Inspection on 08/06/06 for Parkwood House

This inspection was carried out on 8th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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 18/11/05

Parkwood House 07/06/05

Parkwood House 21/02/05

Parkwood House 29/12/04

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Thorndene

Insight - Eastchurch

Southfields

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Seabourne House

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Dovedale Court

Lyncol House

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 Maria Tucker Key Unannounced Inspection 8th June 2006 09:30 Parkwood House DS0000023988.V299648.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 Parkwood House DS0000023988.V299648.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. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 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 Post Vacant Care Home 13 Category(ies) of Learning disability (13), Physical disability (3) registration, with number of places Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Three service users who have a physical disability also have a learning disability A young person with a learning disability is accommodated whose date of birth is 28 June 1988. 18th November 2005 Date of last inspection Brief Description of the Service: Parkwood House is a home for younger adults with a learning or physical disability and is owned by Counticare. It is a detached property with extensive grounds, garden (incorporating a sensory garden) and car parking for several vehicles. Also on site adjacent to the main building is a separate small day care unit, which provides activities of a more educational nature. A further facility containing a range of soft furniture and aids for relaxation is also available for use by service users. The home is situated on the outskirts of Harrietsham village lying on the main Ashford to Maidstone road. Facilities such as shops etc are within walking distance. There is good access to bus services and a main line station is situated in the village itself. The fee ranges from £900 to £1500 per week. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first key inspection in the year running from April 1st 2006 to March 31st 2007. The visit lasted from 09.38am until 16.10pm. The home currently has ten service users with one vacancy. All rooms are currently used as single rooms with the exception of one double-shared room. The visit was spent talking directly with the acting manager, deputy and 2 care staff. Three service users were spoken with collectively; others were out on activities or did not actively engage with the inspector but were observed throughout the visit. A partial tour of the buildings and grounds was undertaken. Some judgements about the quality of life and choices were taken from direct conversation with service users and observations followed by discussions with care staff and evidencing records held at the home. Additional information was obtained through the receipt of the pre inspection questionnaire and comment cards received. Comments from the comment cards included: • “If I don’t want to get on the bus I may refuse by walking away”. • “Activities I enjoy I will laugh and smile”. • “At the weekend if I want to have a lie in I often choose to do this. I much enjoy my lie ins in at the weekend”. • “Sometimes the personal hygiene of my (relative) does not seem to be of a high standard. I have had to comment on this many occasions”. • “My (relative) has been at Parkwood for(relative) and is very happy there. All staff are very warm and friendly towards(name) and I believe they do a smashing job”. • “I am confident in Parkwood house staff and feel they do an excellent job”. • “The situation at Parkwood House has improved significantly since there has been new management”. What the service does well: The home offers a range of activities and day service options for service users. Service users relatives and friends are made welcome and visits to families are supported by the home. Staff work well as a team in supporting service users with their care. Information and assessments from other professionals are sought and referrals for specific advice and health needs subsequently made. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The management of possible allegations of abuse must be managed in accordance to the adult / child protection procedures. The CSCI must receive Regulation 37 notifications within an acceptable time scale. As identified during the last inspection service users and staff would benefit from having a permanent manager. The areas in the home such as the bathroom with the Jacuzzi; downstairs toilet; laundry room need to be totally refurbished to be fit for purpose. The furniture in the service users private accommodation; lounge and dining room are old, not matching and in need of being replaced. The home’s financial procedures must be firmed up so that money received is recorded, monitored and managed appropriately. The PRN medication needs to be reviewed as does the policy and procedure for administering. The home would benefit from a general de-clutter of old tatty and unused/unwanted items. The care plans still require to be made specific in the details for staff to follow in the risk assessments and with specific guidance from professionals in the management of difficult and challenging behaviours. New staff employed without experience of working with this client group need their induction to be in line with LDAF. Specialist training for autism would be of benefit. The wooden (granddad) shed needs to be made safe and fit for purpose. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 7 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.V299648.R01.S.doc Version 5.2 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.V299648.R01.S.doc Version 5.2 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, 5 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users can expect to have a multi agency assessment prior to moving into the home. The formats for assisting service users and their representatives to base a decision of moving into the home need amending. EVIDENCE: An updated version of the statement of purpose was given to the inspector during the visit. This needs to have all items as listed in Schedule 1, in that items 1; 2; 3; 4 and 16 a written record to include all rooms and their sizes including those outside of the main house. The service users guide was seen to be in widget format. Contracts were held in service users files they need to include the room number occupied and amended if there is a change of room, they need to be signed by the service user or representative. No new service users have been admitted since the last inspection. A service users file contained documentation including assessments from relevant health and social care professionals. During the last inspection it was noted that a recently admitted service user was exhibiting behaviours that led to a very high staffing ratio resulting in the possible determent of care to the other service users. During this visit evidence that these behaviours have subsided Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 10 with a settling in period and from observations made of staff interaction and support that this is no longer the situation. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 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 Quality on this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users do not have enough detail and information within their actual care planning formats to enable staff to follow consistently. Service users and their representatives are not sufficiently included in this process. EVIDENCE: The care plans did not evidence service users or representatives involvement. They did not contain specific detailed information for staff to follow. It is acknowledged that the files do have a vast amount of information contained in them however this needs to be transposed into simple approaches. Again there was inconsistent information in that a service user identified as requiring a special diet did not have this in their care plan. From discussions with staff and observations of behaviours and interactions staff were very familiar with individual service users, their likes and preferences and exhibited behaviours. There was evidence that this is in the process of being addressed through the updating of formats for care plans and in the reviewing of needs. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 12 The risk assessments were completed and still require further detail and expansion to give clear guidelines and strategies for staff to follow. A referral to the community learning disability team has been made to assist with this. Incidents of recorded difficult behaviours were recorded and had reduced in severity. A recent review held with social care professional was positive and constructive. The daily notes varied in detail, they did not provide a full picture of the care being received. The home acts as appointee for some of the service users. Money is held in separate accounts at head office and is requested for by the home when needed. It is very strongly recommended that it be discussed with representatives to enquire if external appointees can be used and that a system for the auditing of how and what service users money is spent on be built into the reviewing process. That when agreements have been made for contributions towards the mini bus this is formalised and transparent agreed and signed as such and reviewed. Service users minutes of meeting were seen. It was discussed that this should include menu planning. Copies of questionnaires filled out by representatives were seen. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 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 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users have a range of opportunities and activities. There are restrictions to personal development due to the layout of the home. EVIDENCE: During the inspection service users were being actively supported to attend day services and go out of the home on walks and in the community. There is an annex for activities and a sensory room that was in the process of being made ready for use. The swimming pool is used mainly in the evenings. The deputy manager was enquiring if life saving training skills would be needed by all staff. The current thinking is that as it is not used by the general public this would not be necessary. In the interest of good practice the home are continuing to seek clarification. It is acknowledged that staff have first aid training and there are procedures in place for the safe use. There is a driver available as an extra care staff to support with activities during the day. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 14 Evidence from document reading that trips out to local pubs and places of interest regularly takes place. Feedback cards received evidenced that family involvement continues and service users are supported as necessary. The laundry room does not lend itself for service users to be included in this activity. The food prepared and provided was of good quality and service users had lunch in various locations at different times. Good practice was noted with a staff member supporting a service user with their meal. It was identified during the last inspection that service users in wheel chairs do not have full access to all parts of the home due to steps and height restrictions of work surfaces. The acting manager stated that due to the design of the home a ramp into the round room would not be possible that the service users preference is to shuffle around and this they do that wheel chairs are mainly used when outside. It is therefore recommended that a referral be made for these individuals to an occupational therapist so that their needs in the environment can be addressed. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 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 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are well supported with their medical and health needs. The PRN medication procedures needs to be firmed up and reviewed for safe practice. EVIDENCE: Observations and discussions with staff demonstrated a good understanding and insight into the individual preferences of service users. A key worker had a high level of understanding into the care and needs of the service user they were supporting. Service users do have routines and these are flexible and responsive as indicated by behaviour and opportunities taken up by service users. As mentioned earlier service users would benefit from the formal recording of these to enable consistency. There was evidence in the care plans that referrals for specialist advice and treatment is actively sought and followed through. Referrals are awaiting allocation. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 16 Good practice was noted in the telephoning recording made to a general practitioner in relation to mediation and from discussions with staff on their concerns from monitoring changes in medication. The PRN medication does need to be reviewed as service users are on a blanket prescription for what may be considered homely remedies. The acting manager was in the process of identifying the need for these and the circumstances when they may be used. This information will be presented and discussed with the general practitioner for clarification. Parkwood House DS0000023988.V299648.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality on this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The homes management of service users personal finances places service users at risk. EVIDENCE: No complaints have been made. Comments received in the comment cards indicated that complaints would be made. The complaints procedure has been translated into widget format. The records of complaints at the home were staffing issues; these should be managed in future by grievance procedures and issues relating to any service acted upon accordingly. It was discussed that it should be in relation to service users. The home has reviewed the policy on adult protection. Minutes of an adult protection alert that had been raised praised the good work of staff and highlighted a good outcome for service users. The CSCI was made aware of a possible incident of abuse in May 2006 that occurred in April 2006. The inspector telephoned the acting manager who stated the correct procedures had been followed and the social services social worker was satisfied. On speaking to the social worker the proper procedure had not been followed this incident was not raised as a child / adult protection or had the home management notified the CSCI in accordance with Regulation 37 notifications. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 18 The home’s management of money for service users being received into the home had not been adequately recorded or a system followed where it is checked as part of the handover. Staff must record all money coming into the home, keep a running accurate balance and record all transactions with proper accounting and management systems. As stated earlier it is recommended that the practice of the home acting as appointee for service users be reviewed for good practice measures. It was noted that a service users personal account had an ample amount of money and that the statements from head office details expenditures. Service users have some money kept for personal spending this amount tallied with their recorded balance. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 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 Quality on this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users independence and opportunities are restricted due to the layout and design of the home. EVIDENCE: Overall the home was found to be comfortable and tidy with some areas having been redecorated and refurbished. The Regulation 26 visit record from 21/04/06 listed some work that has been highlighted as needed and work that has been done listed. This includes radiators that have not already been covered to have these done; a refurbishment to the bathroom; new furniture on order for the lounge and dinning room that have been refurbished. The service users’ bedrooms viewed were individual with one service user’s room being specifically tailored to meet their individual need. It was noted that furniture in service users’ rooms did not always match and was old and tired. Some of the light fittings have been changed in private rooms, which provide extra lighting and a modern feel. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 20 As identified in the report from the inspection report access for wheelchair users to the garden areas and the small round lounge is via stairs. It was identified that a ramp would enable access. The acting manager stated that this had been looked into for the small room but the ramp would take up too much room and would not be possible. That the service users whom use a wheel chair do so mainly outside as inside the preference is to ‘shuffle’ around and be out of the chair. It is strongly recommended that an occupational therapist assessment for individual service users be conducted to ensure that service users are not restricted in choice or opportunity due to the limitations of the environment. The home has no lift so those with mobility problems are unable to access the upper floor. It was not discussed if the use of the main house as an entrance for other service users from other homes to access had been considered or resolved i.e. if another door could be used. The home currently only uses one double room and this was expressed as having been a personal choice to share from the current service users, this is a downstairs room and although an upstairs vacant room was bigger this is not an option due to physical limitations. However this would be reviewed should this change. The acting manager stated