Inspection on 06/03/08 for Parkstone Lane

This inspection was carried out on 6th March 2008.

CSCI 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

Parkstone Lane 15/11/06

Parkstone Lane 06/02/06

Parkstone Lane 03/10/05

Parkstone Lane 16/02/05

Parkstone Lane 04/08/04

Parkstone Lane 24/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Parkstone Lane 31 Parkstone Lane Plympton Plymouth Devon PL7 4DX Lead Inspector Brendan Hannon Unannounced Inspection 6th March 2008 10:00 Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 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 Parkstone Lane DS0000003561.V360512.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 Adults 18-65. 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. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkstone Lane Address 31 Parkstone Lane Plympton Plymouth Devon PL7 4DX 01752 344144 01752 344144 headoffice@durnford.org 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) The Durnford Society Ltd Mrs Sarah Reilly Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 4 people who are learning disabled who may also have a physical disability and are aged between 18 - 65 years may be accommodated at any one time 15th November 2006 Date of last inspection Brief Description of the Service: Parkstone Lane provides care for four people with profound learning disabilities some of whom may also have significant physical disabilities. The house is owned by the Health Authority and the service is delivered by The Durnford Society Ltd, a registered charity. The home is situated in the Plymouth suburb of Plympton. The property consists of a large detached house standing in its own grounds with a large garden to the rear of the building. Each of the four people that use the service has their own single room. There is a large kitchen dining room and a lounge with a conservatory attached on the ground floor. The whole of the ground floor is fully accessible to wheelchair users. The service has its own adapted transport. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was unannounced. Preparation for the inspection included analysis of the CSCI Annual Quality Assurance Assessment, the last inspection report, and contacts with the home over the last 12 months. An inspection plan was developed from this information. The inspector was in the home from 9.15am to 4.30pm on 06/03/08, and again from 9.00am till 1.00pm on the 07/03/08. The inspector met with the acting manager, who is a Registered Manager from another Durnford Society home, the deputy manager and the staff on duty, during the first day of inspection. The following methods were used to carry out the inspection. The care of the four people that use the service was tracked during the inspection. The people that use the service were met. Staff personnel and training information was sampled during the visits to the home. The building was toured. All the people that use the service and their relatives were surveyed. One of the people that uses the service and three relatives of people that use the service responded. These responses were positive. Various areas of documentation were inspected to evidence compliance with the National Minimum Standards. Documents inspected included assessments of peoples’ needs and their care plans and risk assessments, various records including medication administration records, staff records, and health and safety records. All the information gathered during the inspection was considered in the writing of this report. What the service does well: The home is comfortable and warm and the facilities are of a good standard. There is plenty of private and communal space for each person that uses the service. Each person has plenty of private space and their likes and dislikes are considered in the decoration and style of their rooms. People had plenty of personal effects in their rooms to make them both homely and comfortable. There is plenty of food provided and it is of good quality. People that live at the home affect the planning of the menus and take part in some of the purchasing of the food for the home. People are supported to have enough to do and have reasonable access into the community. The service has its own vehicle which assists people to access services and facilities. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 6 There are enough staff throughout the day to meet peoples needs both inside and outside the home. Peoples health and personal care needs are met but the consistency of approach is affected by poor care planning. What has improved since the last inspection? What they could do better: 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. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisation’s pre-admission processes ensure that people that are considering using the service are provided with information about the home as well as having the opportunity to experience life in the home before admission. This would enable them to make a properly informed decision. EVIDENCE: There have been no admissions to the home within the past two years. The Durnford Society has an appropriate admission policy and procedure. The preadmission process thoroughly explores a persons support needs before they are offered a place at the home and each person is enabled to visit the home on different occasions to meet with the other people that live there and the staff. The service and the organisation could not produce the pre admission assessment carried out for the person that was last admitted to the service. The organisation provides a written language Service User Guide. A new shortened simplified version has also been produced by the home. The Guide is not yet available in other formats such as in audio or pictorial form. Any person that is considering using the service would be supported to make an informed choice based on the information in the Guide, from visits to the home, and from explanations from the management and staff. The acting manager stated that everyone that uses the service, or their representative, has received a Service User Guide. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People that use the service are adequately supported and are enabled to manage choice in their day to day to lives. The home’s assessment, care planning and risk assessment processes have broken down and do not provide staff with the information they need to consistently meet the needs of people that use the service. EVIDENCE: Each person’s ‘personal file’ did not contain an adequate care plan of how the service would meet the person’s needs. There was little evidence to show that the assessments and care plans had been reviewed either regularly or in line with the organisations policy that reviews should take place at least every six months. The acting manager agreed that all four care plans and the assessments of needs should be redeveloped. The new care planning will include a detailed and comprehensive assessment of each persons needs, a plan of the care Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 10 required to meet these assessed needs, and each person’s short and longer term goals. Individual risk assessments have not been completed comprehensively or in detail for each person. There was no evidence of regular review of each persons’ risk assessments. Individual risk assessments were not up to date or accurate. The acting manager agreed that each person’s individual risk assessments should be redeveloped. The acting manager supported most of the restrictions of choice or freedom that were in place and stated that these had been agreed with the person affected and with other people involved in the person’s care. These restrictions are in place to protect the person’s health and safety. However a small number of restrictions, including; an issue of physical intervention, peoples’ bedroom doors being kept open at night, the restriction of the use of a toilet and the required staffing level necessary for a specific person to go out of the home, were not supported by the acting manager as being necessary. The acting manager said that with support from other professionals she will define which restrictions of choice and facilities are presently necessary to maintain peoples’ health and welfare. The service will then ensure that each restriction is appropriately documented to demonstrate that every restriction in use has been appropriately agreed and is in the best interests of the health and welfare of the person affected. The staff did not know accurately the content of each person’s care plan or their risk assessments. The staff could not gain easy access to the care plans or risk assessments to ensure that they were aware of the information in them. Without this knowledge they are unable to provide consistent care according to the directions of the care plans. The present system of flat rate charging for the use of the homes transport is not an equitable method of charging people for the use they make of the service’s vehicle. It was agreed with both the acting manager and with the organisations senior management that a ‘pence per mile’ charge would be introduced made based on a clear record of how many miles they each person travelled in the vehicle. Some personal information related to people that use the service and to staff members was found in a communal file that was openly available to people in the dining room. When discovered it was immediately removed to the homes office. The confidentiality of peoples’ information has not been maintained effectively. Due to the complex needs of the people that use the service most are limited in their ability to make decisions independently. The acting manager stated that the care staff encouraged people to make many decisions and choices on everyday issues, such as taking part in activities, and expressing meal preferences. There was little documentary evidence to support this at present. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 11 All of the people that use the service need support with managing their personal money. The personal money cash balances for the people that use the service were sampled. The balances checked were correct and each person has their own named individual bank account. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people that use the service participate in community and leisure activities, can affect their daily routines, and enjoy good food that is chosen with respect for their known preferences. Sometimes activities are not designed to support peoples’ involvement in their local community and are not carried out as directed. EVIDENCE: The managers and staff commented, on a number of occasions during the inspection, that the relatives of the people that use the service are actively involved and welcomed into the life of the home. The survey responses from relatives were very positive and commented on the openness and welcome of the staff and managers of the service. Records of peoples daily activity was recorded on the homes daily communication and recording system. The service encourages people to participate in social activities and develop their social skills. Transport and staff Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 13 are provided to support people’s access to community facilities and to provide trips out of the home. Peoples’ care planning contained information about their activities. This information was not always accurate due to infrequent reviews and the disorganisation of the information. The home has a weekly activity plan. The planned activities were confirmed as carried out by the entries in peoples’ daily records. Local community facilities such as, local shops are used. People often walk to use these facilities. Some of the activities enjoyed by people that live at Parkstone Lane, when outside the home include, pubs, restaurants, ten pin bowling, theatre trips and local attractions such as the National Marine Aquarium and the regional zoos. Within the home activities such as, cooking, magazines, music, television, and arts and crafts are some of the things people enjoy doing. During the inspection people were seen going out for walks, cooking as a specific activity, and going to a pub. During the inspection it was noted that staff did not follow the written directions in the weekly activity plan and supported a different person to go on an outside activity instead of the person that was supposed to go. Similarly the staff’s choice of venue for the activity, a considerable drive away from the home, could not be justified by the additional benefits this venue would give to the people involved in the activity. The homes menus were looked at and the acting manager confirmed there is a good budget to buy food for the home. The staff spoken with agreed that the home provides good quality and wholesome food. The menu is written weekly and is based on the staff’s knowledge of peoples’ likes and dislikes. Specialist dietary needs are met. The main weekly food shopping is carried out at ordinary supermarkets. There was a food record for the main meal of the day. A new food record was being introduced at the end of the second day of the inspection and this will record all of the food taken by each person including when they decide to have something different from the communal main meal. Fridge and freezer temperatures were seen. People that live at Parkstone Lane receive a choice of good quality food and their nutritional needs are met. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People that use the service cannot be assured that their personal, health and medication needs are being well met. EVIDENCE: Staff were observed providing people with personal support. This was carried out in private and the dignity of the people receiving personal care was maintained at all times. However the care planning system was in disorder and the information in care planning was not accessible to care staff at all times. Care plans are not actively used by staff, and the staff are not aware of the contents of the care plans. Staff carry out the personal care procedures as shown to them by other care staff. Staff have not carried out some personal care procedures as directed by care planning. The daily communication/recording system is important to the recording, monitoring, and therefore action taken to meet peoples’ changing needs. The communication records were severely disorganised and some unprofessional language had been used within entries. The acting manager took immediate Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 15 action to re place the existing system with the standard Durnford Society written communication format. Moving and handling information was not documented either comprehensively or in detail within care planning or moving and handling risk assessments. Moving and Handling fittings had not been replaced in response to changes in peoples needs. The acting manager is now taking action to rectify these problems. Appropriate moving and facilities are in place in the building to meet the needs of the people that presently use the service. The home has a key worker system in operation. The keyworker is responsible for a number of specific tasks including review and amendment of the care plan, ensuring health checks take place, and liason with the persons relatives and supporters. All four peoples files were looked at. Various specific charts are being used to monitor people’s health needs. These charts include weight records, bowel charts, epilepsy charts, sleep pattern charts, and skin tissue viability records. These records were being kept poorly. Therefore they could not be relied upon to give comprehensive and detailed information that would assist with the management of peoples care. The acting manager said that each person’s health is monitored for any change in their condition, and any extra provision or support that is needed is then arranged. Peoples care planning and records were not able to support this statement. All of the people that use the service have a draft Health Action Plan. The format was supplied by community learning disability services and has been completed by the staff at the home. When in full use these action plans should help to clearly inform about each persons health needs. Appropriate medication administration policies and procedures are in place for use by the service. A monitored dosage system is used to administer medication that is in the safekeeping of the care home. None of the people that presently use the service manage their own medication. Medication was locked away safely and tidily in the medication storage facilities. One part of the medication storage was not clean. There is a list (profile) of each person’s medication on file. However these were found to be inaccurate and out of date. Medication Administration Records were not well maintained. Some medication administration was not fully recorded and poor recording practices were being used. All staff receive medication administration training from the homes pharmacist. All the staff have received this general medication administration training. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 16 There is a need for staff to administer invasive diabetes medication. Only staff that have received specialist training may give this medication. Most staff had not received this training and were also not being overseen by a named medical professional. There is a need for specialist nutrition to be delivered by the staff. Only staff that have received specific training should carry out this procedure. Most staff had not received this training. In relation to both these issues the acting manager took immediate action to urgently address these training needs. The home is not administering Controlled medication at this time. The Controlled Drug record showed poor record keeping when the last Controlled Drug was discontinued. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff and the Registered Manager at Parkstone Lane have failed to protect the people that live at the home from potential abuse. Both the service and the organisation have failed to work effectively with the Adult Protection process. EVIDENCE: The home’s complaints procedure has been redeveloped into a more accessible form using symbols as well as written language. This complaints procedure was not up to date and was displayed inconspicuously on the wall of the dining room. A copy of the complaints procedure is included within the homes Service User’s Guide. The service has not given relatives a copy of the new complaints procedure. The survey forms returned by relatives said that families did know how to raise concerns about the service. The Commission has not received any complaints, since the last inspection. The people that live at Parkstone Lane have limited communication and limited ability to advocate for themselves. Therefore they are reliant on others to speak for them when potential issues are recognised. All the staff have received adult protection training either through a specific in house course or through the in house induction and foundation courses. People that live at the home have been put at risk by the actions of the service and the organisation. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good, providing the people that live at Parkstone Lane with a comfortable and homely building to live in. EVIDENCE: Parkstone Lane is a large detached building set in its own grounds on the edge of the Plymouth suburb of Plympton. The building is owned by the local Health Authority. In 2006 a ground floor extension was built incorporating a fully accessible bathroom fitted with a ceiling hoist, shower area and an Arjo bath. This facility is mainly an ensuite facility for the adjoining bedroom. However it is also accessible from the corridor and is partially used as a communal facility. This extension also incorporated a large conservatory lounge. The kitchen was refitted at the same time as the extension. On the first day of the inspection the building was toured. The building was warm, clean and tidy. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 19 In the past year the large, pleasant garden area to the rear of the house has been landscaped and it now includes raised beds, scented plants, a hard paved patio area and various paths. All four people that use the service have single bedrooms. These have been decorated to a high standard and personalised to the tastes of each person. The three service users who have bedrooms on the first floor share a large bathroom and two toilets. The service users have the use of a large lounge, the conservatory area and a kitchen/dining room. Disability equipment is available as needed, including hoists, an adapted bath and adapted toilets. All the radiators that were noted were fitted with covers to protect people from hot surfaces. The acting manager stated that all the radiators in the building were covered. The homes laundry facilities are good and meet the needs of the people that use the home. The home has one industrial washing machine and one industrial drying machine. Red bags with dissolvable fastenings are used for heavily soiled laundry and yellow bags for incineration are used for soiled waste. Infection control practices are good and personal protective equipment, such as disposable gloves and aprons, are easily available to the staff. Paper towels and soap are available in all the bathrooms and toilets. These practices help to prevent infection and ensure that the home is free of offensive odours. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough trained and experienced staff provided by the service to meet the needs of the people that live at the home during the daytime. The organisation has good recruitment and generally good training practices. The staff generally have an adequate understanding of the support needs of the people that live at the home. However the staff have not been adequately supervised by the homes management to ensure that peoples’ needs are always met. The service has failed to train staff adequately to ensure that vulnerable adults are not put at risk and that some specialist health needs are met safely. EVIDENCE: The home has a reduced staff team. The service regularly uses agency staffing. Both agency and regular staffing have not received clear and consistent instructions on how to meet the needs of people that live at the home. Throughout the inspection staff were observed responding sensitively and respectfully to people that use the service. Staff seen on duty were seen being friendly and good-natured. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 21 Through discussion with the acting manager, looking at care planning, risk assessments and records it was evident that the people that use this service have high support needs. The care planning and care needs assessments demonstrated that in order to meet peoples needs a higher level of staffing is necessary during the night time period. At present there is one awake and one sleeping in staff on duty at night. The acting manager said that the following minimum staffing level is provided and is sometimes exceeded. From 8am till 11am there are always at least 3 staff, from 11am till 4pm there are four staff and from 4pm till 8am there are 3 staff. The staff rota confirmed these arrangements. The acting manager said that the daytime staffing level was adequate to meet the needs of the people that use the service. A training programme is run by the organisation to ensure that the needs of the people that use the service are met by skilled staff. The organisation is training new staff in the Learning Disability Award Framework (LDAF) as part of their induction. This qualification gives staff specific skills to work with people with a learning disability. This induction training then forms part of an NVQ2 and enables staff to meet peoples’ needs soon after beginning work at the home. However due to the generally settled nature of the staff team only one staff member has undertaken this training. Core principles of care is part of this training. Staff have sometimes not provided care to best practice quality. At present 55 of the staff team have an NVQ2 or above, qualification in care delivery. The acting manager hopes this will rise in the future when a further 4 staff of the 15 person staff team complete their NVQ2 courses. All care staff at the service require specialist training in delivery of specialist nutrition methods and administration of invasive diabetes medication. At present the staff working at the care home are largely untrained in these skills. An agreed short term action plan for emergency training was agreed with the acting manager until such time as external training can be identified and delivered, within the required timescale, from appropriate resources. A sample of staff records were seen. These confirmed that the homes recruitment procedure is carried out appropriately. All staff had a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adult (POVA) register check. Staff meetings have taken place on a regular basis at approximately monthly intervals. Staff have not been receiving regular formal 1:1 supervision. The organisations policy is that staff receive one meeting every two months. The amount of supervision taking place was negligible. The care staff have not been adequately supervised in order to meet the needs of vulnerable people with complex high dependency needs. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The day-to-day running of the home has been poorly managed leading to some of the needs of the people that use the service not being adequately met. The organisation’s senior management has not adequately overseen the service to ensure the effective running of the home. EVIDENCE: An acting manager from another service within the Durnford Society organisation is currently overseeing the home. The widespread failures in the maintenance of the homes systems show that both the internal management and organisation management has failed to maintain the quality of the service being delivered to the service users. Many of the records inspected were being poorly maintained. The acting manager said she would improve the care-planning and recording systems to Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 23 an adequate standard to ensure that information is easily accessible and understood by those providing care. The records of people that use the service were poorly organised. These records included accident/incident records, health related charts, training records and inventories of personal valuables. The lack of good records made it difficult to obtain an up to date and accurate picture of people’s needs, from which to then understand how their needs should be met