Inspection on 30/07/07 for Parkside Nursing Home Ltd

This inspection was carried out on 30th July 2007.

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

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

Other inspections for this house

Parkside Nursing Home Ltd 21/01/08

Parkside Nursing Home Ltd 24/04/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Parkside Nursing Home Limited Park Road Banstead Surrey SM7 3DL Lead Inspector Sandra Holland Unannounced Inspection 10:00 30th July 2007 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 Nursing Home Limited DS0000067171.V339138.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 Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkside Nursing Home Limited Address Park Road Banstead Surrey SM7 3DL 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) 01737 361518 01737 361833 Parkside Nursing Home Limited Kalsum Mohd Noh Care Home 26 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (26) of places Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th April 2006 Brief Description of the Service: Parkside is a large detached property that provides nursing care for up to twenty six people. The home is situated near to Banstead village. Accommodation is provided on the ground and first floor. There are twenty-five bedrooms and some have ensuite facilities. Passenger lifts provide access to the first floor. The home has a large, central lounge/ dining area which is used for activities, as well as for serving meals. The home has a large garden and all areas have wheelchair access. There is ample parking available to the front of the home. The fees at the home range from £ 535.00 - £ 700.00 per week. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection site visit was carried out by the Commission for Social Care Inspection (CSCI), under the Inspecting for Better Lives process. The site visit formed part of a key inspection, during which all the information about the home which has been gathered since the last key inspection has been analysed. Mrs Sandra Holland, Regulatory Inspector carried out the inspection visit over nine hours. Ms Kalsum Mohd Noh, Registered Manager was present representing the service. A full tour of the premises was carried out and a number of records and documents were sampled, including residents’ individual care plans, medication administration records and staff recruitment and training records. Twelve residents, three visitors and six staff were spoken with during the course of the inspection. An Annual Quality Assurance Assessment (AQAA) form was supplied to the home prior to the visit and this was completed and returned. Information from the AQAA will be referred to in this report. The home states in the AQAA that it promotes equality and diversity, by treating each resident as an individual and respecting their rights, needs and choices. A number of CSCI feedback forms were supplied to residents, relatives and healthcare professionals, to obtain their independent views as to how the home meets the needs of the people living there. Seven feedback forms were completed and returned by residents, six by relatives or visitors and three by healthcare professionals. A summary of the responses is detailed at Standard 33, which relates to quality assurance. The people living at the home prefer to be known as residents and that is the term that will be used throughout the report. The inspector wishes to thank residents and staff for their hospitality, time and assistance. What the service does well: A number of positive comments were received in feedback from residents or their representatives, including “my mother’s quality of life has improved since she has lived here”, Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 6 “they keep a happy atmosphere in the home”, “the manager has been determined to keep the home operating smoothly during the building works”, “the home is friendly and welcoming”, and to the question “what the home does well”, the response was “care for all the patients”. Residents healthcare needs are well met and positive feedback was received from visiting healthcare professionals. Major changes are being carried out to improve the standard of the premises and facilities at the home. What has improved since the last inspection? What they could do better: Five of the twelve requirements made following the last inspection have not been met and CSCI will determine what action needs to be taken to secure compliance. Pre-admission assessments of residents’ needs must be signed and dated by the person carrying out the assessment. Residents’ care plans must accurately record their needs, and residents or their representatives must sign their care plans to show that they have been consulted and involved. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 7 Assessments must be carried out of any known risks to residents or any risks which may develop. An immediate requirement was made at the time of the inspection, that the receipt of all medication into the home must be recorded and records must be maintained to enable an audit trail to be followed. Residents must be consulted about their interests and the facilities provided to ensure they can take part in these. The home’s policy on abuse must be reviewed and revised to include reference to local authority procedures and all appropriate actions which must be taken to safeguard residents. Staffing in the home must be reviewed to ensure that enough staff are available to meet all the needs of residents. An immediate requirement was made at the time of the inspection that people must not be employed to work at the home unless all the required information and documents have been obtained and the required checks have been carried out. The registered person(s) must be satisfied on reasonable grounds about the authenticity of any references provided for people applying to work at the home. A record of staff induction must be maintained and kept in the home. An immediate requirement was made at the time of the inspection that doors designed to close automatically when the fire alarm is activated, must not be wedged open and products hazardous to health must be kept in a locked provision. The security of the premises must be maintained. 