that the home have plans to upgrade the other two double rooms so that they have en suite facilities and are for single use. The acting manager confirmed that a fire officer from a private company was due to visit the home to undertake new fire risk assessments. There was no evidence that risk assessments had been undertaken for those service users who may not be compliant to the evacuation process. The Jacuzzi in the upstairs bathroom is no longer in use. The acting manager stated that there are plans to refurbish two double rooms to have en suite facilities, which would mean having internal work undertaken to the building. The downstairs toilet needs refurbishing and indicators that are suitable for the service uses fitted. The staff room in the main building does not have a safe lockable facility for staff to store their personal belongings. Staff stated they keep their things locked in their car and get them when required. The laundry room is very small and not suitable for service users to access with staff to learn independent living skills or to assist with the washing. The kitchen does not have surfaces that are low enough for wheel chair users to have access. It is recommended that the occupational therapist assessments include guidance and advice to overcome these difficulties. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 21 There was no evidence that the home have had any advice or guidance to ensure that each service user has any specialist equipment or that the home has had any adaptations i.e. grab rails fitted to accommodate the service users needs. The infection control nurse has visited the home and made some recommendations most of which have been completed. Outstanding is the replacing of sofas and the laundry room. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 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 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staffing arrangements are adequate to meet the needs of the service users. EVIDENCE: The home has specific staff for different tasks such as cooking, cleaning and care staff. The staffing rota was not complete in that it did not contain full names and designations of staff. The management structure consists of an acting manager, deputy and team leaders. There is a key worker system in operation and staff spoken with demonstrated a clear understanding into the roles and responsibilities concerned with this. The home continues to use agency staff to cover shifts. Where possible the same agency staff are used. Staff training has taken place for SCIP in March 2006; sexuality and learning disability May 06; fire training May 06; epilepsy and adult protection training. The pre inspection questionnaire lists planned training and training undertaken. Staff spoke of how the medication ASET training was interesting and how much they had learned and benefited from this. The home does not have 50 of care staff trained to NVQ level 2 or above. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 23 It was discussed that all staff need to have an annual appraisal to establish training needs. That permanent staff should have training booked so that mandatory training does not lapse. The induction training is not LDAF accredited. The staffing levels are 5 care staff an acting manager and deputy. During the inspection staff were observed to be in sufficient numbers to meet the needs of the service users. Good practice was seen with staff working together as a team in supporting a service user with challenging behaviour. Staff files inspected contained all items as required. Supervision for staff is undertaken. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 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, 39, 40, 42 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There are systems in place so that the conduct of the home and management are adequate to meet the stated purpose of the home and needs of the service users. EVIDENCE: There is an acting manager in place from a sister home. It was stated that this has been provisionally agreed to be for a 3-month period. Regulation 26 visits by the registered provider take place with reports forwarded to the CSCI. The Pre inspection questionnaire lists maintenance and associated records these were spot checked during the inspection. Policies and procedures are held in the home they were dated as having been reviewed and seen by staff. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 25 Service user / relative feedback is sought through surveys. These were seen to have been conducted although no formal feedback has as yet been produced. Service user meetings take place. The garden ‘granddad’ shed lock was broken, there contained many items some of which were combustible. The wood in some places needed attention. A copy of the gas certificate for 29th May 2006 was seen. The infection control nurse visited the home and assessed the home, as being amber at 89 the areas outstanding from this report are the laundry areas and the sofas that needed to be replaced. There is a list of service users in case of emergency as a ‘snatch file’. There were items stored in the house and outside areas that were no longer in use. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 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 Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 3 X 2 X Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 (1) (c) Requirement The registered person shall compile in relation to the care home a written statement of purpose, which shall consist of all items as listed in Schedule 1. The registered person shall make arrangements, by training staff or by other measures, to prevent service users from being placed at risk of abuse. In that safe procedures are in place for the management of service users finances. That child / adult protection alerts are raised when appropriate that Regulation 37 notifications are made. 