Inspection on 10/06/10 for Parkside Health Care Ltd

This inspection was carried out on 10th June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Parkside Health Care Ltd 28/10/08

Similar services:

Hendra House

Larches, The

Charles Davies House

Lyndel Homes

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Edgeview Nursing Home

Westfield Lodge

St Marks House

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Parkside Health Care Ltd 1a Tibbington Terrace Parkside Tipton West Midlands DY4 9HJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karen Thompson     Date: 1 5 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Parkside Health Care Ltd 1a Tibbington Terrace Parkside Tipton West Midlands DY4 9HJ 01709565822 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Parkside Health Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder (MD) 20 Date of last inspection Brief description of the care home 3 0 1 0 2 0 0 8 20 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One inspector carried out the inspection over a three day period, the home did not know we were coming on the first day of our visit. The focus of inspections undertaken is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet the regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The majority of people living at the home have complex health and nursing needs. We case tracked four peoples care which involves establishing individuals experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Some of the people who live at the home were not able to tell us their views because of their communication Care Homes for Adults (18-65 years) Page 5 of 37 needs. Time was spent observing care practices, interaction and support from staff. Members of the management team were present for the duration of the inspection. We looked around the home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. Prior to the inspection the Registered Manager completed an Annual Quality Assurance Assessment (AQAA) and returned it to us in November 2009. This is a questionaire that gives us information abut the home, staff, people who live there, any developments and plans for the future. The majority of plans for the future had not been implemented and it is clear from the questionaire that there has been a decline in the service provided since it was completed. Prior to this inspection visit, we completed an Annual Service Review report in March 2010. We did this because we had concerns about the service and a number of anonymous concerns had been raised with us. We did identify in this report that there had been a high turnover of staff and no registered manager which may be affecting the quality of care people were receiving. As stated in this report we advised the home we would be carrying out a key inspection finding of which a summary is at the begining of this report with specific details listed thoughout the main section of the report. Care Homes for Adults (18-65 years) Page 6 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The medicine management must improve to safeguard those people that live at the home. All systems must be improved to ensure that all medicines are administered safety to people living at the home. Quality assurance systems should be further developed so that the home can demonstrate views are actively sought and that issues have been identified and are actively addressed. There needs to be a review of training provided to ensure slippage does not occur and that staff have the most up to date knowledge and skills to meet the needs of people. Work is required to develop the care planning and risk assessment process further, so that the home can demonstrate all needs have been assessed and are being met appropriately. People living in the home and or their representatives should be involved in this process if they would like to be. The home must support individuals to develop their life skills and to participate in activities within the home and community that meet peoples needs. The Statement of Purpose and Service User Guide require amending to be an accurate reflection of what the service is offering. The staffing levels and deployment of staff needs to be reviewed across the home to Care Homes for Adults (18-65 years) Page 7 of 37 ensure peoples needs are met appropriately at all times by people who know them well. The home must improve its arrangements for safeguarding people in their care so that they can be confident their best interests are being respected and promoted. A strong permanent leadership is needed in the home to ensure the home is run in a way that meets the needs and expectations of the people living there. Overall communication systems with everyone within the home must improve so that staff are aware of what is required of them and concerns can be dealt with appropriately. There must be a system in place to deal with maintenance issues swiftly. Recruitment procedures need further work to ensure they are robust and protect people living at the home. Procedures in relation to people money must be reviewed so they are not considered part of the companys assets. Records pertaining to running of the home must be available so that evidence is available to demonstrate the home is being run in the best interests of people living there. Staff training must improve in a number of areas so that staff have the skills and competence to meet the needs of people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does supply information for people in order to help them make a choice about living in the home. There are significant improvements needed by the home to make sure peoples needs are assessed in full and staff understand what is required of them. Evidence: Whilst the Service Users Guide and Statement of Purpose given to us during the inspection did contain most of the information