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 Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Contracts between the home and the residents must be signed by both parties to be effective. The needs of most prospective residents are assessed before they are admitted to the home. EVIDENCE: A requirement was made following the last inspection, carried out on 24th April 2006, that the manager must ensure that all residents or their representatives must sign the new contract detailing the terms and conditions for living at the home. This requirement was made because the home had been taken over by new owners prior to the last inspection, and it was advised that the existing contracts had been reviewed and new contracts were to be supplied. A timescale for this requirement of 8th May 2006 was given, but this has not been met. The files of a number of residents were sampled, including those of recently admitted residents. It was noted that of the contracts sampled, one had been signed by the resident’s next of kin and another had the next of kin’s Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 10 name written on it but had not been signed by them. It was also noted that the new style of contract did not provide space for the contract to be signed on behalf of the home or specify which room was to be occupied. Neither of the two contracts mentioned above had been signed by a representative of the home. All contracts must be read, agreed, signed and dated by both parties to ensure that both sides understand their rights and responsibilities and for the contract to be effective. The needs of most prospective residents had been assessed and recorded on a detailed pre-admission assessment form. These had been completed for two recently admitted residents, but had not been completed for another, as the resident had moved to the home from a great distance away. The manager advised that for this resident, pre-admission information had been supplied by the resident’s family, and the resident’s full needs were being assessed during the initial trial period at the home. It was observed that the home’s pre-admission assessment form did not provide space for the signature of the person carrying out the assessment, so it would not be possible to know who had carried it out. The manager stated that she carries out most of the pre-admission assessments. A number of residents are supported financially by a local authority, the manager stated. Where this was the case, an assessment had been carried out under the care management process and a copy of the assessment had been obtained. For one resident, a contract between the home and the local authority was held and had been signed by both parties. The previously made requirement regarding contracts as at Standard 2, has been made again and a requirement has been made regarding Standard 3 that pre-admission assessments must be signed and dated. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans have been drawn up for each resident, but these need to provide more accurate information to staff and any risks to residents need to be assessed. The administration of medication must be more robust to safeguard residents. EVIDENCE: An individual care plan has been drawn up for each resident to guide staff to the care and support needs of residents and these were marked to show they had been reviewed. The care plans were seen to include residents’ needs in relation to personal care, mobility, continence, social interaction, mouth care, appetite, pressure areas, medication and the involvement of healthcare professionals. Most of the care plans that were seen had been renewed since the residents’ admission, to ensure they were laid out in the correct way manager stated. It was observed that some of the information in the care plans did not accurately match information provided in other areas. Assessments were Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 12 included in the care plans of residents’ needs in regard to moving and handling and pressure area care, but it was noted that these did not fully link with other areas of the care plan. For one resident, the Waterlow assessment regarding the risk of developing pressure sores indicated a very high risk, but the area of the care plan relating to personal care stated “may need hoist”. The mobility section of this resident’s care plan stated that they were “immobile” , required two staff to assist and the use of a hoist. The mobility section also stated that the use of a pressure relieving mattress would be used according to dependency, but that had already been established in the Waterlow assessment. For another recently admitted resident, no moving and handling or pressure sore risk assessments had been carried out, although their care plan indicated that they too, were immobile. The manager stated that other information regarding residents which is used to guide staff is contained in a separate file. This was seen to include a photograph of each resident, the residents’ past social history, such as whether they had been married or the type of work they did, and daily notes of the care and support provided. To provide a more holistic and person centred approach, it is recommended that all information relating to individual residents, is stored in a single place. This would ensure that all staff are aware of all aspects of the residents’ health, personal and social needs as recommended in the National Minimum Standards (NMS) for Older People. As mentioned above, some of the risks to residents in relation to pressure sores and moving and handling had been assessed, but the assessments were not detailed and did not inform staff of any control measures which could be taken to minimise risks to residents. Other risks to residents had not been assessed, including the risk of choking, which affects a small number of residents or of the risks involved with