are at risk of ill informed or out of date staff practices. Management and Administration – poor. • The accumulative evidence shows that the home is not being managed properly. • Any systems of checking the quality of care are not effective because there are serious breaches in regulation. • The AQAA and comments made by the manager do not give confidence that the home is in a financially viable situation to meet its aims and objectives and consistently meet National Minimum Standards and the Care Home Regulations. • Systems and methods of holding peoples personal money for safekeeping fail to meet requirements because their money is held in a business bank account that only the manager has access to. Record keeping falls below the integrity of good financial record keeping and audit trails. • The home is not always notifying the CSCI of significant events. • There are failures to make sure that staff are trained and up to date in safe working practices, including fire safety and this does not give confidence that the home is a safe place live and work in. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 8 • 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. Parkside DS0000001490.V365421.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 Parkside DS0000001490.V365421.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): 3. Standard 6 does not apply to this home. People who use the service experience poor quality outcomes in this area. People are not properly assessed before admission so no one can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When providers and managers are sent the AQAA to complete they are given guidance on how to fill it in. The guidance is also available on the CSCI website. This guidance requests that the provider/manager completing the form answers all the questions as fully and as accurately as possible. It also asks that reference be made to the relevant National Minimum Standards and regulations for the service and that as much detail be provided as the provider Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 11 feels necessary. The AQAA sent to us said that barriers to general improvement had been the suspension of the Local Authority contract that has led to a great financial loss. To reduce the impact of this the home, has reduced costs although this was not explained. For this outcome group the AQAA made no reference at all to pre admission assessments (Key Standard 3), and since this was raised as a requirement in the last inspection report we would have fully expected the AQAA to set out what the home had done during the last year to meet the requirement. Three care files were checked in detail to see what improvements, if any, had been made. Two of these were for people who had lived at the home for some time, but had specific care needs identified that we wanted to look at. It was easy to see from these files how the previous requirement had been reached as the assessments lacked the detailed information that must be recorded about people’s specific needs. The third file was for a person recently admitted for respite care. That file had no evidence that a pre admission assessment had been carried out at all. The person had been admitted on 14 April 2008 and the first initial assessment was dated on 16 April 2008. During the feedback the manager confirmed that no pre admission assessment had been done, but offered no explanation of why this was the case. This is very poor practice and the home was not in a position to be sure it could meet that person’s need. This is all the more worrying because there have been requirements to do with pre admission assessment that have been outstanding since 29 May 2006. Although the AQAA said that in respect of the Standards outlined above, they were not in a position to make improvements because of barriers connected with the suspension of the contract causing financial loss; Key Standard 3 has no cost factor. It is a straightforward information process that must be gone through to make sure the home can meet a persons needs, otherwise they may be at risk. Parkside DS0000001490.V365421.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. People who use the service experience poor quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. Although people think they are getting the care they need, their plans of care are difficult to follow and unnecessarily complicated which means staff may miss things and fail to see all the care a person must receive. The staff team lacks the knowledge, skill and specialist healthcare support for people who have dementia and challenging behaviour, so their care needs may not be fully met. Medication procedures and practices are not safe, so people may be at risk of not receiving prescribed medication. People value their relationships with the dedicated and caring staff and are treated with respect and in a dignified way. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 13 EVIDENCE: Once again there was an outstanding requirement from the previous inspection this time last year that itself was outstanding from 29 May 2006. This was to do with increasing the detail in care plans about how the personal, health and social care needs of people will be met. The expectation that the AQAA would outline how the home had tried to make improvements was not realised. It simply stated: What we do well – • ‘Provide showering/bathing weekly. Nail care, chiropody etc.’