Inspection on 27/10/08 for Parton House

This inspection was carried out on 27th October 2008.

CSCI found this care home to be providing an Adequate service.

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.

Other inspections for this house

Parton House 10/12/07

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Parton House Parton Road Churchdown Gloucester Glos GL3 2JE Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 27th October 2008 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.V372903.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.V372903.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 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.V372903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th December 2007 Brief Description of the Service: Parton House is registered to provide personal care for 36 older people, and 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 £465.00 to £604.00 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.V372903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 on one full day in October 2008. Care records were inspected, with the care of three residents being closely looked at in particular. The management of residents’ medications was also 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 and staff. Comments were received from less than half of those issued, but their comments are featured in this report. Three out of four visiting healthcare professionals also completed survey forms for CSCI. 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, provision, training and supervision 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. We required an Annual Quality Assurance Assessment (AQAA) from the home; this was provided, and the contents informed part of this inspection. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 6 What the service does well: Parton House provided a generally safe, pleasant and welcoming atmosphere for its residents and visitors, and ensured that there was a good amount of information about the home, its services and facilities to assist residents and their families. Residents were admitted here on the basis of an assessment of their individual needs, and upon admission each had their own personal documented plan of care. Appropriate medical reviews and support were sourced and provided, and there were many examples seen of residents receiving good care. Residents spoke very well about the care, the staff and the services they received in the home, with comments heard such as ‘the staff and the care are wonderful here’. Although some residents were more dependent on staff than others, they were generally encouraged to be as independent as possible, with some enjoying a high degree of privacy, independence and freedom of will. All confirmed that the staff respected their dignity and personal choices. A social activities programme was provided, although this was not daily, and outings were reduced in number due to current restrictions with transport. The quality and quantity of food served to residents was good, and in the main the residents said they enjoyed their food; two said that the meat could be a ‘bit tough on occasions’. People were assured that the home took any complaint seriously, and there were policies and procedures in place for the protection of the vulnerable residents. Staff were recruited in accordance with good recruitment procedures, with the necessary pre-employment checks taking place, although some recommendations have been made to further enhance the procedures. Staff were encouraged to develop professionally, and had access to good training opportunities. The home’s AQAA was completed to a good standard, and provided us with the information we required. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: In many respects the standard of care planning documentation had improved, but the shortfalls identified in this, and the failures within the medication management systems have posed a risk to some residents in terms of meeting their health needs. Although the quality of the catering was generally good, some recommendations have been made in relation to care staff entering the food preparation area and also in relation to the service of hot puddings. The new part of the home provided accommodation to a high standard; however, certain aspects of the original part of the home were showing signs of wear and tear and would benefit from some decorative attention. Care staff continued to be involved in non-care tasks, and it was previously agreed that they would not be involved in laundry duties. The effect of not having a housekeeper on the day of this inspection was evident by some isolated unpleasant odours and unclean areas, and by care staff being responsible for laundry duties. We continue to recommend that this home have catering support for all mealtimes and designated laundry staff, as there were periods when residents were sitting unattended whilst staff were engaged in these activities. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 8 The manager carried out a regular audit of the incidence of accidental falls in the home, and we have recommended that the availability of the staff to residents be taken into account as part of the audits and reviews. Despite staff feeling well supported in the home, the informal way of providing their supervision must now be formalised in a planned and recorded way, and this was fully acknowledged by the manager during the inspection. The home is now required to ensure that chemical storage in the laundry room is made more secure. 