Inspection on 18/11/05 for Parkwood House

This inspection was carried out on 18th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Parkwood House 06/08/07

Parkwood House 08/06/06

Parkwood House 07/06/05

Parkwood House 21/02/05

Parkwood House 29/12/04

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Insight - Eastchurch

Southfields

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

CARE HOME ADULTS 18-65 Parkwood House West Street Harrietsham Maidstone Kent ME17 1JZ Lead Inspector `Mrs Lynnette Gajjar Announced Inspection 18th November 2005 13:00 Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 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 Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 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. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Parkwood House Address West Street Harrietsham Maidstone Kent ME17 1JZ 01622 859710 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) parkwoodhouse@counticare.co.uk Counticare Limited Vacant Care Home 13 Category(ies) of Learning disability (13), Physical disability (3) registration, with number of places Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three service users who have a physical disability also have a learning disability 7th June 2005 Date of last inspection Brief Description of the Service: Parkwood House is managed and owned by Counticare. The home offers 24 hour residential care to 13 younger adults with a learning or physical disability. The home is a large property with extensive grounds, garden (including a sensory garden) and car parking for several vehicles. Within the grounds adjacent to the main building is a separate small day care facility, offering activities that are more educational led. There is also further facilities’ offering soft furniture and aids for relaxation and an indoor swimming pool. The home is situated on the outskirts of Harrietsham village lying on the main A20 Ashford to Maidstone road. Local amenities can be accessed in the village such as shops, public house etc. There is a good bus service and main line railway station also located in the village. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the announced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection took place on 18th November with two inspectors Lynnette Gajjar and Justine Williams. The visit lasted from 13:00 to 19:15pm. The home currently has ten residents and is running with one single bedroom vacancy. All rooms are currently used for single occupancy with only one room currently used as a shared room on the ground floor. Time was spent speaking directly with three residents collectively and privately; others were out on activities or did not actively engage with the inspectors but were observed through the visit. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service in the report. Some judgements about quality of life and choices were taken from direct conversation with residents and observation followed by discussion with care staff and evidencing records held at the home. Time was spent in discussion with those working at the home; four care staff, cook, newly appointed deputy-acting manager, and the acting manager and area manager. Additional information was obtained through receipt of the acting manager’s pre-inspection questionnaire, a tour of the premises and conducting a case tracking exercise, by reading the files and care plans of the two Residents and three care staff, as well as some policies and records maintained by the home. Questionnaires feedback was also received from 10 relatives/visitors, 8 residents (all completed with staff assistance) 2 other professionals, and a GP. Comments included: “Our (relative) is very happy and well cared for at Parkwood House” “There have been management changes at my (relatives) home. I don’t feel quite as confident as I did in the past.” “(Name of Resident) needs more stimulation and activities, always subject to his abilities” “I feel that the staff do an excellent job. My relative is very happy at Parkwood House which in turn makes me happy” “A lack of knowledge from them, as to when he visits doctors or has hospital appointments. Requires to be kept informed of his appointments etc.” Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 6 “I visit 3-4 times a year and I am fully confident in Parkwood House staff and feel they do an excellent job.” The current acting manager is leaving the service in the coming week. A newly appointed deputy manager has been in post 1 week. The area manager stated interviews are taking place for a new acting manager but that interim arrangements will be: the area manager will be based at the home until the new acting manager is in post. Both inspectors were concerned that there are ongoing issues from previous inspections still remain outstanding specifically residents care plans and information on support to be provided. What the service does well: What has improved since the last inspection? New staff have been employed to fill the vacancies in the past months offering more stability and consistency to residents and less use of agency staff. Staffing rosters and hours worked have been reviewed offering shorter shifts. Residents have managed well with the external and internal decoration and works being undertaken. All windows have been replaced. Communal corridors and stairway decorated. Ground floor parker bathroom and shower room have been retiled and decorated. Residents can access the homes phone line to make personal calls. Cordless phones have been purchased and used in the privacy of their own rooms. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 7 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. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 8 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 Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, Current information provided by the home does not enable residents to understand and make informed decisions as to whether the home can best meet their individual needs. EVIDENCE: The home has a Statement of Purpose and a Residents Guide, which as been amended since the last inspection. This gives information about the home and the services provided. Minor changes were discussed to enhance this further. Both documents have been converted to ‘Widget symbol’ format but on discussion, current residents still did not understand this. Options to develop this format into a simpler format using photographs and object referencing, simpler written word and clip art were discussed and the involvement of residents to develop this into a working document they understood and were part of. The home has had a recent admission. Staff detailed visiting the school and previous placement talking with carers and family to gain information to aid the assessment process. Records seen today gave a baseline of personal preferences and management of behaviours. Direct observation showed staff and management were not prepared for the excessive behaviours presented and enjoyment of free space and energy to use the grounds. Staffing levels was not meeting the needs of this individual and taking staff care away from others living at the home. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 10 Contract seen for new admission did not include room to reside or signed by representative on their behalf. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Care plan records currently do not offer clear and concise information to the home to meet the needs of current residents. Risk assessments and guidelines are not detailed enough to ensure consistent approaches by staff. EVIDENCE: A sample of records was assessed. The current care plan format is still being developed. The organisation does not give specific formats to follow but leave this the acting manager to develop. The acting manager and staff have begun to write up information and develop risk assessments. However those seen needed further expansion to give clear consistent strategies and approaches. For example, an admission assessment detailed a food allergy; there was no further mention of this through risk assessments or care and support provided. On walking around the home the inspectors were advised the resident hiding behind a curtain did this because they were nervous of strangers, the care plan detailed this to be because they were indicating they wished to play. Consistent care and support guidelines with ensure consistent care and security to residents. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 12 Risk assessments are being completed but they require further expansion to give clear guidelines and strategies for staff to follow. The inspectors were specifically concerned over the new residents accessing the grounds, the youthful speed of this resident meant that staff (even 3) were not able to keep up with the resident. There is no secure fencing to prevent the resident from leaving the grounds and ending up on the busy main road. Other residents were left for long periods with little staff interaction due to this. Staff continue to work with residents at risk of potential physical abuse resulting from the behaviour of others due to the complex needs of individuals living at the home. Referrals have been made to local Learning Disability teams for support but they were on a waiting list for allocation. Incidences may have reduced with the moving on of one resident but the new admission has high records of incidences in the first week directed at themselves, other residents and staff. Daily records seen were varied in content some detailed and giving good information of care provided and social interaction and feelings for the individual that day. Others were open to personal interpretation / assumption. Records seen do not give detailed evidence of care provided on daily basis. Some records held were not dated or signed on completion or evidencing other agency involvement including representatives, particularly where restrictions are in place to personal choice and safety. Records were seen to be stored securely. Staff and management need more training and support in the care planning, person centred approach. It was very difficult to assess whether residents knew or are even interested in the written care plan or evidence that they agree to the current content. Personal goals and aspirations have not been detailed. No other formats were evident that encourage residents involvement such as visual, object reference or audio systems or writing in their daily record of events. Either relatives or placing authority finance officers manage the resident’s finances. Personal money is still held in a single account managed from the Head Office. Within that account residents were named. Small amounts of money are held securely at the home, larger amounts must be requested through Head Office and countersigned by a Director. This continues to delay the monies being received by the resident. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Resident’s lifestyles would benefit from further opportunities through management reviewing current protocols, to be more personal to the individual accessing activities other than those offered by the company day services. The food prepared and provided is of good quality and served in accordance with residents’ own personal preferences. EVIDENCE: Parkwood House has its own separate annex, which can be used for day and evening activities. Use is made of Counticare day services in Folkestone. A driver/support worker is appointed who uses Counticare transport based at the home to take residents to day services. Those staff that are able and willing to drive may use additional Counticare transport based at Parkwood. Good use is made of the indoor swimming pool. Staff currently do not undertake lifesaving training for this in-house activity. Staff expressed how they would like to offer more locally accessible resources as not all residents enjoy the sessions and use this more for social interaction. One resident has stated they don’t like the woodwork session but the acting manager stated until they find something else to fill this, company policy Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 14 states they have to continue to attend. On direct observation today there are not the staffing levels to stop this woodwork activity and engage in quality time with staff at home or access local amenities. Personal goals and aspiration were presented as being stifled by company policy and limited staffing levels. Residents are part of the local community and attend local pubs. A resident confirmed regular contact with their direct and extended family through home visits and outings. Written feedback