required they did not reflect the management structure in the home at the time of our visit. Also the Service User Guide also did not contain the range of fees. We looked at the way the home arranges peoples admission to the home. We looked at the admission and assessment information for one recently admitted person. We found there is room for improvement. The pre-admission assessment was not dated so we were unable to tell how old the information was prior to admission. Whilst this person had had a trial visit to the home prior to permanent admission there was no evidence that the person had been reassess on being permanently admitted to the Care Homes for Adults (18-65 years) Page 10 of 37 Evidence: home. We were aware prior to our inspection that the local authority had decided to suspend placements in the home until there had been significant improvements. This meant the home was unable to accept any new admissions at this time. We are concerned about the homes ability to meet the needs of the people living here. Staff informed us they were not always aware of a persons needs on them arriving at the home and information was not passed onto them. Care staff told us they were not aware of the needs of new people on admission to the home they stated none of us told. During the inspection both the Homes manager and care manager resigned, thus leaving the home without any senior day to day management structure in place. Also a number of trained nurses have resigned over the last few months, meaning the home is borrowing staff from another sister home or using a supply of agency nurses that have been allocated to work for them. This means the home is without strong clinical leadership which impacts on the care being offered at the home. Following the inspection we were advised that the organization had re-allocated senior people from the company to oversee the day to day operations of the home. Care Homes for Adults (18-65 years) Page 11 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not demonstrate needs and risks are reassessed appropriately or that people living at the home are always actively encouraged to participate fully in makdin decision about their care. Evidence: Many of the people living at Parkside have complex care and nursing needs. We looked at two care plans in depth. Care plans explain what each persons needs are and the care and support they require to make sure these needs are met. These plans included risk assessments. We found no evidence that people using the service and or their representative had been involved in drawing up their care plans. Care plans were not person centered it was evident from talking to care staff however that people living at the home are treated as individuals. We found restrictions placed upon people in relation to smoking but staff working at the home and documentation was unable to support the rationale for these restrictions or whether these had been discussed with people living at the home. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being promoted. Risk assessments consisted of individual and generic risk assessments, including pressure area relief, falls, mental health assessment, manual handling and nutrition. We found in one persons care plan two falls assessments both being reviewed monthly and on the same date. We discussed with the homes manager the duplication of the documents but no explanation could be offered for this practice. We also found a skin intergrity assessment had not been completed accurately and therefore gave a false reading of risk. Care plans and risk assessments are being completed by night staff for a number of people living at the home. Whilst night staff provided a valuable insight into the care of people living in the home it is not good practice that they complete care plans and assessments for observations and care provided during daylight hours. Care Homes for Adults (18-65 years) Page 13 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are not always supported to make choices about their lifestyles or develop these though social and recreational activities. Evidence: We looked at care plans and daily records to establish that people were taking part in activities that they enjoyed. Care plans gave very limited information about what people like to do. We observed one person being taken out to visit their family on the second day of our visit. This is positive but will be discussed further under the staffing section of the report. The home at the time of our visit had no dedicated activities person but we were told that the organisation was advertising for two activities persons to cover seven days a week. The home has a dedicated activities fund which has been acquired by donations from families and fund raising. We were told that fund had previously been used to Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: purchase a Karaoke machine and they were planning to purchase a Wii for people living in the home. From looking at care records and our observations on the days of our visits people living at the home have very little in terms of social stimulation. The care records demonstrate that for some people living at the home had been out and this is a positive experience but this was very limited and further work is required to meet peoples lifestyle needs. We were informed that no one living at the home attended an educational establishment or attended work. We were however informed by one person living at the home that everyone gets fairly treated, no favouritism. We observed staff interaction with people living at the home. Staff addressed people appropriately. People living at the home were clearly delighted to see the deputy manager who had returned from her days off. We were told and records shown to us demonstrate that people living at the home are offered a choice in relation