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Inspection on 20/11/06 for Parton House

Also see our care home review for Parton House for more information

This inspection was carried out on 20th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Parton House is generally a well managed home, and provides a clean, comfortable and well-maintained environment for the residents living there; the relatively new extension to the home provides a particularly good standard of accommodation. The home is welcoming for visitors and poses no restrictions in this regard. Residents are admitted on the basis of an assessment, so that they can be assured the home can meet their individual needs. Each person has their own plan of care to meet their personal and health needs, although very isolated gaps were seen in recording which now need more attention from staff. The home works constructively with other health care professionals in order that residents have good access to all health care services and treatments. Residents themselves were very complimentary about the home, the staff and the care they received at Parton House. Without exception, they confirmed that respect was shown towards their privacy, personal choices and preferences. There was very clear evidence that residents are enabled to maintain a good level of independence and freedom here, with good social contacts in the home and the local community maintained. Staff were seen as attentive, friendly and helpful. The food served was of a good standard, and residents said that they had plenty of choice, and that they enjoyed their meals very much. Residents and their families can be assured that the home has a robust approach to addressing any complaints or concerns, and that the standard of care, services and facilities is reviewed as part of a quality monitoring system. The home has policies and procedures for the protection of vulnerable residents, and staff have attended some adult protection training, although this is now due for updating. The home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Staff have good access to training opportunities, and are making good progress with the National Vocational Qualification (NVQ) training programme. Recruitment is carried out using rigorous employment procedures, with new staff appropriately supervised.

What has improved since the last inspection?

The home now provides two waking night staff, and has increased the amount of housekeeping hours on a daily basis. A new staff induction programme is being implemented, which will incorporate the new Common Induction Standards for care staff.

What the care home could do better:

In many regards there is a good system for the management of medications, but on this occasion isolated shortfalls were identified in areas pertaining to recording and to stock balances, which warrant further investigation by the manager. The way in which meals are served to residents should be reviewed, as the current method was seen as disruptive to the smooth running of the dining room, and not always timely. A small number of improvements are needed in the kitchen, which relate to catering records and storage of refrigerated foodstuffs. Although there is a good staff team at Parton House, who are well thought of by the residents, there are now considered to be insufficient numbers during the afternoons and evenings. Upon CSCI requiring it at the time of registering the additional thirteen places here, the CTCH Ltd proprietor agreed to increase staffing during all day time hours, but has so far failed to meet this agreement in full. In addition to this, care staff are distracted from the care of residents, as they continue to be involved in laundry duties, despite the proprietor agreeing that they would not. It has been recommended that a designated laundry assistant and evening catering assistant be employed. The health and safety of the residents is promoted, however there is one hoist that must be removed from use now, given that it has not been serviced and checked for safety for some considerable time. It has been recommended that lighting be provided to the long tree-lined driveway to the home, as this area is very dark for those using it after dusk.