the use of bed rails, which affects almost all residents. Residents’ care plans provide space for the resident or their representative to sign to indicate their involvement and awareness of the plan, but only one of the four care plans that were seen had been signed. From the records seen and the feedback received, it was clear that residents’ healthcare needs are well met. A number of healthcare professionals are involved in the support of residents, including general practitioners (GP’s), chiropodist, optician, speech and language therapist and hospital specialists. It was positive to note that where a change had been identified in the health of a resident, prompt referrals had been made to appropriate professionals, and any action taken was recorded in the care plan. Medication is supplied to the home by a local pharmacy, in “blister” packs the manager stated. Each blister pack contains an individual dose of medication Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 13 and is supplied appropriately labelled by the pharmacy. Printed medication administration record (MAR) charts are also supplied and monitoring visits are made to the home by the pharmacist. The manager stated that she and another member of staff take the lead in ordering and checking the receipt of medication, after another member of staff has initially received it into the home. Medication was appropriately stored in an allocated room, to which only authorised staff had access. A lockable fridge was available for medication requiring chilled storage and portable medication trolleys were secured to the walls when not in use. The majority of medication is received into the home on a monthly basis the manager advised, and the receipt of this had been recorded on the MAR charts. The amounts of medication were checked with the records held and it was noted that for a number of medications, the amount present could not be determined because the amount brought into the home when the resident was admitted, had not been recorded. As the initial amounts brought into the home were not recorded, it was not possible to follow an audit trail. It was also noted that for one resident who had been prescribed a medication to be given “as required”, and had been receiving it regularly, a gap had been left on the MAR chart. As a result it was not possible to know whether the resident had not required the medication, whether it had been overlooked or whether the person administering it had forgotten to sign for it. The quantity of this medication did not accurately match the record held. It was positive to see that hand-written entries made on a MAR chart for a recently admitted resident had been signed by the person making the entry, and had been checked and countersigned by a second member of staff. Unfortunately, as above, the amounts of medications that were received were not recorded by these staff, so again it was not possible to know how much medication should be present or to follow an audit trail. The manager stated that one resident is able to administer their own medication and they are supported in this by staff. Information supplied in the AQAA referred to “updating risk assessments for residents who self-medicate”, but it was noted that no risk assessment had been drawn up for this resident. Staff provided assistance with personal care discreetly to ensure that residents’ privacy and dignity were protected and promoted. A immediate requirement was made at the time of the inspection, that the receipt of all medication into the home must be recorded, and records must be maintained to enable an audit trail to be followed. Two requirements have also been made regarding Standard 7, that care plans must accurately reflect residents’ needs and be signed by residents or their representatives to indicate Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 14 their involvement, and that assessments of any known or identified risks to residents must be carried out. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A limited range of activities are offered to residents, but visitors are made welcome in the home. Residents would benefit from a more varied diet and a review of the menu is required to ensure the dietary needs of all residents are met. EVIDENCE: The manager stated that a member of the care staff is allocated for an hour on three weekday afternoons specifically to carry out activities with residents. This allocation is recorded on the staff rota so that staff know who is to be allocated. Other activities take place on the remaining weekdays, the manager stated, including visits by the hairdresser and a lay preacher from a local church, who conducts a short service with hymns and prayers. A representative attends from another local church to provide a communion service once a week to those residents who wish it. A mobile library visits the home at intervals and a selection of large print books were seen in the bookcase in the hall. A written activities plan was displayed on the wall in the lounge/dining room, where activities usually take place. It was noted that a written plan may not Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 16 be accessible to residents with dementia, and it is recommended that this is also made available in a picture format. Information supplied in the AQAA indicated that the activities organised by care staff include chair bound exercises, painting and colouring, quizzes, bingo and indoor games. Concerts are also held at the home approximately every two months, and the plan of these for the year was seen. This included a summer “open day” and a Christmas party. A requirement was made following the last inspection, that a record must be maintained of individual activities carried out with residents who do not wish to join group activities, and that this must be recorded in their care plan. A timescale of 24th may 2006 was given and this has been assessed as partially met. A number of residents were observed spending time in their rooms, either through their own choice or because of their frailty or mobility needs. A