to meals. The catering department records demonstrated they were actively seeking out people preferences in relation to food choices. The catering department has a proactive approach to meeting peoples nutritional needs and were aware of each individuals requirements. We observed staff to provide appropriate assistance where required at meal times. Care Homes for Adults (18-65 years) Page 15 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not being met appropriately. The care planning recording system needs to be more robust to demonstrate consistency. Medication systems need to improve so that people can be sure that they will receive their medication safely and as prescribed by their doctors. Evidence: There is a mixed group of people living in the home in respect of age, gender and ability. Observations made during the inspection confirmed that peoples privacy and dignity is respected. Everyone living at the home was registered with a local General Practitioner (G.P). There was evidence of visits to/from health and social care professionals such as dietician, specialist nurses and social workers. Care plans provided some information about the support people required with personal and health needs. Information was not easily retrieved for example food diaries whilst detailed were being kept simultaneously in two different places, staff could not offer an explanation as to why this was happening. We found evidence that a tissue viability Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: nurse had visited the home and made a number of recommendations but there was not care plan in place so that the staff had instructions on how to meet the skin integrity needs and from this monitor and evaluate its effectiveness. Barrier cream had been obtained as per the specialist nurses instructions but staff were unclear as to how often this was to be applied. We were told that one of the people living in the home had recently had a number of epileptic fits, we asked staff at the home whether they had ruled out any underlying medical condition such as infection. Staff had not done this but had assumed that this was just part of that persons medical condition. Whilst this may be the case staff must not assume this, especially since the epileptic fits were a new phenomena. We looked at the arrangements in place for medication management. Medication is stored in locked trolleys in a two locked medication room on each floor of the home. We observed the returns medication to be stored in a bin in the nurses station, one person living in the home was observed to open the door of the nurses station by pressing the numbered key pad lock with the correct numbers. The medication returns bin needs to locked in a cupboard and not accessible to people living in the home. Copies of prescriptions are retained so that staff can check the right medication has been received from the chemist. However the copies being kept with the Medication Administration Record (MAR) were not for the medications that had been dispensed that month. We were unable to audit medications due to balances from the previous cycle not being included on the current MAR chart. We found several examples of medication having not been given as prescribed by the clinician and there was no written explaination as to why medication had been omitted. This means people are not recieving their medication which places their health and well being at risk. We looked at the care plans of people living in the home and in one instance we were unable to ascertain why someone was requiring such high levels of pain relief. The care plans in relation to medication were not specific to the individuals medication requirements. We left an immediate requirement on the first day of our inspection visit due to the concerns identified above. This required the home to review its systems for management of medication in the home and take the appropriate action to put insafe systems to ensure medicine is administered as prescribed and maintain the safety of people living in the home. We also contacted the Primary Care Trust (PCT) pharmacist due to the concerns we had identified as peoples health and well being was being compromised. For example care staff informed us that one person living at the home complained their medication was not working. Looking at this persons daily notes it was evident that on a number occasions they had not received their medication as prescribed. Care Homes for Adults (18-65 years) Page 17 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and arrangements in place at the home do not ensure that people can be confident that their views are listened and responded to. Overall the home is failing to safeguard peoples health and well-being to ensure their health and well being is promoted and protected. Evidence: The home has a complaint procedure that is available and people living at the home were aware of how to raise concerns but these were not always being taken down the formal route. Concerns were found to be documented in care records. The homes complaint log contained two formal complaints since the previous key inspection in October 2008. The home has systems in place to record complaints but the log did not demonstrate how these issues had been dealt with in relation to the investigation and outcome. The daily records of people living in the home recorded concerns but these are not being transcribed into concerns or complaints in the log. Complaints monitoring forms an important part of the quality assurance system within the home. Issues being recorded in daily records are not being monitored as part of the overall quality assurance strategy for the home. We found one issue recorded in a persons daily records that should have been referred under safeguarding but the home had not done this. The home was asked to make a referral for