CARE HOMES FOR OLDER PEOPLE Parton House Parton Road Churchdown Gloucester Glos GL3 2JE Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 20th November 2006 09:00 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.V310103.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.V310103.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.V310103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: Parton House is registered to provide personal care for 36 older people over the age of 65 years. 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. An additional extension to the property has recently been completed. This provides additional communal space and an additional 13 bedrooms, a hairdressing salon, an activities room, a new kitchen, additional assisted bathing facilities, and improved laundry and staff facilities. 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 £435.00 to £565.00 per week. Hairdressing, chiropody, newspapers and private telephones are charged at individual extra costs. Parton House DS0000016532.V310103.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 inspection over two days in November 2006. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of four residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and a visitor 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 number of residents, visitors and staff to complete and return to CSCI if they wished. 40 of resident and 20 of relative surveys were returned; none of the staff surveys were returned. Some of the survey 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. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home now provides two waking night staff, and has increased the amount of housekeeping hours on a daily basis. A new staff induction programme is being implemented, which will incorporate the new Common Induction Standards for care staff. Parton House DS0000016532.V310103.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. Parton House DS0000016532.V310103.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.V310103.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough pre-admission assessment process provides prospective residents with an assurance that their needs will be met. EVIDENCE: Copies of pre-admission assessments carried out on three prospective new residents confirmed that the assessment had been conducted and recorded in full before their admission to the home was agreed. Appropriate care assessments and health information from other health and social care professionals involved were also on file where applicable. Parton House does not provide intermediate care. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite isolated shortfalls in recording, the care planning system provides staff with the information they need to satisfactorily meet residents’ health and personal needs. The systems for the administration of medications are satisfactory in the main, and provide appropriate safeguards for residents when consistently applied. Residents are treated with courtesy and respect. EVIDENCE: All residents have a recorded plan of care that is based on a very detailed individual assessment of their health and personal needs. In most regards plans are regularly reviewed, although there were isolated gaps with this, which need closer attention. Three were chosen for closer scrutiny as part of the case tracking exercise. Care plans contained instructions for staff to follow when delivering both personal and health related care. Planning took into account residents’ personal preferences and choices and levels of independence. Daily records Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 11 were recorded sporadically, and there were examples of inappropriate language being used by care staff in very isolated instances. Most plans contained appropriate risk assessments, such as for risk of falls, pressure sore vulnerability and moving and handling, and there were associated care plans documented accordingly to address any risks identified. There was just one case where there was evidently a history of falls, with no documented risk assessment for this, despite a plan of care that took into account some of the mobility needs. For those with a risk of developing pressure sores, appropriate healthcare intervention and support equipment was in place, having been provided by the district nurse after assessment. There are records of regular weight monitoring and nutritional assessments, based on the Body Mass Index (BMI) for each resident. Care plans on this basis are in the main detailed and informative to address any areas of concern; they incorporate medical referrals and the introduction of additional nutritious snacks and/or supplements where necessary. There was just one exception to this, where a dietary care plan had not been written on the basis of a nutritional risk being identified. Records show that the residents are afforded regular medical reviews and consultations, and access to a range of health care services, either in the community or in the home. Residents surveyed confirmed they were very happy with the care and support they received, and with the dedicated way the staff cared for them. One person said that they liked having a key worker. Residents who were spoken to directly, without exception, indicated their complete satisfaction with the way in which staff looked after them, saying they were ‘caring and kind’, ‘nice and very patient’, and that Parton House was a ‘wonderful place to be’. One lady said that she always got excellent support when she was unwell. One visitor spoken to was also very complimentary about the home, and the way in which her relative was cared for here. Two of the relatives surveyed said they were not entirely happy with the care of their relative; they felt that the staff could be rushed. Residents are able to self-medicate if they wish and are able; evidence of this was seen in one particular case, with a documented risk assessment for the individual on this basis. This resident was very glad of the option to manage their own medication. There are clearly printed Medication Administration Records from the supplying pharmacist; a small number of hand written entries on charts had been signed by the author, but not in full, and there was no second signatory as a witness. In cases where a medication is prescribed on an ‘as required’ basis, there are clearly written protocols for their usage. There were examples of some items Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 12 being prescribed ‘as directed’; staff have handwritten clearer instructions for usage in the interim, as the manager addresses the inadequately printed usage instructions with the relevant doctors. The exact amount of variable dosages had not been recorded consistently when administered. Storage of medications is safe, with appropriately detailed records for receiving, disposal and management of all types of medication. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date. Random audits were carried out on two specific boxed medications, and a discrepancy was identified in each case. There seemed to be a small number of dosages in excess of what there should have been; it was thought that this could be due to staff ‘topping up’ boxes from an earlier supply. The manager resolved to meet with the relevant staff straight away, with a view to investigating these circumstances more closely, and to carry out random medication audits of her own in the future. Care was being delivered in the privacy of residents’ own bedrooms and bathrooms throughout this visit. Staff were observed whilst interacting with residents, and each was seen being thoroughly polite, respectful and considerate. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Respect is shown towards individuals’ chosen and preferred lifestyles, with residents able to maintain social contacts in the home, and with their families and friends. Dietary needs are well catered for, with a selection of good food available that meets residents’ tastes and choices. EVIDENCE: A programme of social events, showing particular dates of interest, is produced for each resident each month; this is also displayed in public areas. Organised social activities only happen approximately two or three times each week, and can include games, arts and crafts or film shows in the home’s own small cinema. Some residents pursue their own interests, with many choosing to spend their time quietly resting, or reading and watching television. One gentleman had installed his own digital television box, and enjoyed staying up late to watch what he liked in his room. A small number of residents were part way through a large jigsaw puzzle, which was laid out in one of the lounges; a magnifying glass was helpful to at least one of them for this pursuit. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 14 Some of the residents seemed to have forged good relationships and friendships, and enjoyed spending time together. One particular person remained extremely active in the local community, attending University of the Third Age music groups, using the local shops on her scooter, and playing the organ at local concerts. This person said that there was a lot on offer at the home, but that many chose not to join in, and that this was respected. Another person felt that there were not enough staff on duty during the afternoon to coordinate a group activity properly. One written survey response said that they often went out to pursue outside interests, which staff are very understanding and supportive of. They also continued to enjoy playing the piano and doing gardening. There is a monthly religious service, and ministers from two faiths regularly visit the home at present. Patron House has no restrictions on visitors, and relatives and friends are free to visit at any time of theirs or their relative’s choosing. The home provides tea-making facilities for visitors to help themselves when they come. Relative surveys indicated that they were made to feel welcome in the home. However, two felt that they were not consulted properly or kept adequately informed. A regular visitor spoken to directly during the visit was very positive about the home and the manager and staff, saying that she was always made to feel extremely welcome, and that she was always kept very well informed. This visitor also said that she had ‘complete faith in the home’, and finds everyone most approachable and supportive. Wherever possible, residents’ independence is respected, and there were a number of residents who continued to manage their own affairs. Some have power of attorney arrangements, and family support if needed. Advocacy and a variety of support group information is readily available in the home. Throughout this visit it was very evident that residents are enabled to enjoy a free and independent lifestyle, in accordance with personal choice, and within the bounds of their abilities. Many were observed going out, taking walks, and generally spending their time how and where they wished. Residents’ own bedrooms appeared personalised, with some of them in particular being filled with personal furniture and treasured personal items. Some of the residents spoke of the way in which staff respected their independence and choices, with one person saying that ‘it’s just like home; you can do what you like’. One person said that staff are very understanding and ‘give in to our little idiosyncrasies’. Another said that she enjoyed being independent, but was reassured in her confidence that help would be available if she needed it. One lady who had come into the home for a short stay had brought her pet budgerigar with her. The service of the lunchtime meal was observed. The spacious dining room was very attractively laid out for the meal, however service was somewhat staggered and disruptive, as care staff went in and out through the kitchen Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 15 door, bringing back one plate at a time. This meant that the door was constantly opening, shutting and banging, and many residents were waiting quite a long time for their meal; one resident did actually comment on this. The meal looked wholesome, nutritious and appetising, and residents confirmed that the meals were always very good, with just one exception, who said that there was room for improvement. Menus show that there is a choice of food available to residents at each meal, and some confirmed that they have a good degree of choice, with one person particularly mentioning that staff will accommodate personal tastes if there is nothing particularly suitable on the menu. The kitchen was seen during the morning, and appeared clean and orderly. However, previously prepared foodstuffs, apparently from the weekend, were stored in the refrigerator, and were uncovered and undated. Catering records were very superficial, with no record of high-risk food temperature monitoring, refrigerator or deep-freeze temperature monitoring. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory system for dealing with complaints, with evidence that residents feel any concerns they may have are listened to and acted upon. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: A copy of the written procedure for addressing complaints was clearly displayed on the home’s public notice board. Residents confirmed that they all knew how to make complaint if they needed to, and confirmed their confidence in the staff to listen and act upon concerns raised. Those spoken to directly all said that the staff were most helpful if they had any concerns at all, with one saying that when she had raised an issue in the past, she got a wonderful response from the staff. Just one person had an unresolved issue, which related to the reception on her television, and this was relayed to the manager for attention. Visitors surveyed also confirmed their awareness of the complaints procedure if they needed it. A record of any concern or complaint and investigation outcomes was maintained appropriately. The home has written policies and procedures for the protection of the vulnerable residents, although this should be reviewed as it currently reflects Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 17 some detail that is incorrect, such as the details of the regulatory body and the named contacts within the Adult Protection Team. Staff have received instruction in adult protection issues, and were conversant in such issues relating to the protection of vulnerable adults. However there is a new and updated adult protection training programme being implemented for the staff within the next three months. The ‘Alerter’s Guide’ regarding the recognition and reporting of abusive practices, had a high profile in the home, being displayed on the public and staff notice boards. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good, and provides residents with a very comfortable and clean place to live. EVIDENCE: The home has a maintenance person, who works across all six homes in this care group; records of all maintenance carried out are kept. The relatively new extension to the home provides a high standard of accommodation for the residents. It is very well equipped, with good quality furnishings, is very spacious, and is beautifully decorated. The original part of the home is undergoing a degree of refurbishment and redecoration in areas where it was decided this was most needed. The home was clean and fresh throughout, and liquid soaps, paper towels, gloves and aprons were provided for staff as part of infection control protocols. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 19 Residents surveyed said the home was kept very clean, with one saying that it provided a good laundry service; one relative did say however, that there are occasions when her relative’s clothes got mixed up in the laundry system. Laundry was being handled appropriately, and with due regards to infection control measures for foul items. The laundry room was clean and orderly. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing provision is not consistently adequate to meet the needs of the increased number of residents now living in the home. Robust recruitment procedures ensure that suitable staff are employed for the protection of residents. The arrangements for the induction and training of staff are good, with the staff able to learn the skills necessary for their role. EVIDENCE: In the last year, Parton House has increased its registered number of places to provide care to an additional thirteen residents; at the time of this visit, thirtyfive of the thirty-six places were occupied, with the thirty-sixth due to be filled in the week after this date. As part of the registration process of these increased places for care at the time, a written agreement was sought, and obtained, from CTCH Ltd proprietor regarding the required staff increases necessary to meet the changing needs of the home, and that this would be implemented well ahead of full occupancy. This has not been met in full by the proprietor. There are now two waking night staff on duty over night, and housekeeping hours have been increased during the day as was required; however, a designated laundry assistant has not been employed, and despite an Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 21 agreement for the agreed numbers of care staff not to be involved in the laundry, they continue to be, and this is taking a significant amount of their time away from the residents. This occurs periodically during all daytime hours, and is of particular concern in the evening, when one member of only three staff is allocated to deal with laundry. There continue to be only three care staff during the afternoon and evening, despite an agreement that care staff would increase, as required, from three to four during all daytime hours, with the manager being supernumerary to this number. An additional concerning factor is that one of the three afternoon/evening care staff is allocated to the kitchen to prepare, serve and clear away the evening meal for the residents. Given the laundry and catering responsibilities that are part of the care staff duties at present, there are only two care staff