record is maintained in the daily notes for each resident, of the activities they have taken part in, but these were not very specific, stating for example, “reading paper with resident”, with no further detail or indication as to who carried out the activity or the time spent on it. Information supplied at the inspection indicated that six of the twenty residents require one to one support for activities, which would suggest that one member of staff providing activities for one hour on three afternoons each week, is not sufficient to meet the social and recreational needs of all the residents. A large proportion of the residents may also be suffering from dementia, so their social and recreational needs are likely to be greater, but there is no indication that the care staff providing activities have received any training in planning or organising activities generally, or for residents with dementia particularly. As the AQAA stated that activities need to be more personalised and flexible, it would appear that the home has recognised that more needs to be done to meet these needs. A number of visitors were present in the home on the day of inspection, and those visitors spoken with confirmed that they are welcomed to visit and at any time. Residents also spoke of receiving visitors and of family who come to see them on a regular basis. Residents’ preferences, in regard to going to bed and getting up for example, have been recorded to enable staff to provide support at the preferred times. The manager advised that a four week menu plan was operated and copies of these were provided at the inspection. It was noted that at each meal, only one option was offered and no alternatives were listed, although residents said Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 17 that staff ask them the previous evening if they would like the main meal on offer for the next day, or what they would prefer. A notice advising of the main meal of the day is displayed on the dining room table. Three residents were sitting at the dining table for their lunch-time meal, whilst other residents had their lunch at small tables over their armchairs. A list which recorded residents’ likes and dislikes was seen in the kitchen as a guide to staff. Feedback from relatives, visitors and residents indicated that residents could take their meals in their rooms if preferred and that when pureed food was served, it was served individually to ensure it was well presented. Other comments in regard to food were “because of the recent changes in staff, the choice of food offered is limited”, “the quantity and quality of food could be improved” and “food has improved a lot for lunches – ample portions - tea portions quite small and lack variety, often bland”. A requirement was made following the last inspection, that an accurate record must be maintained of all meals consumed, that are not recorded on the home’s menu. This was to ensure that a record was maintained of what was eaten by residents who selected an alternative meal to that offered on the menu. A timescale of 24th May 2006 was given but this has not been met. The manager stated that a record was being maintained of the evening meal that was served, but not of any alternatives to the lunchtime meal. The record of the evening meals indicated that residents requiring a soft diet were frequently being offered “mash” for their supper and staff stated on the day of inspection, that this was being offered to residents. The manager stated that other foods such as tuna, would be added to the mashed potato, but this was not recorded. Residents were observed having their supper meal and residents requiring a soft diet were seen to be served mashed potato, with or without baked beans. Information supplied at the inspection indicated that eleven of the twenty residents require either a soft or pureed diet, but the menu planning does not appear to take these needs into consideration. The manager stated that a nutritional screening tool is used in the home to ensure that residents are adequately nourished, although one resident who requires pureed food had not been assessed despite being admitted for two months. Residents are weighed each month to assist in monitoring their nutritional state and one resident had been referred to their GP because of severe weight loss and food supplements were to be prescribed. A requirement has been made regarding Standard 12, that residents must be consulted about their social and recreational interests and arrangements must be made for them to take part in these. The requirement regarding Standard 15 that an accurate record is maintained of all meals consumed that are not recorded on the home’s menu, has been made again. A further requirement has also been made regarding Standard 15, that the menu must be reviewed Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 18 to ensure it meets the nutritional needs of all residents, particularly those with specific dietary needs. Parkside Nursing Home Limited DS0000067171.V339138.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints made to the home have been appropriately managed. Staff would report concerns to the person in charge. To ensure staff are fully aware of how they can protect residents, the home’s policy and procedure regarding abuse needs to be reviewed and an updated copy of the local authority procedure in Safeguarding Adults needs to be obtained. EVIDENCE: Information supplied in the AQAA indicated that six complaints had been recorded in the last year, all had been resolved with 28 days and none had been upheld. Information regarding some of these complaints had been supplied directly to CSCI and this had been referred back to the provider, to be addressed under the home’s complaints procedure. The complaints policy was seen displayed in the entrance hall of the home, to be accessible to all who may wish to use it. The policy states that the home aims for full resolution of any complaints within seven days. This was discussed with the manager, as resolution of a complaint within seven days may be an impractical timescale. Most complaints procedures specify that an acknowledgement would be made within seven days and aim for resolution within 28 days. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 20 The manager stated that she likes to ensure that complaints are responded to in a timely manner, the actions are audited and any lessons are learnt from the outcomes. Feedback from residents indicated that some are aware of the home’s complaints procedure, but others are not. The manager stated that this had been explained at the last resident’s meeting. The AQAA stated that the home has an “Adult Protection Policy that is in line with Surrey Multi Agency procedure”. However, when the home’s policy, which was dated February 2006 was seen, it was noted that it did not make any reference to the Surrey procedure. The home’s abuse policy and procedure listed different types of abuse and many signs or symptoms that may indicate it, but did not refer to actions to be taken to safeguard a resident in the event of suspected or alleged abuse. The home’s abuse policy and procedure states that the “manager has direct responsibility for investigating alleged or suspected incidences of abuse” and “if minor, manager to deal with and if more serious, contact CSCI or police, according to individual circumstances”. This does not accord with the local authority procedure and must be reviewed and revised, if the home is to work in accordance with the Surrey Multi-Agency procedure as stated. A copy of the Surrey Multi-Agency procedure is held in the home, but it was noted to be an out dated copy. It is strongly recommended that an updated copy is obtained for staff to refer to if necessary. A requirement was made following the last inspection, that the manager must attend the local authority safeguarding adults (formerly protection of vulnerable adults) training and this has been met. The manager attended the specified training in June 2006. It was recommended following the last inspection that all staff who act as shift leaders should attend the local authority training in Safeguarding Adults, so that they are fully aware of the procedure to follow in the event of suspected or alleged abuse. This was also recommended so that senior staff would be able to support staff working under their leadership. As this has not been carried out and is still strongly recommended, the recommendation has been made once again. Staff spoken to stated that they would inform the manager or person in charge if they had any concerns regarding residents. Staff were aware that the home has a whistle-blowing policy. The record of staff training indicated that all but two staff had undertaken a training in the protection of vulnerable adults within the last two years. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 21 A requirement has been made regarding Standard 18, that the home’s abuse policy must be reviewed to state actions to be taken to safeguard residents if abuse is alleged or suspected and to refer to the local authority procedure, if this is to be followed. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 24. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Areas of the home are being refurbished to a good standard, but other areas, including bathrooms, urgently require upgrading to ensure residents can bathe in comfort. EVIDENCE: Information supplied in the AQAA indicated that a refurbishment programme is being carried out in the home over a number of phases. The manager stated that some bedrooms are being left vacant to enable residents to move into spare rooms whilst their rooms are being refurbished. Residents and their representatives advised that the works have caused some disruption, but they are being kept well informed about what is taking place. One wing has now been completed and the rooms are very well presented, with en-suite toilets and basins and an additional basin in each room. The Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 23 rooms were spacious, attractively decorated, with co-ordinating soft furnishings and each room has been equipped with new furniture. A resident advised that they had recently moved into a newly refurbished room, they were very happy with it and gave their agreement to the room being viewed. Other residents were spoken to whilst in their rooms and all were pleased with the standard of the decoration now. Other areas of the home are scheduled for refurbishment, but remain in a poor condition. Four requirements regarding the premises of the home were made following the last inspection, that windows required replacing in downstairs rooms, a programme of routine maintenance must be implemented for decoration and renewal of the fabric of the home, that sufficient bathing facilities must be available to meet the needs of residents and the carpet in an upstairs bedroom must be cleaned. The carpet in the upstairs bedroom has been cleaned the manager stated, but the other requirements have not been met. It was noted that none of the available bathrooms provide an attractive or comfortable place in which to bathe. An upstairs bathroom is the one that is most generally used the manager stated, but this is in urgent need of upgrading. The room presents as cold and unappealing, because the bath is marked, there are holes in the wall, the skirting trim has lifted and the decoration is very shabby and worn. The manager stated that this is due to be refurbished in phase five and advised that phase three is currently in progress. This schedule must be reconsidered, to ensure that the bathroom is made fit for use by residents. It was noted that in a resident’s bedroom and in the medication room, internal secondary glazing panels were being propped open with objects. These are a potential hazard to the health and safety of the resident or their visitors and to staff, and must be removed. The manager stated that they were propped open because they were too heavy to move and were due to be permanently removed very shortly. As the programme of routine maintenance has not been supplied as required, it is not possible to know the timescales of the planned improvements. Despite the building & refurbishment works taking place, most areas of the home were clean and orderly. Paper towels and liquid soap were available in all appropriate places to maintain hygiene. Personal protective equipment, including gloves and aprons, is provided and used by staff to prevent infection and the spread of infection. The laundry is situated in a separate building and is away from food storage and preparation areas. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 24 Requirements made previously regarding Standards 19 and 21 have been made again. An additional requirement has been made regarding Standard 21, that the timescale for the refurbishment of bathrooms must be reviewed and the unsafe secondary glazing panels must be removed. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A team of staff are employed to meet the needs of residents, but staffing needs to be reviewed to ensure that enough staff are provided to meet residents’ needs. Staff are provided with a variety of training opportunities. The standard of recruitment practices must be improved to safeguard residents. EVIDENCE: From the staff rota seen at the inspection, it was clear that a team of staff are employed to meet the needs of residents. The team is made up of care staff, qualified nurses, catering staff and a housekeeper/laundry worker, but a requirement has been made that staffing in the home is reviewed, to ensure that enough staff are available to meet all the needs of residents. As stated previously, care staff are required to carry out activities with residents and it was observed at the inspection, that care staff are allocated to prepare and serve the early evening meal. From other documents seen, it was evident that eighteen of the twenty residents, require two members of care staff to assist them to mobilise, and up to ten residents may have dementia, so it is not clear how the three care staff on duty each morning and afternoon, could provide this level of care whilst also carrying out activities and cooking. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 26 It was also noted from the rota, that the housekeeper carries out both laundry and housekeeping tasks at different times of the day and this person was noted to have been on duty for twelve days in a row. A requirement was made following the last inspection that 50 of the home’s care staff must hold a National Vocational Qualification (NVQ) to level 2 or above, and this has been assessed as met. Information supplied in the AQAA stated that five staff have achieved an NVQ to this level, and five more staff are undertaking this. When the staff undertaking the NVQ have completed this, the home will have exceeded the recommended 50 of staff trained to this level. Further information supplied in the AQAA stated that the required recruitment checks had been carried out for all staff, and that “the recruitment process is robust”, but this was not the case when recruitment files for staff were checked. It was noted that a number of staff had been allowed to start working in the home without a Criminal Records Bureau (CRB) disclosure being obtained. Where staff are required to work before a CRB is obtained, a check must be made of the POVA (Protection Of Vulnerable Adults) List, but this had not been carried out. One member of nursing staff had been permitted to work, although the person’s registration with the Nursing and Midwifery Council (NMC) had not been confirmed. An immediate requirement was made at the time of inspection, that persons must not be employed to work in the home unless and until all recruitment documents and information have been obtained and all required checks have been carried out. The manager confirmed before this report was written, that staff without CRB disclosures had been suspended from working in the home until these had been obtained and the CRB disclosure for one member of staff had been received from the home’s head office. A requirement was made following the last inspection that the manager must ensure that all staff have two references held on their personal files. A timescale of 24th May 2006 was given, but this has not been met. Only one reference was held on file for a recently recruited member of staff, and that had been supplied by a qualified nurse who works in the home. The same qualified nurse had also supplied a reference for another member of staff, but this was dated four months after the person had been employed to work at the home. When the personal file of another member of staff was checked, this too had only one reference, and this had been supplied by a different qualified nurse who is also employed at the home. The question was asked on the reference form “would you re-employ this person?” and the referee had responded “Yes”, even though the nurse was not employing the applicant. As part of the Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 27 assessment of a person’s fitness to work in the home, the manager must be assured as far as is practical, of the authenticity of references provided. A record of staff training is maintained and from this it was clear that staff undertake training required by law, known as mandatory training, including fire safety, food hygiene and first aid, and other training to develop their knowledge and skills, including NVQ’s, infection control and dementia care. From the training records, it was noted that one member of the catering staff needs to receive updated training in food hygiene. It was noted however, that no record of the induction carried out was available for three of the four staff, whose files were sampled. Staff must receive induction so that they are aware of their role and responsibilities and of the home’s policies and procedures. The manager advised that the home is part of a larger organisation and that a training manager is employed to provide training to staff. There is a diverse range of cultures and races amongst the staff team and staff advised that this is positively promoted amongst the resident group, with staff talking to residents about their backgrounds and cultural influences. A requirements has been made regarding Standard 27, that staffing in the home must be reviewed, to ensure enough staff are available to meet residents’ needs. The previously made requirement that two references must be obtained and held on file for each member of staff is made again and is included in the immediate requirement made at the time of the inspection. A requirement has been made regarding Standard 30, that a record of staff induction must be maintained and kept in the home. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The outcomes for residents and the standard of recruitment, record keeping, medication and aspects of health and safety, indicate that the home is not being effectively managed and residents are not being safeguarded. EVIDENCE: The manager stated that she is a qualified nurse and was appointed to the home in January 2006, having previously been the registered manager of another care service in Surrey. The ownership of the home was subsequently taken over in April 2006, by the Abbey Total Care Group. Members of the Abbey senior management team were visiting the home on the day of inspection and advised of the improvement plans for the home. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 29 As stated earlier in this report, a number of requirements made following the last inspection, have not been met. Unmet requirements reflect on the fitness of the registered persons, and CSCI will determine what action will be taken to secure compliance. The number of adequate or poor outcomes for residents which have been recorded in this report, indicate that the home needs to be managed more robustly and more effectively. Shortfalls in the standards of care plans and risk assessments, medication, meals, staff recruitment and health and safety, potentially place residents at risk. The manager advised that a quality assurance survey had been supplied to residents and their representatives in June 2007, to ask their views on the service provided. The manager stated that approximately fifteen responses were received, although the total number of responses marked in each section, indicated up to ten responses. A summary of the responses was provided at the inspection and it was positive to note that the majority of residents and / or their representatives, are satisfied with the service provided. A number of CSCI feedback forms were supplied to residents, their representatives and healthcare professionals involved in the support of residents. The feedback received from healthcare professionals is referred to at Standard 8 which relates to healthcare. Seven CSCI feedback forms were received from residents and these gave residents the optional responses to the questions, of always, usually, sometimes and never. The responses indicated that residents usually receive the care that they need, staff are available when needed, residents receive the medical support they needs, there are usually activities they can take part in and that they usually like the meals. All the residents who responded knew how to make a complaint or who to speak to if they were unhappy. Six CSCI feedback forms were received from representatives of residents and these indicated that relatives are usually kept up to date with issues affecting the resident, that the home usually provides the care expected, that staff usually have the right skills to look after people properly, and that the home had responded appropriately if any concerns had been raised about a resident’s care. Four of the respondents indicated that they knew how to complain and two raised a concern about the security of the home, as a door is left unlocked at all times. A number of positive comments were also received, including “they keep a happy atmosphere in the home”, “the manager has been determined to keep the home operating smoothly during the building works”, “ the home is friendly and welcoming” and to the question “what the home does well”, the response was “care for all the patients”. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 30 A requirement was made following the last inspection that visits to the home must be made by the provider to meet the requirements of Regulation 26 and a report of the visit must be left at the home. A timescale of 24th may 2006 was given and this has been met. Regulation 26 specifies that the provider or someone appointed by the provider who is not involved in the management of the service, must make unannounced visits the home each month to monitor the quality of the service. The person visiting should speak to residents and staff, inspect the premises and write a short report of their findings. A copy of the report must be provided to the manager and kept in the home. Copies of reports written following recent Regulation 26 visits were seen at the home. Monies are held for safekeeping on behalf of residents, the manager advised. The amounts of monies held were checked with the records held and these accurately matched. To safeguard the monies held, only senior staff have access the manager advised. Information supplied in the AQAA indicated that equipment and systems in the home are maintained and serviced to the appropriate frequencies, to safeguard the health and safety of all who live and work at the home. Three hazards to the health and safety of residents and staff were noted however, during the tour of the premises. Residents bedrooms doors on the upper floor were wedged open, although they had been fitted with automatic closers. These are fitted to ensure that the door closes to prevent the spread of fire or smoke, in the event of a fire in the home. Wedging the doors open prevents them closing automatically and would not safeguard the residents if a fire occurred. A large container of urine neutralising chemical was seen stored in an unlocked cupboard, in the unlocked upstairs sluice, which is very close to resident bedrooms, and cleaning products were stored on an open shelf in the kitchen. All products which