by the service. Well maintained records would assist the management in monitoring the delivery of support to people and would help to ensure that all their needs are met. Records showed that appropriate fire safety procedures had been carried out and a fire risk assessment for the service was in place. There is an appropriate hold open device on every self-closing fire door that may be held open in the house. The electrical wiring certificates both for the buildings wiring and for domestic electrical items was seen. The storage of incident/accident records was disordered. As a result their accuracy could not be referenced to other records. Appropriate risk assessments were not in place to ensure the safety of each identified unrestricted hot water outlet. The management could not state that all other outlets water temperatures had been restricted. Some window openings above ground floor level were not restricted and risk assessments were not in place to evidence the safety of these unrestricted window openings. All hoisting equipment has an appropriate servicing contract and servicing had been carried out as required. Good health and safety practices will help to keep the people that live at the home safe. The organisation has redeveloped the Quality Assurance system. A quality assurance process will be carried out every year. There is a separate quality assurance process for staff. A quality assurance process was carried out for people that use the service, their relatives, and professionals early in 2007. The organisation made significant efforts to gather information objectively and to produce meaningful feedback on the service from those who use, or are in contact with it. The outcomes from this process have still not been reported even though the information was gathered some time ago. The organisation should collate the outcomes for the process and feed them back to the service, the people that use it, and their relatives. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 3 1 2 LIFESTYLES Standard No Score 11 X 12 3 13 1 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 2 X 1 1 X Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 Requirement An accurate, comprehensive, detailed and regularly reviewed assessment of each persons needs, and the necessary care plan to meet these needs, must be kept confidentially but also accessible to the staff team at all times. Peoples’ individual risk assessments must record any restrictions of freedom or choice including any physical interventions, and must document the multi disciplinary process that was used to reach these decisions. Individual risk assessments must be reviewed regularly to ensure that they remain accurate. People must be supported to take part in their local community. Staff must carry out activities as instructed. Staff must be aware of the personal care procedures detailed in each persons care planning and individual risk assessments. The daily personal record and communication system must be DS0000003561.V360512.R01.S.doc Timescale for action 06/06/08 2 YA9 13, 17 schedule3 06/06/08 3 YA13 16 (m) 06/06/08 4 YA18 12 06/06/08 5 YA18 12 06/06/08 Parkstone Lane Version 5.2 Page 26 6 YA19 17 schedule3 7 YA20 13 8 YA20 13, 17 schedule3 9 10 YA23 YA23 13 18 11 YA33 18 12 YA36 18 maintained so that it is organised, detailed, and comprehensive. It must not contain unprofessional language. Where charts are deemed necessary to record health related information, these records must be kept comprehensively and accurately All staff members involved in supporting PEG nutrition must receive appropriate certificated training from an appropriate professional. There must be a specific care plan detailing the invasive administration of insulin. All staff members involved in this procedure must receive certificated training from an appropriate health professional. A health professional must retain professional responsibility for the practice of each staff member carrying out this procedure on their behalf. The staff and management must comply with the organisation and the home’s policies on recording, handling, administration and disposal of medicines. The service and organisation must protect people that use the service from the risk of abuse. All staff and management with responsibility for the protection of the services users at Parkstone Lane must take part in externally provided Adult Protection training. The staffing level at night must be sufficient to meet the assessed needs and agreed care plans of the service users. All care staff must receive the supervision they require to carry out their roles effectively. 06/06/08 06/06/08 06/06/08 06/06/08 06/06/08 06/06/08 06/06/08 Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 27 13 YA37 12 14 YA41 17 Schedules 3 and 4 15 YA42 13 The management of the home 06/06/08 must ensure that an effective and safe service is received by the people that live at Parkstone Lane. All required and necessary 06/06/08 records must be kept appropriately including, pre admission assessments, inventories of personal valuables, accident/incident records, health related charts, weight records, and staff training records. Each hot water outlet, and each 06/06/08 window opening above the ground floor, that is available to people that use the service, and that has not been physically adapted, must be individually risk assessed to ensure it’s safety. 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. 2 3 4 Refer to Standard YA1 YA7 YA10 YA19 Good Practice Recommendations The Service Users Guide should be produced in formats that are accessible to the people that use this service. A fair and equitable system for charging for mileage when using the services vehicle should be introduced. Peoples’ personal information should be kept confidentially. Moving and handling plans should be clear and detailed and should be followed by staff. Moving and handling equipment should be appropriate for the needs of the person using it. The homes complaints procedure should be displayed prominently. The updated complaints procedure should be distributed to relatives of the people that use the service. All existing staff members should receive the present Durnford Society Induction/Foundation training package. DS0000003561.V360512.R01.S.doc Version 5.2 Page 28 5 6 YA22 YA35 Parkstone Lane 7 8 YA35 YA39 The staff team should receive training from an external provider on the management of epilepsy. The outcomes of the quality assurance process should be collated and passed to the service, the people that use it, and their relatives. Parkstone Lane DS0000003561.V360512.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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