this during our inspection visit. We also made a referral for this incident to Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: the local authority who are the lead in such matters. Prior to this inspection we had received an anonymous concern of a safeguarding nature that we again referred this to the local authority. What is concerning is the home had recorded evidence to demonstrate they were also aware of these same concerns two weeks earlier than us and had not referred them to the local authority. Therefore the home was not following the local authoritiessafeguarding procedure which is placing vulnerable people at risk. Prior to our inspection we were made aware of a number of concerns and these too were referred to the local authority to investigate under their safeguarding procedures. We liased with the providers representative and wrote to them making them aware of these issues and they agreed to ensure all staff had training in safeguarding and whistle blowing procedures. This was completed by end of March 2010. This was a positive step on behalf of the provider but the two safeguarding referred to above occured after March 2010 in relation to safeguarding and suggest that the culture in the home was not encouraging people to whistle blow or follow the safeguarding route. One member of staff informed us that when they first came to work in the home they found it difficult at first due to the staff can be a bit clanny. Staff working in specific groups does not encourage openess and transparancy. Staff spoken to during the inspection demonstrated an understanding of safeguarding, whistle blowing and the Mental Capacity Act. But when questioned on some of the differing choices offered to people living in the home they were unable to offer an explanation as to why there was limited choice for some and not others. Care Homes for Adults (18-65 years) Page 19 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe and comfortable home, which promotes their well being. Evidence: The home is a recently purpose built to care home providing accommodation on two floors. Parkside is located along a residential road close to the Tibbington estate in the Tipton area of Sandwell. It is close to all amenities and transport links for Sandwell, Dudley and Birmingham. There is off road parking located to the rear of the home. The home has ground floor and a first floor each floor comprising of ten bedrooms. A passenger shaft lift enables people to access both floors. The home has a wide variety of specialist equipment to care for dependent people whilst also maximizing their independence. There is a bathroom on each floor with both having an assisted bath. The assisted bathing facility have specialist lighting which provides a sensory atmosphere to the bathroom. On touring the first floor bathroom it was found that only one light bulb out of four was working, thus making the bathroom dark. The light for the bathroom was mainly being provided by the sensory facility in this room. All bedrooms have an en-suite with a walk in shower that can be used by people in a chair if required as well as their own toilet. There are a separate laundry area and this has the necessary equipment in place to Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: ensure infection control practices are maintained. There has been some slippage in the maintenance programme we were informed that this was due to unforeseen circumstances. The smoking room on the first floor was observed to have a damaged wall and the water taps on the sink in the medication room on the first floor we were unable to use. Therefore staff do not have a convenient working facility to allow them to wash their hands pre and post medication round. There is a pleasant garden to the rear of the premises mostly laid to lawn but there are patio areas and a large gazebo. People living at the home were observed using the garden on the days of our visit. The garden has suitable perimeter fencing to provide privacy and is gated guaranteeing access and security. Care Homes for Adults (18-65 years) Page 21 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers, training and knowledge does not meet the needs of people living at the home. Evidence: The home was unable to supply copies of staff rotas , for the month of April 2010. All paperwork pertaining to the running of the home must be kept for a minimum of three years from the date of the last entry. We wanted to look at the rota for this month to check the staffing levels as we are aware of a number of incidents occuring in this period. From our observations of the three days in the home staffing levels do not appear to be meeting current needs of people living in the home. The home plans too staffed for three carers and one trained nurse each floor of a morning and evening. The night shift planned rota consists of two trained staff and four carers for the whole of the home. In recent months three qualified nurses have left the employment of Parkside and this gap has been filled by agency staff and staff from another home within the organisations group of homes. Care staff are also being obtained from another home within the organisations group of homes. Staff told us that issues arose around staff being allocated to work but when in the home were attending training sessions so were not available to deliver care to peoples. We observed one person leaving the home with two members of staff to visit their family which is to be commended, but this meant that the home was short of two carers for over two hours. Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: This issue may be resolved when the home recruits an activities co-coordinator . We were told they were in the process of recruiting two people to this post hopefully in the near future. Care records demonstrated behaviour that challenged was significantly reduced when people living in the home were occupied such as going out to the shops. Discussions with staff also confirmed that behaviour that challenged became an issue during the evening when the number of staff dropped. One member of the care staff told us they were: Stressed, vicious circle with them phoning in sick as cant have another day like that. Trained nurse turnover in recent months has meant the home has lacked a strong clinical lead which means people living at the home do no have their needs meet in a consistent manner. The organization has tried to ensure that agency nurses working in the home are the same people and have borrowed nurses from within the organisation other homes. The home however needs to recruit its own trained staff to provide a stable clinical base to build upon. Recruitment checks were sampled for four staff. Independent Safeguarding Authority first checks (ISA first) are completed prior to awaiting a full Criminal Record Bureau check (CRB). The home however needs to carry out a risk assessment if they decide to employ someone only on an ISAfirst whilst awaiting return of the CRB. The CRBs were not available to us until the third day of the inspection, as the homes representative initially refused to produce them. Eventually they were persuaded that the inspectors did have the authority and responsibility to see them and it transpired that they were kept at head office. If the CRBs are not being kept at the home, permission must be obtained from CQC to do this. These checks are to ensure people living at the home are protected from the risk of having unsuitable staff work in the home with them. There was no documentation in relation to the type or quality of induction that staff had received. We were informed that staff undergo an induction prior to commencing work within the home. We found this to be correct for one member of staff who had enjoyed their induction training. We did however speak to another member of staff who stated horrendous my training ....staff didnt know I was coming I did my training in bits and dabs. We were given a copy of a training matrix which gave an overview of what training staff had received. The majority of staff have recently received training in safeguarding. Not all staff working at the home had completed the mandatory training and deficits were identified in moving and handling, food hygiene and fire safety. Records indicate that three of the 17 care staff have an National Vocational Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: Qualification (NVQ) level 2 in care. Therefore just under seventeen percent of the workforce have a nationally recognized qualification in care. The minimum standard is fity percent of the workforce should have this qualification. This training ensures staff have the appropriate skills and knowledge to care for people living in the home. Staff also informed us that they had no specific training in meeting the needs of people with the specific physical and mental conditions and they though this would be useful. Staff need to have some awareness of the underlying physical and mental conditions of people living in the home so that these can be monitored and managed appropriately. We spoke to three members of staff in depth during our visit they were enthusiastic about their work and keen to learn and develop their skills. This needs to be built upon to ensure that people living at the home get the care they need. There has only been one staff meeting for staff within the first six months of this year. Staff supervision had only recently recommenced after a period of absence for staff. Supervision had taken place on an individual basis. We were aware of issues from care records in relation to staff practice we could however find no evidence that this had been discussed during supervision. Supervision is about supporting staff to meet the needs of people living at the home, but also acts as a way of monitoring and maintaining care skills. Care Homes for Adults (18-65 years) Page 24 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not always be confident that the service is run in their best interest. Evidence: At the time of the inspection we were assisted by the Care Manager and deputy Manager. We were told on the second day of our visit by the Care Manager that they had tended their resignination. We were also informed by the providers representative that the homes deputy manager had tended their resignation following the inspection visit. We became concerned about the homes ability to meet the needs of people living there in March 2010 and wrote an annual service report statings: We have concerns about the lack of permanent manager at the home and how it is affecting outcomes for people living at Parkside. We continue to have these concerns based on the finding within this report. One member of staff told us they dont feel supported..carers fine it is higher due to changes of managers.. need to get back to being supported. Another member of staff told us they found it difficult , new managers telling us different things. The AQAA though completed in November 2009 has a section for the future plans of Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: the home. We also had to sent the home a reminder to complete this questionaire. The majority of the plans for the next the forthcoming twelve month had not been implemented. The AQAA demonstrate a decline had occured in the service provided. The provider had put in some good management systems for the running of the home however these were not found to be working. A variety of quality assurance systems were in place. We did encounter problems with record keeping. Record keeping was problematic in the home as evidenced in health and personal care, complaints and safeguarding and staffing. The management system at the time of the