are hazardous to health must be stored in a locked provision, to safeguard residents. The security of the premises is not maintained. On arrival at the premises the inspector entered by an unlocked side door, which is commonly used by staff and visitors to enter and leave the building. A number of people were seen to use the door during the morning of inspection and feedback had been received from residents’ representatives that they were concerned about the security of the home because of the use of this door. The manager stated that visitors to the home are being encouraged to use the front door, as that is where the visitors book is located. The manager then locked the side door, but it was later seen to be unlocked again. The manager advised that the side door had been used to access the building for a number Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 31 of years and some visitors were not aware that the front door was in use. there is currently no sign at the front of the house to indicate the main entrance, it is recommended that one is provided. As An immediate requirement was made at the time of the inspection, that doors fitted with automatic closers must not be wedged open and that products hazardous to health must be stored in a locked provision. A requirement has been made regarding Standard 38, that the security of the premises must be maintained. Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 32 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 1 X X X X 3 STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 33 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 OP2 Regulation 5A Requirement The registered manager must ensure that all service users and/or their representative receive and sign the new contract detailing the terms and conditions of residency. Previous timescales of 23/3/06 and 8/5/06 not met. The needs of prospective residents must be assessed by a suitably qualified or suitably trained person. The preadmission assessment must be signed and dated by the person carrying out the assessment. Care plans must accurately reflect the needs of residents and must be signed by the resident or their representative. Timescale for action 27/08/07 2 OP3 14 (1) (a) 27/08/07 3 OP7 15 27/08/07 4 5 OP7 OP12 13 (4)(c) 16 (2)(n) Assessments of risks to residents 27/08/07 must be carried out. The registered manager must ensure that activities undertaken with residents who spend time in DS0000067171.V339138.R01.S.doc 28/09/07 Parkside Nursing Home Limited Version 5.2 Page 34 their rooms and do not wish to join in group activities must be recorded, how this is achieved as part of the activities programme and on individual plans. Timescale of 24/05/06 not met. 6 OP12 16 (2) (M & n) Residents must be consulted about their interests and the programme of activities, and arrangements must be made to enable them to engage in social activities. Facilities must be provided for recreation for all residents. 26/10/07 7 OP15 (17) (2) Schedule 4 The registered manager must 27/08/07 ensure that accurate record must be maintained of all meals consumed that are not recorded on the homes menu. This is to provide a clear record of anything eaten by service users in the home. Timescale of 24/5/06 not met. Arrangements must be made, by training staff or other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. The home’s abuse policy and procedure must a) state actions to be taken to safeguard residents if abuse is alleged or suspected and b) must refer to the local authority (Surrey) safeguarding adults procedure, if this is to be followed. a) The Windows require Replacing in the down Stairs windows. b) A programme of routine Maintenance must be 28/09/07 8 OP18 13 (6) 9 OP19 23 (1) (a) 26/10/07 Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 35 Implemented for Decoration and renewal Of the fabric in the home Timescales of 23/3/06 and 24/5/06 not met. 10 OP21 23 (2) (j) The registered manager must ensure that sufficient bathing facilities are available to meet the needs of the service users. Timescale of 24/7/06 not met. The premises to be used as a care home must be kept in a good state of repair and all parts of the care home must be kept clean and reasonably decorated. a) The timescale for the refurbishment of bathrooms must be reviewed and b) the unsafe secondary glazing panels must be removed. Staffing in the home must be reviewed to ensure that there are enough suitably qualified, competent and experienced people working in the home, as are appropriate to meet the needs of residents and ensure their health and welfare. The registered manager must ensure that all staff have copies of two references on their personal files. Timescale of 24/5/06 not met. Persons must not be employed to work at the home unless the registered person(s) are satisfied on reasonable grounds, as to the authenticity of references provided in respect of those persons. DS0000067171.V339138.R01.S.doc 26/10/07 11 OP21 23 (2) (b & d) 27/08/07 12 OP27 18 (1) (a) 28/09/07 13 OP29 19 (1) (b) Schedule 2 30/07/07 14 OP29 19 (1) (c) 27/08/07 Parkside Nursing Home Limited Version 5.2 Page 36 15 OP30 17 Schedule 4.6 A record of the induction of staff must be maintained and kept in the home. 27/08/07 16 OP38 13 (4) (c ) All parts of the home to which residents have access, must be free from hazards to their safety and unnecessary risks to the health or safety must be identified and so far as possible eliminated. The security of the premises must be maintained. 27/08/07 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 OP18 Good Practice Recommendations It is strongly recommended that all staff working in the home that act as shift leaders attend the local authority protection of vulnerable adult training. It is recommended that an updated copy of the Surrey Multi-Agency procedure for Safeguarding Adults is obtained. 2 OP18 Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Parkside Nursing Home Limited DS0000067171.V339138.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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