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 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 Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 28 Timescale for action 20/07/06 2 YA23 13 (6) 20/07/06 3 YA29 23 (1) (2) 20/07/06 4 YA30 13 (3) 5 YA32 18 (1) 6 YA33 Schedule 4 (7) 7 YA37 8 adaptations, aids and facilities to meet the needs of service users with disabilities including those with challenging behaviours. Advice must be sought from an occupational therapist for those service users who are restricted so that other options can be explored and their independence and choice is not compromised. The registered person shall make suitable arrangements to prevent infection, and the spread of infection at the care home. In that the recommendations made by the infection control nurse in respect of the laundry area are followed. 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: In that 50 of care staff have attained the NVQ level 2 or above and all staff receive mandatory training. The home shall maintain a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked. In that full names; hours worked and designations be included in the roster. The registered person shall appoint an individual to manager the care home where there is no manager in respect if the care home. In that a permanent registered manager is in post. The registered person shall ensure that any activities in which residents participate are DS0000023988.V299648.R01.S.doc 20/07/06 20/07/06 20/07/06 20/07/06 8 YA42 13 (4) 20/07/06 Parkwood House Version 5.2 Page 29 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, all radiators must be guarded or low surface temperature. Rusting radiators and towel rails are replaced. The granddad shed be made secure and mended or made safe where broken. The home and grounds are de cluttered with combustible items stored properly. 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 be reviewed and amended to a format 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. The service users contracts need to include the room number. 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. It is recommended that the care plans be drawn up with DS0000023988.V299648.R01.S.doc Version 5.2 Page 30 2 YA5 3 YA6 4 YA6 Parkwood House 5 YA6 6 YA7 7 8 9 YA8 YA9 YA11 10 11 YA14 YA18 12 13 14 YA20 YA22 YA23 the involvement of relevant professionals and representatives. That they are dated and signed identifying the next review date. That they are consistent and accurate providing sufficient guidance for staff to follow. It was recommended that residents’ daily notes should be written in more detail of the care and support given. It is anticipated with the updating of care plans this will enable this to be developed. It is very strongly recommended that if possible external appointees be used. That a system for the auditing of how and what service users money is spent on be built into the reviewing process. That when agreements have been made for contributions towards the mini bus this is formalised and transparent agreed and signed as such and reviewed. It is recommended that work to involve residents in the day-to-day running of the home should continue and be developed. It is recommended that risk assessments in care plans evolve further in content and strategies to reduce the risk in everyday activities and life choices. It is recommended that a referral be made for those service users who use a wheel chair to an occupational therapist so that their needs in the environment can be addressed. It is recommended that clarification be made as to the swimming activities arranged by the home needing to be run by trained staff with appropriate lifesaving skills. It is 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. Referrals are awaiting allocation. It is strongly recommended that the PRN medication policy and practice be reviewed. 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 recommended that all furniture that is old and tatty be replaced. That a review be made of the need for plastic chairs in the dinning room to enquire if a more suitable appropriate alternative can be found. DS0000023988.V299648.R01.S.doc Version 5.2 Page 31 15 YA24 Parkwood House 16 YA24 17 YA25 18 YA26 19 YA27 20 YA28 21 22 23 YA28 YA35 YA39 It is strongly recommended that a fire risk assessment for 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 and 18th November 2005. This will also include the phasing out of shared rooms, ensuring that service users in shared rooms have evidenced that they have made a positive unbiased choice to share, that a shared room is suitable for the person being accommodated. The home has one shared room at present. It is strongly recommended that a review be made of each service users bedroom so that the care plans can clearly state the individual choice and reasons why some items listed are not in the rooms. That those rooms that have un matching odd items that are tatty old or worn be reviewed and replaced. It is strongly recommended that a review be made of the bathrooms to ensure that they are fit for purpose for the service users in that suitable taps are fitted; heights for wheel chair users are considered; appropriate indicators are fitted; the Jacuzzi that is not in use be replaced. It is strongly recommended that a review be made of the kitchen and laundry facilities to ensure service users are not restricted due to the physical limitations of the design and lay out of these areas. It is strongly recommended that staff be provided with lockable facilities in the staff room in the main house. 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 the formal feedback and quality assurance survey collected from service users and others is made available and a summary submitted to the commission. Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 32 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. Extracts may not be used or reproduced without the express permission of CSCI Parkwood House DS0000023988.V299648.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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