visit could be seen as very poor and reactive to situations. There were no regulation 26 visit rpeorts available at the home for the months of February, March and April 2010. Supervision for staff had occurred recently for the majority of staff in April, however formal supervision sessions in the home had not occurred for several months. Staff told us they felt that there had been a decline in the standard of care provided since November 2010. We asked whether people living in the home had been asked for their comments about the service via a survey which we belived was sent out annually. We could not ascertain whether this annual survey had been sent to people living in the home as we got two different answers. In the six months prior to this visit there had been one meeting held for staff, health and safety, heads of departments and nursing staff. There had been no meeting with people living in the home or their representatives. The home has been carrying out medication audits but had not picked up any of the issues identified in the medication management that lead to us issuing an immediate requirement due to concerns about the safety of medication administration in the home. Concerns were expressed at the time of the inspection and with the provider representative post inspection about a number of issues identified in the report. Good audit trails feed into the quality assurance systems of the home and if these are poor or flawed then ultimately the health and well being of people living at the home is compromised. All staff working at the home need an awareness/training in the Mental Capacity Act 2005 and the deprivation of libery safeguards. We are concerned about the safety and well being of people living in the home especially as we had to prompt the home to make two safeguarding referrals during our visit. People living at the home can manage their own money. The home however does hold money for a number of people living at the home. Money from family members is paid by cheque into the organisation bank account and transfered though a variety of systems to people living in the home. The home needs to establish a bank account solely for the residents at living at the home. The present system does not meet the current legislation. Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: A sample of health and safety records were checked, including electrical installation, fire, emergency lighting and call bell system, lift, and gas safety. They were all found to be satisfactory with the exception of the hoist and bath hoists who had been due to be checked end of May 2010 and this had not happen. Care Homes for Adults (18-65 years) Page 27 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 20 13 Within forty eight hours the home should ensure there are effective systems in place for the management and administration of and disposal of medication. To ensure the safety of people living in the home and receiving medication. 12/07/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The home must make sure 30/07/2010 that peoples pre admission assessments are a reflection of peoples current needs They should do this so that peoples needs are recognised by the home and so people can feel confident their needs will be met. 2 6 14 The home must make sure that peoples assessments are kept up to date and are a reflection of peoples needs. The should do this so that peoples needs are recognised by the home and 31/07/2010 Care Homes for Adults (18-65 years) Page 29 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action this will help reduce the risk to people living in the home. 3 6 12 Care plans must be based on a though assessment of needs and show how care is to be delivered. Care plans must be accessible to staff delivering the care and be a reflection of the care being given. Care plans must be reviewed and amended at the point where a persons needs change or routinely and staff must be aware of these changes. This will ensure that people in the home have their health and welfare promoted and protected. 4 20 13 All nursing staff must be 31/07/2010 trained to understand the clinical reasons a medicine is administered together with their side effects. This is to ensure that they are able to fully met the clinical needs of people living in the home. 5 20 13 The medicine chart must 31/07/2010 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the persons medicine and be signed directly after the 06/08/2010 Care Homes for Adults (18-65 years) Page 30 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action transaction and be an accurate record of what has occured The prescribed medicine must be adminstered to the right perons at the right time and at the right dose prescribed and records must reflect this. 6 20 13 The quantity of any balances 31/07/2010 carried over must be recorded to enable audits to take place. This will demonstrate that medicine has been administered as prescribed. 7 20 13 A quality assurance systme must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicine are not administered as prescribed and records do not reflect practice. This is to ensure that all medicines are administered as prescribed and this can be demonstrated. 31/07/2010 Care Homes for Adults (18-65 years) Page 31 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 20 13 Systems must be in place 31/07/2010 for appropriate pain control and documentation available to demonstrate appropriate pain relief has occured. To ensure pain relief is managed appropriately and meets peoples needs 9 20 13 The home must have in place safe systems for the ordering, safekeeping, safe adminstration and disposal of peoples medication. This is to protect the people living in the home and to make sure they have their medication as it has been prescribed. 