. Our evidence to show we do this – • ‘Residents always look well cared for’. What we could do better – • ‘Offer residents showers twice weekly when possible’. How have we improved in the last 12 months – • ‘Not possible, due to barriers listed’. Our plans for improvements in the next 12 months – • ‘None, until suspension lifted’. In fact around the time of the last inspection the manager was introducing a computerised system of care planning. The files that were checked showed the home was operating a dual system of computerised and handwritten recording for care plans. Staff spoken with said they found things complicated. Although the computerised system has its merits, it is based on the information being held on the database. The confusion arises from the weighty amount paper work that is printed off and held as a paper copy on the file. It has to be printed off because only the manager and supervisor have had training in using the computerised system. The manager said that other staff have neither the computer skills or motivation to be trained in this. There was duplication of information and no logical sequence of organisation in the files. There was no simple method of identifying what a person’s basic care needs were. The database works on a pre set list of care needs that was used regardless of whether theses met specific care needs or not. The system is able to prompt when updates are needed for risk assessments. One of the care plans checked seen was for a person with dementia. For the purpose of this report, named A. There were some good entries held in the file in the computerised print offs. For example – ‘Memory Care Plan – Memory problems, comprehension’. These were not clarified though. Advice to staff was ‘Introduce yourself and explain what you are going to do in simple terms. Keep routines consistent and try to provide consistent carers. Present just one thought, idea, question or command at a time. Ask yes or no questions to determine her needs’. Whilst there is much more information that could be provided, like what are the person’s preferred routines and are there systems Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 14 to make sure there are consistent carers, there is at least some sound guidance for staff to follow. But then in the same person’s computerised mental health care plan that was created on 19/10/06 from the records in the file, the plan had not changed since June 2007. It stated: ‘To monitor A’s mood on a daily basis through daily recording. Care staff to record potential triggers, antecedents to mood disturbance. Inform A of, and positively reinforce social behaviours. To make A aware of boundaries to ensure compliance with them. In a heightened state of anxiety state of mood disturbance, A will need to be removed from situations of potential harm due to behaviour having a negative impact on others. Due to the threat if assault from others, physical prompting may be required. Psychology assessment and intervention programme’. The daily recording showed some reference to mood. For example - ‘A had shower this a.m. A shouting as usual’. There was no ready evidence in the daily recording of staff noting potential triggers, antecedents to mood disturbance. It is worrying to see that A might need to be removed from situations but there was no clear guidance how to do this. And in the light of the manager saying there had been no staff training since early in 2007 there is clearly a void in staff knowledge/guidance in managing challenging behaviour. There were similar repetitive evaluations in the care plan relating to social interests. It noted A reluctant about joining in activities. ‘Make sure A does not become socially isolated’. The evaluation suggested that staff should be trying to discover what events and activities A enjoys and encourage her to join in. The daily recording did not show they were doing this. A’s plan for injury/harm sated that she was at risk of harming herself and others. ‘Place her on a behaviour chart to assess and see if there is a pattern’. There was no behaviour chart and there was no evidence from contact with healthcare professionals that advice had been sought or a referral made for an assessment. With regard to weight and nutrition, A had a stable weight from 2005 to 1 May 2007. Her weight was recorded as 7st 7 lb at that point. There had been no further weight checks recorded until 5 March 2008 when A was 6st 8 lb. A was still described as having a good appetite but there was no interest/alarm/investigation proposed into A’s weight loss. Although another file checked showed similar inconsistencies, there was good attention and liaison with the community nurse about pressure care in this case, but there was further evidence of the shortfalls in the home meeting the Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 15 needs of people with dementia when a visitor arrived and was looking at her father’s records. He had had a challenging night previously and the relative had been informed of this. In watching and listening to the conversation with the relative and home supervisor it was clear that the relative was driving referral to a psychiatrist rather that the home taking the initiative based on that person’s patterns of behaviour. The base line here is that the home is not registered to accommodate people with dementia or mental health care problems; the care plans fall short of identifying and giving staff clear and up to date guidance on an approach to manage behaviour and meet needs, or to seek professional help and advice. Staff spoken with were not entirely clear on the care plan documentation and find it confusing. The lack of organisation, some of the repetitiveness, the dual computerised and paper systems make the whole process confusing and allow opportunities for staff to miss information, to become disillusioned with paperwork and to use word of mouth and self knowledge rather than up to date meaningful care plans that are day-to-day working documents. One member of staff said that if they had a few days off it was far easier to get up to date by speaking with other staff. That approach is reliant on memory