actually working directly with thirty-six residents for a time, and the safety of this, given the layout of the home, and the ability to satisfactorily meet the needs of the residents is not acceptable. Residents surveyed said that staff were very kind and helpful. Residents spoken to on the day were extremely complimentary about the staff team, as was a regular visitor to the home. At least two residents said that there were not enough staff, with one of these saying that this was particularly the case during the afternoon. One resident said that she could hear the call-bell sounding for prolonged spells before it was answered on occasions. One resident said that very little ‘goes on’ at the home in terms of social activity, as staff simply do not have the time to spend with them; this comment was also echoed by some of the staff. Two relatives were of the opinion that the staff were too rushed. Some of the staff themselves also indicated that more staff were needed on the late shift. There was also evidence that there have been occasions when only two care staff have been on duty during the evening in times of staff sickness, which only adds to the staffing concerns at this home. The home was making good progress with the National Vocational Qualification (NVQ) training programme for care staff. There were eight who were qualified to at least this level, with two others just completing the award, and two currently on the training programme. Five staff files were chosen for inspection, on the basis of their recruitment to the home since the last inspection. Each record contained application forms, including a full employment history. Records of interviews were seen, although in some cases the recording could have been more thorough. Full and complete evidence of the required pre-employment checks was seen in each of the files, including medical checks, proof of identity, two written references, POVA (Protection of Vulnerable Adults) checks and CRB (Criminal Records Bureau) clearances. The manager has not routinely made a record of Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 22 the supporting proof of identity that she has seen for each case, and it is recommended that she now does. New workers have a structured induction to the home, with records of their induction training maintained. A supervisor is allocated to mentor a new worker, and although the manager could identify this person, there was no actual record kept of whom the supervisor should be. A new starter was working alongside an allocated supervisor at the time of this visit, and was able to discuss the home’s plans for her complete and structured induction to the home. In addition to the in-house list of topics for instruction, new workers attend a recently revised induction training programme at the CTCH Ltd office, which is delivered over six days in total. This programme has been devised to incorporate the new Common Induction Standards for care staff, which include the following: Principles of Care, Roles and Organisation, Health and Safety, Communication, Abuse and Neglect, and Developing as a Worker. Training records were maintained for each member of staff, and these showed a range of mandatory and optional training available and undertaken by all levels of staff. Staff themselves spoke very positively about the training opportunities that are made available to them, and confirmed some of the topics relevant to their role that they had undertaken. Care staff have been issued with a copy of the General Social Care Council Code of Conduct. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In most aspects the home is well managed, and has safeguards in place to promote the interests, health and safety of the residents living here. Despite outcomes in this group being generally good, there are some areas of concern where the home has not performed well, and this is in relation to the overall management responsibility of this home by the proprietor, as reported under the previous outcome area. EVIDENCE: The home manager has had experience in this post for four years. She has achieved the NVQ level 4 in care, and the Registered Manager’s Award; she is registered with CSCI for her role. She has recently undertaken an additional management course with an external training provider. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 24 The manager has undertaken a small range of internal quality monitoring audits in relation to care, catering and housekeeping and medications; audits were last carried out earlier this year, and are generally done when CTCH Ltd issues audit forms to the home for assessment and completion. The CTCH Ltd Group Care Manager conducts regular monitoring visits to the home, producing reports on this basis. Outcomes of CSCI reports are discussed with staff where applicable. A resident survey was carried out some months ago, and sought people’s views and experiences regarding care and privacy arrangements in the home. A written report and action plan on the basis of collated results was published in one of the home’s information brochures. Previous quality monitoring surveys that residents have been involved with have covered areas such as staffing and accommodation. Residents have also had the opportunity to participate in regular meetings, and recorded minutes of such meetings demonstrated that residents’ views and ideas are sought so that they can have a say in how their home is run. Visitors and relatives have not been formally surveyed, but they are able to speak to the manager in an informal way regarding their views if they wish. Residents spoken to all confirmed that the manager and the staff were most approachable, and did all they could to help people; this was also echoed by a visitor spoken to directly during the visit. Some residents have placed personal money and valuables with the home for safekeeping. Clear and transparent records for each person, which included transaction details, running totals, and receipts were kept. A case tracking audit on one particular resident’s money proved to be correct, with