31/07/2010 10 22 22 All complaints should be 31/07/2010 logged and fully investigated in a timely manner and the home must have a retrievable audit trail. This will ensure that people concerns are listened to and responded to appropriately. 11 23 13 All incidents in relation to adult protection must be reported to the appropriate agencies in a timely manner and the home must have a retrievable audit trail to demonstrate this has occurred. 31/07/2010 Care Homes for Adults (18-65 years) Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to promoted and protect the well being of people living at the home. 12 34 19 The organisation must write to the Commission and obtain written permission to keep CRB at their head office. This will ensure they comply with the current legisilation and guidance in this matter. 13 34 17 The home must make sure 31/07/2010 that staff allowed to work in the home whilst awaiting a satisfactory CRB and only have an ISA first check have a written risk assessment completed and a copy of this risk assessment is kept in the staff members file. This will demonstrate how the home intends to protect the people living in the home when staff start work without all the required safety checks in place 14 37 20 The home must set up a bank account specifiically identified for use of people living in the home. 23/07/2010 31/07/2010 Care Homes for Adults (18-65 years) Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that money belonging to people living in the home is not regarded as a company asset. 15 42 13 Moving and lifting equipment must be tested yearly to ensure that it complys with LOLER regulations To ensure the safety and well being of people living and working in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/07/2010 1 1 The home should amend its Statement of Purposes to reflect the current management structure and also the Service User Guide. The Service User Guide should also include the range of fees. Trained staff working at the home should re-familiarise themselves with the Nursing and Midwifery Council (NMC) Record keeping document to promote and protect the health and well being of people living in the home. People living at the home should be encouraged to part take in the drawing up of their care plan instructions so that their wishes and preferences are fully explored and meet. Staff should receive guidance with regards to the completion of daily records so that they promote peoples rights to respect. (recommendation first made February 2008 key inspection) A best interest protocol should be introduced to ensure decisions are made in line with the Mental Capacity Act so Page 34 of 37 2 6 3 6 4 6 5 7 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations that peoples best interests and rights are upheld. (recommendation first made February 2008 key inspection) 6 13 People should be supported to develop interests and being integrated into community life so that people are supported to lead full and active lives. (recommendation first made February 2008 key inspection) Recommendation by external health care professionals should be incorporated into the care planning process so this information is available to all but can be monitor and evaluated regularly as to the affectiveness Trained staff working at the home should re-familiarise themselves with the NMC Standards of Medicine Management to promote and protect the health and well being of people living in the home. It is recommended that the home obtain a copy of the Department of Health guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training, so that staff are aware of their responsibilities and peoples rights are protected. It is recommended that the home reviews its systems for ensuring maintenance issues are dealt with swiftly. The homes staffing levels must be reviewed so that people living in the home receive care in an appropriate and timely manner that meets their needs. It is recommended that the responsible person must aim to have at least 50 of care staff who are trained to level 2 National Vocational Qualification (NVQ) so that people can feel confident that their needs will be met by a skilled and competent workforce. (recommendation first made February 2008 key inspection) Exit interviews with staff should be undertaken to ascertain whether there is a pattern or trend for staff leaving the home and whether anything can be done to encourage good staff to remain at the home. The home should carry out a review of training needs and from this implement a training programme to ensure staff have up to date skills and competences. This training analysis need to look at both mandatory and specialist training for example topics to consider should include pressure area care, epilespy, and mental health conditions. Page 35 of 37 7 19 8 20 9 23 10 11 24 32 12 32 13 34 14 35 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 15 35 The home should keep a copy of the induction records for new staff. They should do this so they can demonstrate new staff have been supported though the process and have received a suitable induction to social care work. Staff supervision should be occuring on a regular basis with a minimum of 6 sessions occuring a year. This will ensure that staff are supported to do their job. Meeting for people living at the home and their representatives should be occuring on a regular basis minimum of four times a year so that views and opinions as to the running of the home can be expressed. These views should be used to ensure the home is run in the best interest of people living in the home. All records pertaining to the running of the home must be available for inspection. Formal systems to monitor quality in the home should be reviewed to ascertain why issues have not been detected and acted upon eariler. 16 36 17 37 18 19 37 39 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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