Inspection on 10/12/07 for Parton House

This inspection was carried out on 10th December 2007.

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

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

Other inspections for this house

Parton House 27/10/08

Parton House 20/11/06

Parton House 05/12/05

Parton House 12/07/05

Parton House 05/01/05

Parton House 03/08/04

Parton House 08/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Parton House Parton Road Churchdown Gloucester Glos GL3 2JE Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 10th & 12th December 2007 08:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parton House Address Parton Road Churchdown Gloucester Glos GL3 2JE 01452 856779 F/P 01452 856779 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) CTCH Ltd Mrs Margaret Littler Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th November 2006 Brief Description of the Service: Parton House is registered to provide personal care for 36 older people. The home is situated in a semi-rural location in the village of Churchdown, between Cheltenham and Gloucester. It is owned and managed by CTCH Ltd. The home is an older style property, which has been adapted and extended for its current purpose, and is set in large grounds. Residents bedrooms are situated on two floors, which are accessible via shaft lift or staircase. All bedrooms have en-suite facilities, and there are separate assisted bathing facilities available. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Parton House range from £451.00 to £586.00 per week, depending on the room available or chosen, and the home is able to accommodate residents in certain rooms at the Local Authority contract rate of funding. Hairdressing, chiropody, newspapers and private telephones are charged at individual extra costs. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection over two days in December 2007. Care records were inspected, with the care of four residents being closely looked at in particular. The way in which staff addressed and worked with many of the residents was observed. The management of residents’ medications was inspected. A number of residents and visitors were spoken to directly in order to gauge their views and experiences of the services and care provided at Parton House. Some of the staff were interviewed. Survey forms were also issued to a large number of residents, visitors and staff to complete and return to CSCI if they wished; a small number of responses were received, and some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. What the service does well: Parton House provides a very pleasantly appointed care home for residents. It is clean, well maintained and safe. The newer extended part of the home has been purpose built, and provides accommodation and facilities for residents at a good standard. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 6 Residents confirmed their satisfaction with the way they are looked after and cared for here, and spoke positively about the staff group in general. This inspection found evidence of appropriate sourcing of medical reviews and healthcare, and there were many examples seen of residents receiving good care and support. The home generally had a calm and organised atmosphere throughout this inspection, and positive relationships were witnessed between residents and staff. Visitors are welcomed into the life of the home, and also spoke positively about the way in which they viewed and experienced the home and the care their relative received. Wherever possible residents’ ability to enjoy high levels of independence and freedom of choice are fully respected by the staff; many maintain strong links within the local communities, and are able to maintain a social side of their lives. Residents are free to pursue their chosen ways of life. The home has policies and procedures in place for the protection of the vulnerable residents, and staff receive appropriate instruction and training in this area. Staff disciplinary procedures are followed whenever necessary. The competence of the staff group is developed through a structured induction-training programme, and through ongoing training in topics relevant to the needs of the residents. There is also a good focus on the National Vocation Training programme for care staff, with progress being made in this area. What has improved since the last inspection? Staffing has been increased during all daytime hours from three to four as required; any unavoidable lapses in this arrangement are notified to CSCI. The remaining sitting room under refurbishment has now been completed, and provides very comfortable communal room for the residents. The home manager has undergone training in the recently implemented Mental Capacity Act, and there are plans to cascade this training to all other staff as soon as possible. A regular servicing and maintenance contract has been put in place for all pieces of load bearing equipment, ensuring an improved level of safety for the residents who use them. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In the majority of cases people living here can be assured that the home will be able to meet their needs on the basis of a pre-admission assessment, however an incomplete assessment recording has compromised this for at least one person. EVIDENCE: Assessment forms belonging to two residents were seen, with each having been completed in full prior to their admission to the home being agreed; each process had identified their care needs prior to admission to the home. Assessments had been carried out at locations convenient to the prospective resident, and were supported by information provided by other health and social care professionals previously involved in the care of the individual. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 10 In the case of a third resident, now no longer in the home, some significant mental health issues had arisen following admission that had not been accurately identified to the home by other health care professionals, and which had not become fully evident during the assessment process. The placement of this person had not been successful ultimately, with staff unable to meet the mental health needs of the individual that had manifested following admission. The pre-admission assessment form does not contain a comprehensive section to assess and complete regarding a person’s mental health needs, and therefore in this case recording to support any decisions taken was not sufficiently comprehensive. It was stated that prospective residents receive written confirmation of their placement in the home, however it has not been the home’s practice to maintain copies of correspondence, as is required. Parton House does not provide intermediate care. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home have their health and care needs met in a manner that is mindful of their privacy, although omissions in documented care planning and medication management are posing a degree of risk in this regard. EVIDENCE: Each resident has their own plan of care that has essentially been developed on the basis of an assessment of their health and care needs. Most aspects are regularly reviewed, but some gaps and omissions in this regard were identified, with infrequent reviews being recorded. Three were selected as part of a case tracking exercise for closer scrutiny, as were two others during the inspection of their medication arrangements. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 12 A general assessment of needs was recorded in each case, as was a risk assessment in relation to pressure sore vulnerability and manual handling. Appropriate support equipment was provided where needed, however in one case, despite a high risk of developing pressure sores having been identified, no referral had taken place to the community nurse, with staff deciding that support equipment was not needed in this case as the pressure areas were intact and healthy; there was no recorded rationale to support this decision however. A referral to the continence specialist had not yet taken place in this case either, despite the resident experiencing a problem on occasions, and this was currently being monitored with a view to this taking place in the future. This person was also at risk of falling, although the recorded falls and manual handling risk assessment did not accurately reflect the degree of risk this person was actually at. The falls clinic had undertaken a review and assessment in this case however. Nutritional risk assessments were recorded in some cases, and weights were being monitored; the dietician had been consulted in one case. In one case the risk assessment had not incorporated all of the factors that placed the person nutritionally at risk, despite prompts being on the form for staff to do so. In another case, despite the assessment directing staff to weigh the person each month, this had not been happening as regularly as it should. In another case the person had a history of falls; there was no falls risk assessment in place, although care planning in relation to mobility did incorporate the risk the person was at to a degree. This person was also at risk in terms of general safety due to wandering behaviour, and had in fact walked out of the building on a previous occasion. Although care plans directed staff towards regular monitoring, there was no actual record or chart of monitoring arrangements and their frequency maintained by staff. The psychiatric team had been involved in the care of this person, although their interventions were not actually included in the associated plan of care. Residents themselves were very happy with the care they received in the home. Many said that staff were very caring and kind. One person commented that they ‘always get prompt attention to their call bell’, whilst another said that ‘staff were always there for them day or night’. Visitors who responded to survey, or were spoken to directly, were also very complimentary about the home, and were happy with the care their relative was receiving. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 13 Residents are able to manage their own medications if they wish and are able, and this is done on the basis of a risk assessment protocol; arrangements in one such case were seen directly. In the main medications were safely stored, although the box for containing medications requiring refrigeration was broken, with liquids and external preparations dated on opening to ensure they were not used beyond their expiry date. Despite this, a pot of prescribed cream was seen, which had gone well beyond its expiry date, with staff taking no action to dispose of it as they should have done by the due date of three months from the actual recorded date of opening. It was noted that the refrigerator temperatures were recorded as being very slightly above the required temperature on an isolated number of occasions. Tablets were mostly dispensed in a monitored dosage system, and random audits were conducted on three boxed items. There were slight discrepancies in two cases, which the manager is required to investigate further with the staff responsible for medication management. The medication administration charts were printed clearly by the supplying pharmacist, and any handwritten entries were