rather than accurate records of events so is not safe. When the medication systems, storage and records were checked further problems were found. There were general omissions in the recording of the administration of medication and no explanations for these. So we cannot be sure that people have received their prescribed medication. The home keeps and administers a Schedule 3 controlled drug, Temazepam for one person. This must be stored in a Controlled Drugs (CD) cabinet. Although there is no requirement to record the administration of the drug in a controlled drugs register, it is good practice to do so. The tablets were not stored in the CD cabinet. The home was not controlling and checking these properly and stocks did not equate with the administration charts. Over an 8 day period from when the new stock had been recorded as being delivered, there were 7 signed entries of administration, there was 1 omission. It was disturbing to find that when the stock was checked 9 tablets were dispensed. 2 tablets were therefore unaccounted for and 1 definitely missing. To add to this concern, a check was made on some sleeping tablets prescribed to another person. This person held her own tablets and the administration record showed drugs delivered, but there was no indication from the chart that the prescribed dose had been taken. Stocks were checked with the person who held the drugs in an unlocked drawer. The stocks equated with the number of days and this person was able to confirm that she holds on to the drugs but staff come to her room and get it ready for her to take. Later in the day the same person said – ‘You are not going to take the drugs away are you?’ The person was reassured that there was no intention to do this but when asked why they were concerned? She said that when the home had kept the drugs for her previously, they had regularly gone missing and there were Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 16 times that staff said she could not have her tablet because there were none left. At that time she then requested to the manager that she kept her own tablets. She said there had been no problem since. At the feedback session this was not disputed by the manager and throws further doubts about the integrity of the systems that operate in the home. One of the most positive features of the day was to see how well the staff and people they cared for got on. There were good relationships and overheard conversations showed that people really appreciated the care and good humour of the staff on duty. Conversations during the day with people and their relatives confirmed that relationships were good and there was a good atmosphere. Some of the written comments made in surveys that were returned said: Relatives: ‘It appears from regular observation on regular visits that the needs of residents are well looked after’. ‘All the residents are extremely well looked after. Mum is spoilt, as very homely, spotlessly clean and the meals are beautiful’. ‘They create a very friendly atmosphere that makes you feel welcome when you ever visit. You feel they really care about your relative. My Mother’s room is always clean and her clothes very clean’. People who live in the home: ‘I am here on respite and enjoying my stay’. ‘Happy at Parkside. Staff always willing to help’. ‘I am very happy living here because I was lonely on my own and there always someone to talk to and thinks to do’. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 17 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. People’s social expectations and personal preferences are generally met but more could be done to stimulate them. They are able to exercise choice in their lifestyles so they can be as independent as they can be. People living at the home are provided with a varied and nutritious diet so they can eat healthily. EVIDENCE: The last inspection found that the level of activities provided did not always meet people’s expectations. At this visit there were no adverse comments about activities and people seemed content. This is despite the range of activities being provided by visiting organisers being reduced for financial reasons. The staff were good at engaging people in conversation and there Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 18 was some friendly banter and laughter from time to time. Two relatives who visited took people out for a short walk at the nearby Canal Gardens and one other received visitors in her room. One person is a keen gardener and devotes a lot of her time skilfully maintaining flowerbeds and making up planters. In conversation with her she clearly valued the opportunities and independence to ‘potter about’ as she wanted. There are two people of eastern European origin and it is good that the home encourages their links and friendships with their community and has also bought newspapers and magazines in their native language on a weekly basis. The conversations with people showed that they enjoy living their preferred routines like getting up times and bed times. They choose where to spend their time whether this be with others in communal areas or in the privacy of their own room. The cook has worked at the home for a considerable period of time and knows the people well. She said that she tries where possible to buy things that an individual has a particular liking for and might request from time to time and two people spoken to confirmed this. The menus are traditional and offer good wholesome food that the generation of people living at the home enjoy and that was certainly the view expressed during and after the meal. Relatives also said that they felt the food was good. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience poor quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. The people who live at the home and their relatives know how to complain and feel confident that they will be listened to and that action will be taken when necessary. There is a lack of staff training in adult protection and lack of awareness of what to do if abuse is suspected or identified. This combined with poor recruitment practices and poor practices for holding peoples’ personal money, mean that people are not protected from abuse as they must be. EVIDENCE: Surveys that were returned and conversations with relatives and people living at the home suggest that they are comfortable in raising concerns, and feel that action is taken to put things right. There are policies and procedures for adult abuse and safeguarding. These were not seen as they were checked at the last inspection. But it is worrying that a requirement made in the last inspection report saying that staff must Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 20 receive adult protection training, to ensure people in the home are not at risk of abuse. The manager confirmed what staff had already said that they had not received any such training. The section in the AQAA that should have addressed this was not completed. The home supervisor was asked what procedures she would follow in the absence of the manager if an allegation was made. She was unclear, simply saying that she would manage the situation. She was not aware of the organisations that must be notified or of the need not to compromise investigations that may be undertaken by other agencies like the police. This lack of training, the lack of understanding of procedures combined with other issues noted in the staffing and management sections of this report place people at risk. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. People living at the home live in a clean, comfortable environment that is beginning to need investment to maintain good standards and measures need to be taken to make sure people can have privacy and hold personal belongings securely. EVIDENCE: The tour of the building found standards of cleanliness to be good and although there is only one housekeeper she does well to keep the building this way and free from unpleasant odours. The relatives spoken with said that they had Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 22 chosen the home because of its ‘homeliness’ and this was echoed by people living there. The surveys suggest that the home is always clean and tidy. Bedrooms are personalised with peoples belongings and they are free to spend time in their rooms or in communal areas. Not all rooms have privacy locks and not all have a lockable item of furniture and in the case of one person who holds her own medication, this makes the situation unsafe and insecure, particularly as the medication in the wrong hands could be dangerous. The AQAA did not suggest the home does anything well, but stated that ‘Fire doors are kept clear and corridors. Home always warm’. Since the last inspection two ‘wet rooms’, shower rooms have been installed replacing old baths. These make showering easier and safer for staff and people being cared for. The AQAA stated that no improvements are planned until the suspension of admissions to the home by the Local Authority are lifted. In conversation with some relatives they said that there were times during the day that there was no hot water. This was tested but there was plenty at that time. The manager did say that there were problems with one of the boilers that an engineer was trying to fix but without replacing the boiler. In the current financial climate we are unclear if the home would have the capital to replace the boiler if this were necessary. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 23 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. People who use the service experience poor quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. People living in the home appreciate being cared for by committed and personable staff. There are serious shortfalls in the way that staff are trained and recruited that place people at risk. EVIDENCE: When watching staff at their work it was clear that their relationships with the people they care for and their relatives are good. Conversations and survey results indicate that people find staff caring, approachable and ‘will do anything for you’. There were three carers on duty during the morning of the visit. Nobody was sure who was in charge. The cook and housekeeper supported them. The home supervisor came on duty during the afternoon. The manager was not available during the morning. The three carers were organised and focused on Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 24 the tasks that needed to be done, but at the same time chatting with people and setting a friendly and lively atmosphere. Conversations with staff soon showed that there had been no training going on recently, so staff were not up to date with safe working practice training like moving and handling. There has been no specialist training to address people’s specific needs like dementia. The home falls short of the 50 target for the numbers of staff who should have a National Vocational Qualification (NVQ). The manager said that there had been no training since ‘early 2007’. The recruitment files of 5 staff who had been recently appointed were checked to make sure that good employment practices are followed and recruitment checks made. The AQAA that was returned said that all of the staff employed over the previous 12 months had satisfactory employment checks. This was not the case. One member of staff who had since been dismissed had a reference from a previous employer that needed to be followed up and the Criminal Record Bureau (CRB) check had been obtained for a previous employer so was not current and valid for Parkside. In the other four cases, there was no evidence at all of first checks with Protection of Vulnerable Adults list, or of CRBs being sent for. Neither in any cases were no references from previous employers. This is very poor practice and leaves people living at the home vulnerable because the home cannot demonstrate proper checking, required by law has been done. When asked, the manager said that the reason for the lack of POVA and CRB checks was due to financial reasons. Parkside DS0000001490.V365421.