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.V372903.R01.S.doc Version 5.2 Page 9 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.V372903.R01.S.doc Version 5.2 Page 10 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): 1, 3 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have access to a good amount of information, and are assessed fully prior to their admission so that they can be assured that the home will be able to meet their needs. EVIDENCE: The home’s AQAA stated that all prospective residents were issued with a copy of the home’s Service User Guide (information brochure), and that all interested parties were given the chance to view and tour the home, stay for trial periods, and have access to latest CSCI inspection report. The information brochure was currently under review and was not seen in detail on this occasion, but we gave advice to the group’s care manager regarding the fee and contract information that must be included in all copies. We inspected three examples of pre-admission assessments. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 11 Each assessment had been carried out and documented prior to admission being agreed. The assessments had been signed and dated, with just one exception to this where the date was not recorded, with the location where it was conducted identified. The assessments also identified if the person’s family or representative was present. The assessments took account of the person’s personal and health care needs; their past medical history and involvement of healthcare professionals; their medications; their mobility needs and history of falls; their dietary, social and spiritual needs; their communication needs and their understanding and legal status. Assessment and care plan information had also been obtained from other social and healthcare professionals involved in the care of the individual, where appropriate. Confirmation letters regarding residents’ admission to the home were issued. Parton House does not provide intermediate care. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 12 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. There are some good arrangements in place for meeting residents’ health and care needs, but occasional shortfalls within the care planning and medication systems are posing a degree of risk to residents in this regard. EVIDENCE: All residents had their own personal plan of care. Three were selected for a case tracking exercise, and were scrutinised in closer detail. Each of these care plans was directly linked to a full assessment of needs that incorporated all health, personal and social issues. Recorded risk assessments in each case included pressure sore vulnerability, falls, nutrition and moving and handling. Although there was very evident improvement overall in the care planning documentation on this occasion there were still areas for improvement, such as Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 13 with expanding the detail of a continence care plan in one case, and the management of pain relief in another. We saw evidence of consultation with the resident concerned and of family input. Care plans had been regularly reviewed, although review information was generally brief and uninformative. In one case we found that a risk assessment showed the person was at risk of developing pressure sores, and although this person had not done so to date, there was no recorded plan of care regarding how the identified risk was being managed. In a second case the person had developed a sore, with care planning put into place only after the event; this did not include all the detail associated with the relief of pressure areas and further preventative actions necessary by the care staff. A referral had been made to the community nurse, with appropriate treatment and support equipment provided. Residents’ weights were monitored, and where concerns had been identified the appropriate care planning was in place. The management of a catheter was very well documented. Mobility care plans were reflective of any degree of risk that had been identified on a falls risk assessment, and walking and lifting aids were in place for those residents for whom it had been assessed as needed. We found that people had been medically reviewed on a regular basis and had good access to all health care services. We saw that a comprehensive range of health care interventions had been provided where necessary, and that some good multidisciplinary approaches had been adopted for the benefit of the residents. Each of the three visiting healthcare professionals who returned survey forms to us indicated that the home worked well and in partnership with them, with their advice heeded, and the appropriate care decisions taken. The small number of residents who responded to our survey confirmed that they were happy with their care. Residents we spoke to during the visit were overwhelmingly positive regarding the way in which the staff looked after them, making comments such as staff are ‘wonderful’, ‘excellent’ ‘I’m looked after very well’ and ‘the staff and the care is wonderful here’. At least two residents were managing their own medications within a risk management framework, and had secure storage in their room for their items. A list of medication supplied to them was maintained, although recording was slightly cramped and in a restrictive format. The majority of medications were supplied in a monitored dosage system, with some supplementary boxed and bottled items; such items had been dated on opening to ensure their use before any expiry date, and to allow for auditing. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 14 Medication administration charts were printed by the supplying pharmacist, and any handwritten entries added in the home had been signed in full by the author, with a second signatory in most cases as is recommended. There were care plans to direct the use of prescribed external creams, with a record of application. We saw at least one exception to this where directions were to apply to the ‘affected part’ with no indication of where. There were protocols for the use of analgesia and any medication prescribed for use ‘as necessary’. Some of these did not identify the site and reasons for the person’s pain, and in one case there was no protocol for the use of their occasional pain relief. There were clear records of medication administration, although there were very isolated gaps in this. We carried out some audits and found that in one case there were signature gaps on four recent days. An audit of the boxed tablets remaining since the date of opening revealed that the medication had not been administered as prescribed. Compliant storage facilities had been installed for Controlled Drugs. The Controlled Drug register was old, well used and in poor condition. Pages in use did not run concurrently, and the register was difficult to follow. It was agreed that a new one would be implemented in the interests of safety and clarity. An audit of the controlled drug stocks was mostly satisfactory, except that the pharmacy label for one drug did not match the prescribed instruction. Staff should have been checking the pharmacy label against the prescription on the medication administration chart at each administration time, and had not detected this. Medications were held securely, although a few items requiring cold storage were held in a small locked metal box within an unlocked refrigerator. Cold storage temperature must be between 2 and 8 degrees centigrade, and temperature recordings showed that this was not being consistently achieved, with it being at 10 degrees at the time of the visit. We witnessed staff being respectful when helping residents. Many residents said that staff were ‘sensitive and discreet’ and that they were ‘very patient, often in trying circumstances’. One said that he had ‘never heard an unkind word from staff’. Some residents had their own telephones in their rooms, and some chose to lock their door for privacy. We witnessed staff knocking on doors before entering residents’ rooms, and residents confirmed that this was usually the way it was, with staff respectful of their privacy and dignity. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People living in this home have the opportunity to remain socially active, exercise choice, and have a nutritious diet that offers choice and variety. EVIDENCE: The home did not have a designated social activities coordinator for the residents, and care staff were allocated on certain days to do this. An activity programme was displayed, which showed a variety of activities and events for the month of October, to meet different tastes and abilities. The home had a small ‘cinema-style’ room where residents could watch films. Nothing was taking place on the day of this inspection, with a number of residents sitting unattended in the lounge or in their room, whilst some of the care staff were busy elsewhere during the afternoon. Some of the residents were pursuing their personal interests and hobbies very actively, and were enjoying maintaining their social contacts within the community. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 16 A mixture of comments and views were received from residents, with some saying that they ‘joined in with activities’, some saying they ‘chose not to and that this was respected’, whilst some said they ‘didn’t think much was going on’. Staff said that activities did take place, but not daily. One said on survey that the home ‘could do better with the provision of activities for residents’. Very few outings were taking place, which was reportedly due to the lack of availability of the mini-bus and a driver. Some residents were going out independently however, and a group of seven were being taken to an event in the local area. Religious services were available in the home, with three local churches visiting in rotation every month. Different religious denominations were being catered for. Records of activity were maintained, and it was recommended that in cases where residents were offered the opportunity to participate in social events but declined, that this be recorded also. Visitors were coming and out of the home quite freely. One resident said that visitors were always made welcome, and that staff always offered refreshments to hers when they came. We spoke to one regular visitor, who said that all the family were made welcome and that they often took their relative out. There were evidently mixed levels of ability and dependence amongst the residents, with some being more reliant on staff than others. However, the general philosophy of the home was clearly to support people to be as independent as possible, and to respect individual choice and wishes. Residents were moving freely around the home, spending their time as they chose and preferred. Their rooms were personalised, and some of the residents said that ‘they could do anything they liked in their room’. The home provided numerous information leaflets regarding support and advocacy services and funding and legal arrangements for those who may have wanted or needed such advice when making choices and decisions. Residents also confirmed that they had a very good choice with their food. A list of their selections from the menu was delivered to the cook in readiness for the meal preparations. We saw a small part of breakfast service, and saw all of the lunchtime service. The meal was hot, well presented and looked very wholesome and appetising. There were good-sized portions, and special diets and cutlery needs had been observed. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 17 Residents generally commented favourably about the quality and quantity of the food, although there were at least two people who felt that ‘the meat was stringy and tough on occasions’. One particular resident had her lunch served to her on a tray in her room. The hot pudding was served at the same time as the main meal in an uncovered dish, and consequently the pudding was cold when she came to eat it. The kitchen was seen during the lunchtime preparations, and although busy, was organised and clean, and appropriate catering records were maintained. The cook was better informed about the needs of the residents on this occasion, and had records of individual preferences, special diets and choices. She had attended a variety of nutritional training appropriate to her role. There were no restrictions imposed upon care staff walking in and out of the kitchen, and when we raised this point the manager acknowledged that this should have been kept to a minimum. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. People living in this home can be reassured by the home’s complaints procedures and the policies regarding the prevention of abuse. EVIDENCE: The home had a clearly written and accessible procedure for addressing any concerns and complaints; a copy was issued to all residents and their families. The AQAA stated that the home had dealt with three complaints in the past year. We saw the records in relation to these, and these contained evidence of actions taken, relevant correspondence, and of resolutions reached. A regular audit was also carried out and recorded on the incidence of complaints or concerns received each month. The home provided policies and procedures to address all forms of abuse. The manager had been liaising with a local advocacy service in order to source support for any vulnerable residents in a broader sense, but this had yet to be fully established. One resident had the support of an advocate already. Staff had been trained in safeguarding vulnerable adults in their care, either during their induction training, or with the care group’s trainer. Training in The Mental Capacity Act 2005 (MCA) had been delivered to a number of the staff Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 19 through the care home support programme, The Partnership for Older People Project (POPPs), although some of the newer staff had yet to have this particular training. The manager and the deputy manager had received additional training in this area. We interviewed four staff about their knowledge of safeguarding procedures. In the main they were conversant about what might constitute abusive practice, what the outward and more subtle signs of abuse might be, and about the steps to follow and agencies to contact if they had any concerns; some prompting was necessary in some cases. The staff disciplinary procedures had been instigated in certain instances, when work related practices had not met with the expectations of the manager. CSCI had been kept fully informed in these cases. We spoke to a number of residents, and each indicated their complete confidence and faith in the manager and staff to listen and address their concerns. The visitor also echoed this, saying that the manager was approachable and always dealt with concerns. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 20 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. Although certain areas in the original part of the home are in need of some attention and there was a degree of risk posed to residents by a shortfall in cleanliness, overall the people living here are provided with accommodation that is suitable to meet their needs. EVIDENCE: Parton House was generally well maintained and decorated, although there were areas in the original part of the house where painted woodwork was severely marked and scuffed, and small areas of wall coverings were torn or damaged. The newer part of the home was of a particularly high standard in terms of facilities and decoration, and each of the communal lounges provided a pleasant, well-appointed room for the residents’ use and comfort. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 21 The home had access to a maintenance person through the care home group, although a resident reported that response times to maintenance issues could be slow. This was reported at the last inspection and seemed to be an ongoing issue. The laundry room contained two washing machines, one of which was capable of sluicing and disinfecting foul or infected items. The laundry room was untidy and very cluttered, with numerous items and detergent containers blocking access to the hand washing facilities. Gloves, aprons and liquid hand soap and paper towels were provided for staff as part of the infection control measures. The home was adequately cleaned overall, but in the absence of a housekeeper on the day of this inspection there were areas that were in an unclean condition, such as communal toilets and some of the carpets. Faintly unpleasant odours were evident in communal toilets and in at least two of the bedrooms. There continued to be no designated laundry worker, with a member of the housekeeping staff allocated responsibility for laundry duties. However during this visit care staff were carrying out these duties in the absence of a housekeeper. The manager is reminded of the provider agreement that the minimum number of care staff provided to meet the needs of the residents must not include them undertaking laundry duties. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Despite some staffing shortfalls on the day of this visit people living in this home receive care from a competent work force, who undergo full preemployment checks, and who are supported to train and develop professionally. EVIDENCE: There were four care staff on duty on the day of this inspection with the home manager working in a supernumerary capacity. Staff rotas were maintained, and there was routinely the agreed minimum of four care staff on duty during all daytime hours, with two waking night staff on duty overnight. A cook and a catering assistant were working in the kitchen, but there were no housekeeping staff on the day of this visit; the manager reported that this was due to some agreed leave and some weekend working arrangements. The absence of such staff was having an adverse impact on the home on this day, in terms of cleanliness and how the laundry was operated. Due to the home not employing catering staff in the early morning and evening carers were responsible for the preparation and service of breakfasts and suppers; this always took at least one of the four carers away from the residents for up to two hours. We spoke to some staff about this, and none Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 23 raised concerns about it, but did not mention any impact the arrangements might have on time spent with residents, only that it did not interfere with other routine tasks. As previously reported carers were quite clearly involved in laundry duties on this day, and this was in direct contravention with an agreement with CSCI. The manager stated that this was necessary due to the absence of housekeeping staff, but would otherwise have been acceptable if a fifth member of staff had not been absent due to unexpected illness. Residents spoke extremely positively about the care staff, confirming they were kind and caring towards them. Visiting healthcare professionals also wrote on survey forms that staff worked well with them. A number of residents were sitting unattended in the main lounge for spells throughout the day, particularly in the afternoon whilst staff were delivering laundry to residents’ rooms and were generally busy elsewhere in the house. We saw one carer available at times to help people in this communal area. A visitor raised slight concerns about this, saying that ‘it was sometimes like this with no-one around the lounge’. The home was making good progress with the National Vocational Qualification (NVQ) training programme for care staff. Seven carers were qualified to at least level 2, with a further four staff currently studying on a course. The home was considering options to source NVQ training at level 3 for some. We inspected three staff files of recently recruited carers. In each instance, the prospective employee had completed an application form providing details of their employment history. Two written references had been provided in each case, with at least one of each of these having been obtained from a previous employer. Proof of identity and medical statements had been obtained, although the exact nature of the photographic identity that had been seen and verified had not been recorded. A recent photograph taken by the home was on each of their files. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for people well ahead of their commencement of employment. Where any concern had been identified regarding an employment history there was some evidence that this had been explored and considered prior to employment being offered, although this had not been done through a documented risk management framework. Each file contained an employment contract, a job description and sickness monitoring. Staff training records were maintained, and they evidently had access to a variety of mandatory and optional training relevant to their roles. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 24 A variety of nutrition and food hygiene courses had been delivered to the cook and care staff. Training had been delivered in safeguarding vulnerable adults and the MCA; Infection Control (although this was some time ago); Insulin management with the community nurse; Medication management and dementia awareness with a local college, and first aid with an external training provider. The home had taken advantage of the numerous good training opportunities that were available through POPPs. The Group Care Manager had delivered care planning and record keeping training, and a list of manual handling updates was seen. The deputy manager had started NVQ training at level 4. Staff confirmed they had good training opportunities. We saw induction training packages for new staff, the depth of which varied according to the worker’s past experience. Those with experience had undergone a tailored in-house induction specific to the home, which covered the fire procedure, the environment and personnel issues. New and inexperienced staff had received induction training in line with the Common Induction Standards for care workers, and workbooks for this were seen. The carers confirmed that they had worked in a supervised capacity during their induction and that they had felt very well supported during that time. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 25 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, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite some issues for closer attention, the improvements to the management systems in place here have ensured that the interests, health and safety of the residents living in the home can be safeguarded. EVIDENCE: The manager has been managing this home for a number of years, and has achieved the Registered Manager’s Award. She has been registered by CSCI for her role, and has continued to maintain her professional development. The manager had taken steps to increase her accessibility to residents, visitors and staff, and all of those we spoke to confirmed that management was approachable and helpful. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 26 The home’s AQAA was completed well. A range of internal quality monitoring audits had been carried out regularly, and it was evident that the home had made a number of improvements since the last inspection, and was striving to identify shortfalls and improve generally. As part of the quality monitoring systems questionnaires had been distributed to residents and visitors in order that the home could assess the quality of its services. Questionnaires gave residents and their families the opportunity to comment on issues that affected them. Residents’ meetings had been held, and information was obviously shared with them, with a number having a strong say in how their home was run. A number of residents had chosen to place personal money with the home for safekeeping. The systems for managing and safeguarding these arrangements were satisfactory and transparent, with receipts kept for expenditure, and signatures documented to confirm any transactions. We carried out two random checks, and these were both in order. Regular audits on these arrangements were also documented, with any points for improvement highlighted. Although staff felt well supported with regular opportunities for discussion and information sharing with their manager and colleagues, there was no formally recorded staff supervision programme. The manager fully acknowledged that she needed to formalise the otherwise informal system of staff supervision, and confirmed she would attend to this. The home had health and safety policies and procedures, and provided training for staff in associated topics. The fire procedure incorporated clear evacuation procedures, and evacuation in the event of fire training had been delivered, although some more practical training was planned. Fire drills had been carried out. Regular checks had been carried out on the fire alarm system, the fire extinguishers and emergency lighting. A fault with an emergency light had been reported to the maintenance person some time ago, but had not been addressed; the manager agreed to follow this up. Hot water temperatures were regularly checked for safe levels, and temperature of the hot water storage was checked to ensure that the appropriate control measures for Legionella were in place. The necessary safety checks and maintenance of utilities and equipment had been undertaken in a timely fashion, and the associated records were kept in these areas. First aid facilities were available and staff had received training in this area. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 27 Accident records were maintained. Monthly audits were carried out on the incidence of accidents, and in consideration of the number of accidental falls in recent months we advised that the availability of staff to residents feature as part of the audits and review. There was a sign on the laundry room door advising that it allowed access to staff only, however the door was not secured and the room was storing large amounts of chemicals, which could pose a potential risk to certain residents at some point. Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 28 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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 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 2 X 2 Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 15(1) 12(1.a) 13(4.c) Requirement In cases where a risk of a resident developing pressure sores is identified the Registered Manager must ensure that care plans are recorded and implemented that include all preventative actions necessary to reduce the identified risk and likelihood of a sore developing. The Registered Manager must ensure that staff administer medications to residents in strict accordance with the Doctor’s instructions, so that residents can receive their medication as prescribed to meet their health needs. The Registered Manager must ensure that medication records contain full instructions regarding the administration of external creams and medication prescribed to be given ‘as necessary’ so that residents receive their medication as prescribed and when needed. The Registered Manager must ensure that the instructions detailed on the medication DS0000016532.V372903.R01.S.doc Timescale for action 30/11/08 2 OP9 12(1.a) 30/11/08 3 OP9 13(2) 31/12/08 4 OP9 13(2) 30/11/08 Parton House Version 5.2 Page 30 5 OP9 13(2) 6 OP26 16(2.j.k) 7 OP38 13(4.a) pharmacy label are the same as those on the prescription, so as to avoid any errors in administration. The Registered Manager must ensure that all medication items needing cold storage are stored at the required temperature of between 2 and 8 degrees Celsius. The Registered Manager must ensure that the necessary measures are taken to ensure that the home is kept clean and odour free at all times, so as to ensure residents’ comfort and safety. The Registered Manager must ensure the safe and secure storage of all chemicals in use in the home. This refers specifically to those in the laundry room on this occasion that could pose a risk to some vulnerable residents. 30/11/08 31/12/08 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP9 OP15 Good Practice Recommendations Staff should record care plan reviews in more comprehensive and informative detail. The home should have a designated secure medication refrigerator. • Staff should avoid serving hot puddings to those residents eating in their rooms at the same time as they serve their main meal, as this prevents the resident eating the pudding whilst it is hot • Staff going in and out of the food preparation area of the kitchen should be kept to a minimum. DS0000016532.V372903.R01.S.doc Version 5.2 Page 31 Parton House 4 5 6 7 OP19 OP26 OP27 OP29 The original part of the house should be better maintained in areas where the standard of decoration is deteriorating. The laundry room should be kept tidy and less cluttered, with items stored on the floor around the sink area removed. The home should provide designated laundry, breakfast and supper catering staff. • The Registered Manager should maintain a record of the nature of the photographic and other identification documents that have been checked to confirm a worker’s identity during the recruitment process The Registered Manager should record a full risk assessment to support the decision making process in cases where concerns are identified on Criminal Records Bureau disclosures during the recruitment process. • Parton House DS0000016532.V372903.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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