signed and countersigned in the home. Variable dosages were identified. The use of external and ‘when needed’ medications were linked to plans of care in a number of cases. In one case, although the prescribed cream was apparently being administered, there was no actual record of it on the medication administration chart, as staff had not been signing. Storage and recording in relation to scheduled drugs was clear and safe. Staff were observed being particularly attentive and kind towards residents throughout this inspection. Care was delivered in the privacy of residents’ own bedrooms or bathrooms, and some residents confirmed that staff were most respectful to them. Staff were seen knocking on residents’ doors before entering. At least two residents said that their level of independence was fully respected by staff, and one family commented that staff always maintained their relative’s dignity. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home have opportunities to remain as socially active as they are able, with respect shown towards personal choice, however certain catering practices are adversely affecting the quality of the meals for some. EVIDENCE: Parton House produces a monthly social activity programme for residents, a copy of which is provided to all and is displayed around the home. Residents have been consulted regarding what they might like to see on this programme, and can participate in it in accordance with their choice and wishes. The current programme contained a range of activities for people, and also featured seasonal activities and religious events. There was evidence of some craftwork around the home that residents had produced, and a large number of residents were participating in a music entertainment during this inspection. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 15 Although one person said that they felt this was an area where the home could make a slight improvement in terms of providing more outings, most people spoke positively about the social opportunities made available to them in the home. One commented that outings were ‘particularly well organised, and that other activities were especially good’. At least two residents were maintaining particularly active social lives outside of the home, and enjoyed very good social links within the local community. Visitors were observed coming in an out of the home freely, and those responding to surveys or spoken to directly said that they always felt most welcome here, with some commenting that they were kept very well informed. One visitor said that staff made them feel like ‘one of the family’, whilst another said the home was ‘particularly supportive to them as well’. Residents were moving around the home in accordance with their wishes, and some had evidently formed friendships and were visiting each other in their rooms. There were some who enjoyed a particularly high level of independence and autonomy. Residents confirmed that their choices were respected, with one in particular saying that ‘staff respected and made generous allowances for their idiosyncrasies’; another said that ‘staff make great efforts to accommodate people’s choices’. Individual choice was also reflected at meal times, with residents selecting their meal from a menu of at least two different meal options, although other alternatives could be requested if wanted. Residents confirmed that they had a good degree of choice with meals, with one saying ‘we can always have what we want’. The service of lunch was slightly staggered, with staff continuing to go in and out through a swing door, delivering two meals at a time to the residents assembled in the dining room; this was in spite of it being pointed out at a previous inspection that this had the effect of a slightly chaotic and disruptive mealtime for residents. Some residents had finished their main meal before some had even received theirs. Although the meals ultimately appeared wholesome, it was noted that the cook was cooking fresh and frozen vegetables two hours in advance of the mealtime. The vegetables were boiled for forty-five minutes, and then kept warm in a heated trolley until serving. This practice of prolonged cooking times would greatly reduce the nutritional content of the food, and would make it less palatable for the residents. This was borne out by at least three residents, who without prompting, said that the vegetables were ‘always very soggy’, or ‘were tasteless and overcooked’. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 16 During interview the cook was not aware of some of the special dietary requirements of some of the residents, and was not conversant in any of the needs of those who were nutritionally at risk. The kitchen was clean and orderly, and there was a well-stocked food cupboard. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home are able to express their concerns, though not all can be totally reassured by the home’s complaints procedure; they can however, be reassured regarding the policies protecting their rights and the prevention of abuse. EVIDENCE: The home has a clearly written procedure for addressing complaints. This is made accessible to people in their information brochure, and is also displayed on a notice board. The home maintains a record of complaints and concerns received. There have been three complaints requiring an investigation this year, some of which were robustly addressed by the provider whilst overseen by the Commission for Social Care Inspection (CSCI), and one of which was investigated by CSCI directly. The latter found that some changes were necessary regarding the use of the laundry overnight, as it was disturbing two residents. Further to this inspection it is evident that this situation has still not been resolved satisfactorily, and requires further consideration. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 18 Some of the residents themselves confirmed that they had confidence in the home to address their concerns, with some saying that ‘staff will do anything they can to help’. Another said that the manager and staff had always acted quickly if they had raised anything. A visitor said that the manager and deputy were ‘always available for a chat, and did their best to help with concerns’. Conversely, one particular complainant remained unhappy with the outcome of their complaint, which had focussed on their dissatisfaction with the care their relative received whilst staying temporarily in the home. Two staff members also indicated on their survey forms that in their experience concerns were not always listened to and taken seriously. The home has clear policies and procedures regarding the protection of vulnerable adults, that confirm that their philosophy is to uphold people’s rights, protect their wellbeing and not tolerate any kind of abusive practice. Staff spoken to directly showed that they were aware of these procedures, including the Whistleblowing procedure should they have concerns. Staff have received safeguarding vulnerable adults training. In response to working practices being unacceptable from some isolated staff members, the appropriate disciplinary procedures have been implemented in order to protect residents. The manager and deputy manager have undergone training in The Mental Capacity Act, and now plan to disseminate this training to all staff through a specific learning package in the near future. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home are provided with comfortable and pleasant accommodation, which is suitable and safe to meet their needs, although the home’s failure to fully meet a requirement in relation to the use of the laundry room overnight has prevented quality in this outcome area being good for all residents. EVIDENCE: Parton House is a well maintained home. The newer part of the home is of a particularly high standard in terms of facilities and decoration, and each of the communal lounges provides a pleasant, well-appointed room for the residents’ use and comfort. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 20 The home intends to make further improvements, and has plans to provide a new bath hoist, and to enhance the garden, with extra seating and improved paving. There are also plans to develop a sensory garden for the residents. The home now provides a non-smoking environment, a statement about which should now be included in the home’s information brochure. A maintenance person is employed within the group to which this care home belongs, who divides his time between the homes as needed. Two residents, a visitor and a member of staff indicated that it sometimes took too long a time to get a response from the maintenance person when things were requested by the home. The home was clean and odour free throughout this inspection, with two housekeepers on duty. Some residents and visitors commented on how clean and fresh the home always was. The laundry room is well equipped, with at least one washing machine designed to carry out infection control procedures in relation to washing foul or infected items. Only a washing load that requires an infection control cycle is laundered during the daytime hours, as there is no designated laundry worker, and care staff are only provided at minimum numbers to meet the needs of the residents. Rather than appoint someone to the laundry, it has been the home’s decision that the bulk of laundry be done overnight. Earlier this year, following a complaint about the noise from the laundry room keeping two residents living above the laundry room awake, CSCI required the home to take whatever actions it deemed necessary to resolve this. Adjustments were made to the laundry room door to make it quieter, but at this visit it was evident that these same two residents could still hear the ‘drumming’ sounds of the machinery and the occasional banging noise during the night. It remains for the home to re-visit this issue and further consider ways to resolve it for the residents concerned. The home does not have a contract for the collection of clinical waste, and only has incontinence waste bags that are collected by the local council. Further to advice from CSCI the home has made contact with the council to ensure that this arrangement is still acceptable, and they are reported to have given no indication that it is not. However, the home must risk assess the clinical waste it produces, as any infected waste would definitely require an alternative method of disposal and collection. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in this home have their needs met through a competent team of staff, however the standard of vetting and recruitment practices for new staff has not been carried out rigorously, and has left residents at risk. EVIDENCE: Four care staff provide care and support to the 36 residents during all daytime hours, with two overnight. Since CSCI has required that the home increase its staffing from three up to four, the manager has tried to consolidate a regular and cohesive team through ongoing recruitment. However, this has, and still is, posing some challenges, and the home still uses agency staff quite regularly. The residents themselves have expressed some concern about this, clearly preferring their own regular team of staff. A degree of consistency has been achieved in terms of the agency staff used however, which is of some reassurance to residents. Residents and their relatives were very complimentary about the staff in general, saying they were ‘cheerful and friendly’ and ‘kind’. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 22 Staff were observed as they carried out certain tasks, and interactions with residents were seen as very positive and sensitive. Staff were meeting residents’ needs promptly, and the home had a calm and organised atmosphere. Two housekeeping staff and two catering staff supported the care team, and the manager was working in a supernumerary capacity. In addition to this, the deputy manager and one of the senior care staff have some supernumerary hours as well. There were conflicting comments from some of the staff about communication, cohesiveness and support within the team; some had a more positive view about this than one or two others. The home has made very good progress towards getting as many care staff as possible to qualify with a National Vocational Qualification (NVQ) level 2. There are currently ten carers already qualified, with another one just awaiting confirmation of her achievement, plus another two carers working towards the award at the present time. The random selection of three newer staff recruitment files showed that in the main the required pre-employment checks had been carried out, with the appropriate documentation on file. However, a serious omission was found in two cases, where procedures had not been fully adhered to in the absence of the receipt of a full CRB (Criminal Records Bureau) disclosure. A POVA First (Protection of Vulnerable Adults) check had not been done on the two workers concerned prior to them actually starting work, and this decision had placed residents at significant risk, and was in direct contravention with regulations and Department of Health guidance. The home has used a ‘Skills Scan’ when starting new workers, which has then determined the level of induction they have required. Experienced carers had received in-house induction training, whilst less experienced carers had undergone this, plus a more formal training in accordance with the National Common Induction Standards for Care Workers. New members of staff had worked in a supervised capacity for that period; staff confirmed that they had felt very well supported during their induction period, and had not worked alone. Training records demonstrated that all staff have mandatory and optional training opportunities which are relevant to their working roles and the skills they require; staff confirmed that they have good training opportunities here. They receive certificated evidence of the training they have undergone, and each is encouraged to develop and maintain their own professional portfolio. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 23 One resident commented that staff were ‘very good at their jobs’. All visitors who responded to surveys confirmed that staff were properly skilled for their work. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some shortfalls in the management practices of this home, which potentially compromise the safety and interests of the residents in certain areas. EVIDENCE: The manager of Parton House has been in post for five years. She has been registered with CSCI for her role, is qualified in Care to NVQ level 4, and has achieved the Registered Manager’s Award. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 25 It is of concern that the management decisions taken during recruitment of new staff have not been robust, and have been in contravention with regulations. Such decisions have posed a degree of risk to the residents living in the home. Certain other issues raised in relation to the management of this home are also being looked into at the time of this particular visit, and will be pursued separately to this inspection. Some of the staff said that the manager and deputy were approachable and supportive, as did some of the residents and visitors. Regular meetings have been held for residents and their families, however recorded minutes demonstrated that these were not particularly well attended. Residents’ views and ideas were sought and welcomed at these meetings, with suggestions evidently put into practice wherever possible. Apart from this there has been no other way of residents having a say in how their home is run or of giving their views as to the quality of the service they receive, as part of a more structured approach for the home to monitor the quality of its service. Furthermore, although the manager and deputy have undertaken a small range of internal quality audits in areas such as care planning, medications, accidents, complaints and the environment, not all of these have proven to be adequately robust, with shortfalls still identified in some at inspection. A number of residents have placed personal money with the home for safekeeping. Detailed records for each person, which include transaction details, running totals, and receipts are kept. Despite regular audits being carried out on these arrangements, CSCI found a discrepancy in one account, with a shortfall of nearly five pounds. By the second day of this visit, the shortfall had been located, having been replaced into the incorrect fund, and was reimbursed back into the correct account. Staff have received health and safety training, which included fire safety procedures involving possible situations and scenarios. Fire drills had not been carried out consistently, with only two performed this year, and which only involved the day staff. A revised fire safety risk assessment is still required for this home; the Group Care Manager is currently working on this, and has agreed to supply the completed and up to date assessment to CSCI. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 26 The fire alarm panel, smoke detectors and extinguishers have been checked and maintained, with weekly and monthly checks carried out on the fire alarm and emergency lights respectively. Records were provided to show that statutory maintenance/inspection of equipment and services is arranged in a timely fashion. Regular checks are conducted on the hot water in order to maintain safe temperatures for the residents, and the proprietor has previously confirmed that Legionella control measures are through the necessary storage and distribution temperatures. The home has first aid facilities, and all staff have received some first aid training. A discussion took place around risk assessing the most appropriate level of first aid training for the needs of the home, as staff have only received a basic level of instruction. The home generally provides a safe environment; however there has been an occasion earlier this year when a resident wandered out of the building during the night. This was undetected by staff at the exact time, as none of the external doors, including fire doors, are linked to any kind of alerting system. The manager confirmed that she had raised this concern with the maintenance team, but had been advised that this was not a possible option here. Advice was given in relation to monitoring and recording arrangements of those residents who may be vulnerable in this regard. Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 28 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 2 Standard OP3 OP7 Regulation 17(1a) Schedule 3(4) 15(2b.c) Requirement Copies of all correspondence relating to any resident must be kept in the home. Staff in the home must ensure that residents’ care plans and risk assessments are regularly reviewed and updated, so as to be accurate and relevant to the needs of the residents. A full risk assessment in relation to falls must be carried out and recorded in residents’ care plans where this is relevant. • Staff must ensure that prescribed medications, specifically external preparations on this occasion, are not used beyond their expiry date, and are disposed of when they reach that date • The lockable box used for holding prescribed medication items in the refrigerator must be repaired or replaced to improve the safety of the storage. Timescale for action 31/01/08 31/01/08 3 OP7 13(4c) 31/01/08 4 OP9 13(2) 31/01/08 Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 29 5 OP9 17(1a) Schedule 3(i) 16(2i) 6 OP15 7 OP15 12(1a) 8 OP26 12(3) Staff must ensure that they consistently sign for administering all prescribed medications, including external preparations. All food provided for residents must be prepared and cooked in such a way as to allow for a nutritious diet. This is specifically in relation to the way in which vegetables are cooked. The Cook must receive instruction and be fully informed regarding the specific dietary requirements of the residents, in order to ensure that the appropriate meals are provided where needed. The registered person must make proper provision for residents’ health and welfare, and so far as practicable ascertain and take into account their wishes and feelings. Specifically, the registered manager must take whatever action is necessary to ensure that no resident can be disturbed by noise from the laundry during the night. This requirement is repeated from the last inspection. 31/01/08 29/02/08 31/01/08 31/01/08 9 OP29 19 Schedule 2 10 OP33 24(1) When recruiting new staff the 31/01/08 registered manager must ensure a POVA First check is carried out and obtained before commencing their employment, in cases where a worker commences work pending receipt of a full CRB disclosure. The registered manager must 31/03/08 establish a system for evaluating, monitoring, and improving when necessary, the quality of services provided in the home. DS0000016532.V354326.R01.S.doc Version 5.2 Page 30 Parton House 11 OP35 17(2) Schedule 4 (9) 12 OP38 23(4.d.e) The registered manager must 29/02/08 ensure that written records in relation to the safe-keeping of residents’ personal money and valuables are thoroughly and comprehensively maintained so as to reflect accurately the amount held for each individual. The registered manager must 29/02/08 ensure that all staff, including night staff, receive fire safety training on a regular basis, which must include regular fire drills. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP7 Good Practice Recommendations The pre-admission assessment form should be revised so as to take account of any potential or real mental health needs a prospective resident may have. • Staff should record the rationale in care records to support decisions taken not to introduce pressure relief equipment in cases where a risk is apparent • Staff should maintain monitoring charts in cases where a risk of wandering behaviour is apparent. The manner in which meals are served should be reviewed and altered, so as to avoid unnecessary disruptions and delays in the dining room. On the basis of the concerns raised in relation to noise from the laundry room use at night affecting residents, a designated daytime laundry worker should be provided. The level of first aid provision should be risk assessed, to ensure that the level of training provided to staff is sufficient for the needs of the home. 3 4 5 OP15 OP16 OP38 Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Parton House DS0000016532.V354326.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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