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, 34, 35, 36, 37 and 38. People who use the service experience poor quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. The home is not managed in a way that makes sure that people are protected and are safe. EVIDENCE: The accumulative evidence of this inspection demonstrates serious shortfalls in the way the home is managed. These are highlighted in poor outcomes in Choice of Home, Health and Personal care, Complaints and Protection and Staffing in the preceding sections of this report. Whilst the AQAA stated that Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 26 for management and administration the home does well by providing a supervisor and manager on every shift, there is no evidence to show that the management is effective. Part of this appears to be routed in financial constraints caused by the Local Authority suspending contracting, so things like staff training, vetting and checking of staff that have a cost factor, have ‘gone by the board’. The AQAA and comments made during the site visit by the manager did not give confidence that things can improve. There is also a lack of simple checking, for example of medication records and medication stock that potentially leaves people at risk. Whilst it is acknowledged that there are positive views expressed by people and their relatives, much of what has been found at this inspection will be unknown to them and they will not realise the vulnerable and unsafe position they are living in. It was noticed that on a day-to-day basis, staff are good at checking that people are feeling happy with things. When asked if the home had carried out its own satisfaction surveys, the manager said these had just been sent out with revised terms and conditions. Staff confirmed that they are now receiving one to one supervision sessions with the supervisor and appraisals were seen on staff files. These are in the early stages of being an established system according to what staff said. The home looks after some people’s personal money for safekeeping. The systems and methods of doing this do not meet requirements. They do not allow people access to their own money and there is neither an audit trail nor receipts to show expenditure. The records are kept solely by the manager. It was found that people’s money is not kept individually at the home as we would expect. The manager said that he had experienced the theft of a person’s money in the past and since then had kept peoples money combined in one business bank account that only he has access to. People do not have ready access to their money and do not accrue any interest from the bank account. Some people had monthly expenditure to the sum of around £30 for newspapers, there were other transactions showing for hairdressing, chiropody but there were no receipts to supported the transactions and because the money was held in a business bank account no checks could be made to reconcile the records with any cash held. This is all very irregular and needs to be addressed quickly so that the home can demonstrate safe and accurate handling of people’s money. In the checking of incidents it was noted that one person had gone missing on 02/05/08 but was located and returned later. The incident form did not identify when the person had gone missing and for how long. This is the type of occurrence (Regulation 37 – notifications) that the home must notify the CSCI about because it is something that affected the health and welfare of the person. The home supervisor said that in her experience she thought it was something we should have been notified about. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 27 The fire safety records were checked and weekly fire alarm system checks were up to date. The last fire drill to have been recorded was on 04/09/07. This indicated that two staff were on duty when the system activated unexpectedly. The record showed that one of the staff was told to follow the fire procedures but said at the time they did not know what they were. There were no recorded fire drills since then as might have been expected to make sure that all staff are aware of procedures. The lack of safe working practice training over the last year together with some staff turnover and new recruits who have not been sufficiently trained in safe working practices places people at risk from ill informed practices. Parkside DS0000001490.V365421.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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 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 X X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 1 1 X 1 1 Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Timescale for action People must undergo a pre- 01/08/08 admission assessment of their needs. Through this process people can be assured that the home can meet their care needs. More detailed information must 01/08/08 be recorded about people’s specific needs. The outcome of the assessment must be recorded along with justification of how the home is able to meet assessed needs. (Previous timescales of 29/05/06 and 01/08/07 not met). New timescale set. Through this process people can be assured that the home can meet their care needs. The care plans must set out in 01/08/08 detail how the personal, health and social care needs of people will be met. (Previous timescales of 29/05/06 and 01/08/07 not met). New timescale set. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 30 Requirement 2. OP3 14 3. OP7 15 4. OP8 12 and 13. Clear and organised guidance to staff will help make sure that peoples needs are met. Staff must be given sufficient 01/08/08 training to provide them with the skills and knowledge to give professional healthcare support that fully meets the specialised needs of people with dementia and challenging behaviour. If the staff are properly equipped with the skills, and knowledge required to provide professional support for people with dementia, peoples specialist care needs are more likely to be met. Safe and accurate policies, 01/08/08 procedures and practices for the safe storage, handling, administration and disposal of medicines must be introduced and followed. This will make sure that people receive the medication that they are prescribed. 5. OP9 13 6. OP18 13 All staff must receive adult 01/09/08 protection training, to ensure people in the home are not at risk of abuse. Previous timescale 01/08/07 not met. timescale set. of New In addition, all staff must be aware of the procedures to follow if an allegation is made. People can then be assured that staff know the indicators of abuse and will follow accepted procedures to protect people. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 31 7. OP19 23 The hot water system must be 01/08/08 made reliable and efficient either by repair or replacement of the boiler. People can then be assured that they can wash or bath at any time of the day. All people must be provided with 01/09/08 privacy locks to their bedroom doors and a lockable item of furniture to keep things safely. People will then have the choice to live their lives privately and be able to keep things like personal money, precious items and medication safely and securely. There must be a designated 01/08/08 person in charge at all times including in the absence of the manager and supervisor. Staff will then be in a position to have clear instructions and know what to do, and know who they are accountable to. All staff are must be properly 01/09/08 recruited, with the required references, POVA and CRB checks being made. Then people can be assured that the staff employed are suitable to work in a care setting and they are as safe as they can be. 8 OP24 23 9. OP27 18 10. OP29 19 11. OP30 18 Training in safe working 01/08/08 practices and in specialist needs like people with dementia must be arranged as soon as possible for all staff. Then staff will be properly equipped to safely care for the people they look after. Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 32 12. OP31 9 The home must be conducted 01/09/08 and operated in a way that consistently meets National Minimum Standards and Regulations. This will make sure that the home is run safely, efficiently and effectively for people living there. Regular quality checks of the 01/09/08 home must be undertaken in order to assess that it is being operated in a way that consistently meets National Minimum Standards and Regulations. This will make sure that the home is run safely, efficiently and effectively for people living there. Evidence that the home is in a 01/09/08 suitable financial position to meet the aims and objectives it has set must be provided to demonstrate the services financial viability. The following must be provided and this must be the most recent information available: • The most recent annual accounts of the home certified by an accountant. • A reference from a bank expressing an opinion as to the registered persons’ financial standing. • A copy of the most recent detailed accounts giving details of the running costs of the home. This will give more clarity that the home is financially viable to meet its aims and objectives and people can be reassured standards can be maintained. 13. OP33 24 14. OP34 25 Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 33 15. OP35 Reg 17 – Schedule 4(8) and Reg 20 Where peoples money is held for 01/09/08 safekeeping, it must not be held in any bank account other than in the name of the individual service user. Records that are kept must demonstrate that transactions made are supported by receipts and an audit trail can be made. Then people can be assured that their money is looked after safely and they are not at risk of financial exploitation. CSCI must be notified, without 01/08/08 delay, of all significant events. Then the CSCI can be fully informed and monitor events in the home as part of its ongoing inspection process. All staff must be fully aware of 01/08/08 fire procedures and be trained in fire prevention, including regular fire drills and practices. Then people can be assured staff will know what to do in the event of a fire thus promoting their safety and welfare in these situations. 16. OP37 37 16 OP38 23 Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 34 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 OP12 Good Practice Recommendations The number and range of activities that people were previously able to experience should be re-established. This will increase the choices and opportunities to people living at the home. The target of achieving a 50 ratio of staff who are NVQ qualified should be continued to be worked towards. This will make sure there are sufficient numbers of suitably qualified staff. A system that identifies when mandatory training updates are due should be introduced. This will make sure things are up to date and there is no compromise to the safety of both staff and people living at the home. 2. OP28 3. OP30 Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Parkside DS0000001490.V365421.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!