no discrepancies seen. Residents or their representative had signed to acknowledge some transactions, but where this was not possible in the majority of cases, two staff members had signed the record to witness on behalf of the resident. Random audits had been carried out on the system, to ensure continued transparency and accuracy of it. There were written policies, procedures and risk assessments and provision of necessary equipment to protect and promote the health and safety of those living and working at Parton House. Staff have received training in first aid, fire safety and health and safety. The actual content of fire safety training was not recorded anywhere, although details pertaining to drills were recorded. A full fire safety risk assessment throughout the whole building has been undertaken, and the manager was in the process of issuing questionnaires to staff in order to gauge their fire safety awareness, so as to incorporate training needs into the risk assessment. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 25 The fire alarm system, emergency lighting and fire extinguishers are regularly checked. A risk assessment had been conducted on the log burner in the Sandmead lounge; at this time the home does not judge any resident to be at risk from it, but it is recommended that a guard be utilised when the burner is in use. Hot water temperatures are regularly checked for safe levels, and hot water is stored and distributed at appropriate temperatures for control of Legionella. Safety checks and maintenance of equipment had been undertaken, although records of portable electrical appliance tests could not be located, and this was due for renewal anyway. A service and safety inspection of the gas boilers and heating system was also due at this time, having last been conducted a year ago. The home owns one load-bearing hoist of its own, which is not currently in actual use at this time. However, in view of this not being serviced or checked for safety by an appropriately qualified engineer for over two years it must be removed from any possible use, so as not to pose a risk to any resident, at least until it is properly serviced and confirmed safe for use. The home has two variable height and position baths, which can be raised, lowered and tipped according to need. In the absence of a servicing agreement for these pieces of equipment, the home must be assured that any checks carried out on them are in accordance with the manufacturers’ recommendations regarding the bath’s maintenance. Accident records were maintained where appropriate, some of which were examined as part of the case tracking exercise. The environment was generally secure. There is a long tree-lined driveway leading to the home, which is set well back from the road. This drive is unlit, and is a potential hazard for any resident, visitor or staff using the drive after dusk. Parton House DS0000016532.V310103.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 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 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement Timescale for action 31/12/06 2. OP15 16(2g) 3. OP27 18(1a) The registered manager must ensure that: • Staff sign in full any handwritten entry or amendment on medication administration charts • Staff record the amount of variable dosages when administered. The registered manager must 31/12/06 ensure that catering staff cover and date prepared foodstuffs stored in the refrigerator. The registered person shall, 31/01/07 having regard to the size of the care home, the statement of purpose and the number and needs of the service usersensure that at all times suitable staff are employed at the care home in such numbers as are appropriate for the health and welfare of service users. The registered manager must ensure that: • Care staff numbers are increased to four during all day time hours • Care staff are not routinely Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 28 4. OP38 13(4c) 23(2c) involved in laundry duty, if only the minimum of staff are provided at the agreed level of four during daytime hours. The registered manager must ensure that, unless the home’s own resident hoist is serviced and deemed safe for use by a competent engineer, it is not accessible for use. 30/11/06 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 OP7 Good Practice Recommendations Staff should review all aspects of care plans and risk assessments each month • Staff should write in the daily record each day, and avoid the use of inappropriate and unprofessional language. A second person should sign as a witness to any handwritten entries on medication administration charts. • The manner in which meals are served should be reviewed and altered, so as to avoid unnecessary disruptions and delays in the dining room • Comprehensive catering records should be maintained, to demonstrate adequate temperature controls in relation to refrigerators, deep-freezes and high-risk foods. The written adult protection procedures should be updated to reflect the correct details of the regulatory body and the named contacts within the Adult Protection Unit. A designated laundry assistant and evening catering assistant should be employed. The registered manager should record in writing interviews with prospective staff in full, and should record the type of identity proof seen in each case. The home should identify the named supervisor for new workers on their induction programme, and/or the staff rota for the duration of their induction. DS0000016532.V310103.R01.S.doc Version 5.2 Page 29 • 2. 3. OP9 OP15 4. 5. 6. 7. OP18 OP27 OP29 OP30 Parton House 8. OP38 • • • The actual content of fire safety training for staff should be recorded in full A fireguard should be in place when the log burner is in use in the Sandmead lounge The long driveway to the home should be lit after dusk. Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Parton House DS0000016532.V310103.R01.S.doc Version 5.2 Page 31 - 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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