from relatives was received (included within the summary section). Residents’ relatives and friends are invited to join in activities within the home. Residents enjoy privacy in their rooms and staff respect this. Bathrooms, toilets and individuals’ rooms are lockable. Residents who require a wheelchair to mobilize are significantly restricted in freedom of movement at the home. Areas are inaccessible by wheelchair users include the secondary lounge area leading off the main lounge, one fire exit on the ground floor and rooms on the upper floor. Access is difficult to the conservatory and activities/snoozelem annex. There is ramped access to the front door (which has been replaced but slippery as rubber footing have not yet been installed) and from the patio to the main lounge. A resident has an electric wheelchair, which he cannot use indoors due to the width of doorways etc. Residents are involved in shopping and cooking wherever possible. The cook was keen to have them involved in the kitchen where possible. Wheelchair users are restricted due to limited space and height of work surfaces. Food hygiene practice is not being adhered to a satisfactory standard, food in the fridge was seen not to be dated on opening and use, food is not being probed as required by EHO last visit or probe wipes purchased. Whilst the home wishes to promote a homely approach and involvement of the residents, staff and residents need to be more aware of basic rules when in the kitchen, washing of hands and surfaces etc. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, Residents would benefit from safer medication storage and administration guidelines. Residents’ emotional and social needs are currently being compromised through limited staffing numbers and environmental issues. EVIDENCE: Staff are clearly aware as to the type and nature of the support required for individual’s personal and intimate care needs. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Blinds not being installed and curtains being removed from windows currently compromise this. Staff have a good understanding of the preferred routines of each resident. These need to be reflected in the care plans. Due to the complex care needs of individuals living at the home and the demands of them as well as the recent new admission. Insufficient staffing and professional support from behaviour therapist and teams compromise individual emotional and social care needs. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 16 Staff have received training in medication and the company have reviewed their medication policy. Spot checks today identified areas of good practice and storage that were not being followed. The acting manager stated they would address these immediately. Clear guidelines must be written in respect of PRN medication particularly where communication is limited and observation triggers are used to decide when to administer. Security can be improved by installing blinds to all windows to this area and being used when not occupied by staff. Some records were assessed, most were complete satisfactorily, however a current infectious skin condition cream was not being signed for at the mid day time slot for over a week. The acting manager was unable to explain this. Issues of not dating opened medication; disposing of and labelling were also identified. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Residents are at risk of being supported inappropriately due to the strategies and guidelines not being detailed to manage current individual behaviours. Systems are in place to enable those living and those visiting the home to raise concerns or complaints with staff and people they trust. EVIDENCE: The home has revised is complaint procedure. New format for recording of complaints has been introduced to give better structure. Introducing a monitoring and tracking sheet can enhance this further. The home has had three complaints since the last inspection one upheld, one unresolved and the third still under investigation. Due to another person undertaking the investigation not all paperwork pertaining to this was available. The area manager discussed action taken so far. Written information about how to complain is provided for residents and their representatives. Due to the nature of the service and those residents living here, using this system is very limited. It was evident a resident was clear about whom they would talk to if they were unhappy about something. Others would require relative/ advocate to identify concerns and raise them on their behalf. Three of the ten relatives who responded were not aware of the complaint process. Both residents and staff are not fully protected from potential abuse by the procedures in place within the home. Occasional physical abuse and self-harm result from the behaviours of individuals. Staff work hard to ensure that this happens as little as possible, although more staff would reduce the risks further. As stated earlier in the report more support from professionals in this field and management through clear strategies and guidelines will help to reduce these events and offer consistent support and familiarity to residents. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 18 Staff stated that they have completed restraint ad intervention techniques using SCIP training. A staff on duty stated they were a trainee trainer and that they rarely use physical restraint but intervention techniques more often. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Residents would benefit further from a living environment, designed, decorated and equipped to promote their personal independence. EVIDENCE: Parkwood House was originally privately owned and some décor reflects this earlier ownership, not being entirely suitable for the current client group. Work continues to redecorate the home with some bedrooms and hallways freshly painted. There is no lift; hence those with mobility difficulties cannot access the upper floor. Privacy continues to be compromised significantly by the continued use of a shared room. Another shared room is currently being used for single occupancy. The area manager confirmed it had been agreed that this would remain for single occupancy whilst the current person resided there. A single room is vacant. Residents should be able to make a positive informed choice to share, and if consenting, with whom, or be offered the opportunity of moving to a single room. The layout of shared rooms, in particular the positioning of the washbasin and door, cannot guarantee privacy. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 20 As detailed in part in the last two inspection reports ongoing concern remains regarding shared rooms and these should be phased out as rooms become avialable. Leading from the main house is an indoor swimming pool, which can also be used by residents from other Counticare services. There was no formal agreement with residents to how they felt about other accessing their facilities. A variety of locking devises were observed to be in use for doors and cupboards. Residents have access to a cordless phone for use in private. Residents have to ask staff to get this for them as in office areas of the home and not free access. There is a wet shower room and bathroom on the ground floor, a standard bathroom on the first floor/are being redecorated and tiled. The inspectors were concerned at the hot water piping that was not boxed in and newly installed heated towel rails (one of which was very rusty.). The inspectors assessed the double sized Jacuzzi bathroom on the first floor unfit for use due to the poor drainage problems and high risk of infection control (particularly wit one service users infectious skin condition at present). The use of communal non-slip mats is not conducive to good infection control management. Not all bathrooms and toilets had paper towel or toilet roll holders in place due to the redecoration. It is strongly recommended that Infection control nurse advice and audit is requested to address these issues and develop clear protocols to follow. The hot piping too was exposed here as well as the radiator being badly rusted and a hazard There are separate toilets for swimming pool and staff use and one close to the communal areas. The lounge is large and leads to the lower lounge and conservatory. Settees and easy chairs are provided. Discussion took place stating all curtains were being removed and blinds fitted. The inspectors’ question what consideration had been given to the effect this will have on the resident who hides in the curtains. Work has commenced to provide facilities for residents with additional needs, but provision still does not meet the stated aims of the service. The fire risk assessment has been sent to the Fire Safety Officer as recommended at the last inspection, with a positive response letter seen. It was strongly recommended individual risk assessments were completed regarding fire safety, and strategies to allow in the event of a fire to meet their needs, behaviourally, physically and understanding of fire safety. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 21 Laundry facilities are compact and do not allow for sufficient clean and dirty storage. There is no room for ironing clothing and linen in this area to meet good infection control management. Directions on the washing machines stated specific washes were to be used of 60 degrees and less. On reading care plans a risk assessment due to an infectious skin condition clearly states all items must be washed at 90 degree. Giving staff conflicting guidance. The main area of safety concern seen today was the grounds and following the new admission the safe use of the grounds. This was discussed in detail with the acting manager and area manager who stated that quotes have been obtained for enclosed fencing but the company had not agreed completion. This is a priority and needs addressing as a matter of urgency. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 The number of staff provided does not meet residents’ needs. There is a keen and committed staff team, who are willing to develop their skills, to support residents. EVIDENCE: Staff morale had improved since the last inspection; staff openly talked with the inspectors, and expressed allegiance to the company and acting managers. Some staff are experiencing conflict with each other and this is being managed through complaint and grievance procedures. Staff confirmed regular supervision was taking place with team leaders. Records were not evidenced on this occasion. Rosters seen showed reduce use of agency and bank staff. Staff shifts have also been reduced offering shorter shifts rather than a long day. New staff have been appointed offering a more stable and consistent staff team. On direct observation today there were not adequate staffing numbers to meet the needs of the ten residents. A new admission was taking a very high proportion of the staff time to the detriment of others. New staff shared detailed recruitment processes, including interview, reference and CRB checks, detailed induction process. The organisation is working to Skills Sector induction format. Files seen were supportive of this. Minor omissions were identified and discussed with the acting manager to address. All staff is issued with an ID badge. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 23 Staff expressed satisfaction at the training offered by the organisation, feeling this was adequate to their needs. A training matrix has been introduced as an evolving document. Of the 16 care staff one has NVQ3 in care, and two are working towards NVQ2. The home is currently unlikely to meet the standard for 50 of staff to hold NVQ level 2 in care training by the end of 2005. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 The home has not had strong management to enable the service to develop and promote good care/ recording practice this potentially could put residents and staff at risk. EVIDENCE: The acting manager has resigned and is leaving in a week’s time. A new deputy manager has been appointed. The area manager stated they would be working from the home whilst recruitment takes place for a new manager. The commission remains concerned at the ongoing lack of effective management structure offering consistent and good leadership to staff and residents. A company business plan with detail specific to Parkwood remains in place. Regulation 26 visits are taking place and quality assurance surveys are planned to be undertaken after Christmas. Policies continue to evolve. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 25 There is a large lawned area to the front of the property, partly secured by strong post and rail fencing. The steeply sloping area bordering the main road is not similarly secured and is of major concern to the commission from evidence today and recent admission. As stated earlier action must be taken to reduce the risks to the resident and staff. Records evidenced fire drills taking place, the acting manager and area manager were aware all staff must take part in a fire drill at least six monthly and night staff 3 monthly a year. Due to the nature of the service and resident individual behavioural needs, individual risk assessments should be undertaken regarding fire safety and evacuation. Action required by the EHO has not been implemented in the kitchen and must be addressed with immediate effect by management. Staff using the swimming pool have not undertaken basic lifesaving skills/competency assessments. Many staff stated they do not like to go swimming and only staff who feel they are confident swimmers undertake this activity. The acting manager was not aware if the home insurance covered this. There is a current employers liability certificate on display. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 26 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 2 3 X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 1 1 2 2 2 2 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 2 1 1 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Parkwood House Score 3 2 1 X Standard No 37 38 39 40 41 42 43 Score 1 1 2 X X 1 X DS0000023988.V252193.R01.S.doc Version 5.0 Page 27 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 YA3 Regulatio n 14(1) Requirement The registered person shall not provide accommodation to a service user at the care home unless following assessment the home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. In that the latest admission raises concern over staffing numbers and homes environment to meet their specifc needs safely. This was a requirement from the inspections of 7th June 2005, 25 March 2003, 15 May 2003, 29 December 2004 ,21 February 2005 and 7th June 2005 Action plan to be submitted to the commission by timescale date. 23 (1) (2) The registered person must ensure that the physical design and layout of the premises to be used as the care home meet the needs of the service users. This will include that where persons who are wheelchair users are Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 28 Timescale for action 31/12/05 2 YA16YA18 YA24YA29 31/12/05 accommodated, there must be level or ramped access to those areas which are used or provided for use by service users in the home and suitable adaptations, aids and facilities to meet the needs of service users with disabilities. This will also include the phasing out of shared rooms, ensuring that service users in shared rooms have evidence that they have made a positive unbiased choice to share, that a shared room is suitable for the person being accommodated there and that a suitable single room has been offered. This was a requirement from the inspections of, 25 March 2003, 15 May 2003, 29 December 2004,21 February 2005 and 7th June 2005. Action plan to be submitted to the commission by timescale date. The registered person shall make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines receive to the care home by: Putting blinds up at all windows to the storage area and to be pulled when this is not manned by staff. All bottles/tubes of creams/lotions should be dated on opening and disposed of within in directed timescales. Internal and external medication should be stored separately. On accepting medication to the home all MAR sheet direction should correlate to those on the label. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 29 3 20 13(2) 20/12/05 Procedures should be in place where a label is not longer readable this is replaced. Clear guidelines of administration should be written for individual PRN medication to include triggers ad indicators to follow ensuring consistent administration by staff. Compliance must be achieved by the timescale date The registered person shall ensure that any activities in which residents participate are so far as reasonably practicable free from avoidable risks; and unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. In that the jacuzzi bath is not fit for purpose and should cease use due to poor drainage and poor infection control management until repaired or replaced. Compliance must be achieved by the timescale date There must be staff on duty in sufficient numbers who have the skills and knowledge to carry out the work they are to perform, this will include: Staff on duty in sufficient number to meet the needs of the individuals. Action plan to be submitted to the commission by timescale date The registered person shall appoint an individual to maanger the care home where there is no manager in repsect if the care home. The registered personshall forthwith Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 30 4 YA27YA30 13 (4) 31/12/05 5 YA32YA33 18 (1) 31/12/05 6 YA37 8 31/12/05 give notice to the commission the name of the person so appointed and date to which is will take effect. Application to register with the commission must be made at this time. Action plan to be submitted to the commission by timescale date All records relating to staff, including disciplinary records, must be available for inspection in the home. Records pertaining to current investigation of complaint were not avaialble at the home. Compliance must be achieved by the timescale date The registered person shall ensure that any activities in which residents participate are so far as reasonably practicable free from avoidable risks; and unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. In that, the risk to both staff and residents of physical abuse resulting from the behaviour of a individual must be reduced. The risk of self-harm for one resident must be reduced. In that, all radiators must be guarded or low surface temperature. Rusting radiators and towel rails are replaced. In that all hot piping in bathrooms are boxed in. In that EHO recommendations are implemented with immediate effect. Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 31 7 YA41 17 (2) Schedule 4 31/12/05 8 YA42 13 (4) 31/12/05 In that a review of the current risk assessment of the grounds must be carried out which identifies any areas of risk particularly pertaining to the new admission. Action must be taken to reduce or remove the risk with timescales for such action to be completed. Compliance must be achieved by the timescale date 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 YA1 Good Practice Recommendations It was recommended that both the Residents’ Guide reviewed to a format that is presented that is easily understood by the current residents. Such as combining photographs, object referencing rather than just the written word and widget system. It is recommended that service users be supported by family, friends and/or advocate (care manager) as appropriate when drawing up the contract with the home. Where the service user is unable to understand the contract, this is explained and signed on their behalf by family, friends and/or advocate (care manager) as appropriate It is strongly recommended that the care plan establish individualised procedures for service users likely to be aggressive or cause harm or self-harm, focusing on positive behaviour, ability and willingness through current dept of health guidance and legislation It is recommended that all entries made to the care plan are clearly dated and signed by all involved.Staff sign strategies and guidance in care plans of their understanding and commitment to follow as detailed. It was recommended that residents’ daily notes should be written in more detail of the care and support given It is recommended that staff and management DS0000023988.V252193.R01.S.doc Version 5.0 Page 32 2 YA5 3 YA6 4 YA6 5 6 YA6 YA7 Parkwood House 7 YA7 8 9 10 11 12 13 YA8 YA9 YA13 YA14 YA14 YA16 14 YA18 15 16 18 19 YA20 YA20 YA22 YA23 20 YA24 21 YA24YA38 demonstrate how individual choices have been made and record instances when decisions are made by others and why. It is strongly recommended that where limitations on facilities, choice or human rights to prevent self harm or self neglect or abuse or harm to others are made only in the persons best interest, consistent with the purpose of the service and the homes duties and responsibilities under the law. It is recommended that work to involve residents in the day to day running of the home should continue. It is recommended that risk assessments in care plans evolve further in content and strategies to reduce the risk in everyday activities and lifechoices. It is strongly recommended that transportation used is unlabelled or discreetly labelled on condition of a gift It is strongly recommended that swimming activities arranged by the home are run by trained staff with appropriate lifesaving skills. It is recommended residents are encouraged and supported to pursue their own interests and hobbies. It is recommended that the daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual care plan and contract. It is strongly recommended that psychiatric/psychologist and learning disability nursing/behavioural care is accessed and supervised as specified in individual care plans, monitored, recorded and regularly reviewed. It is strongly recommended internal auditing and monitoring of medication practice /storage is developed. It is strongly recommended that staff are regularly monitored and assessed as competent in the safe handling and administration of medication It is recommended that an internal tracking and monitoring sheet be used for the complaint records. It is strongly recommended that were physical and verbal aggression by a resident occur this is understood and dealt with appropriately with multi professional assessment, guidelines and strategies recorded within individual care plans. It is strongly reocommended consideration to replacing curtains in the main lounge with blinds is carefully assessed and consulted with residents/professionals especially the possible distress and behavioural impact this may cause to a specific resident. It is strongty recommended that a fire risk assessment for DS0000023988.V252193.R01.S.doc Version 5.0 Page 33 Parkwood House 22 23 YA25 YA30 those risks presented by residents who by choice or otherwise may not be compliant to the evacuation process. This recommendation is repeated from the inspection of 21 February 2005 and 7th June 2005. It is strongly recommended consideration to address compromised privacy and dignity to the resident whose bedroom can be looked into from internal corridor window. It is strongly recommended that contact be made with kent and Medway Health Protection Nurse Specialist for a full audit of infection control maangement in the home and recommended advice pertaining to bathrooms and laundry areas. Guidelines for use of washing machine do not contradict careplan and risk assessment strategies. There is adequate space to store and work safely with clean and dirty laundry. It is recommended that work should continue to ensure that a minimum of 50 of staff have achieved NVQ level 2 by 2005. This recommendation is repeated from the inspection of 25 March 2003, 15 May 2003, 23 October 2003, 29 December 2004, 21 February 2005 and 7th June 2005 It is strongly recommended that staff working in learning disability use LDAF accredited training to provide underpinning knowledge for progress towards NVQ It is strongly recommended that methods for formal feedback and quality assurance survey to be collected from staff and service users and others is undertaken and a summary submitted to the commission A range of policies should be available, shared and understood by staff, signed and dated by the manager and appropriate for the service This recommendation is repeated from the inspection of 21 February 2005 and 7th June 2005 in respect of being routinely signed and dated. To evidence the verbal statement that all servicing of supplies and equipment have been carried out a safe current gas supply certificate should be on file in the home. Dates were evidenced for gas engineer to visit the following week. Certification was therefore still unavailable to assess. It is recommended that a formal auditing and tracking system be devised for the accident / incident records. DS0000023988.V252193.R01.S.doc Version 5.0 Page 34 24 YA32 25 26 YA35 YA38YA39 27 YA40 28 YA42 29 YA42 Parkwood House Parkwood House DS0000023988.V252193.R01.S.doc Version 5.0 Page 35 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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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