Inspection on 27/06/06 for Queen Elizabeth Park

This inspection was carried out on 27th June 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.

Other inspections for this house

Queen Elizabeth Park 05/11/07

Queen Elizabeth Park 13/12/05

Queen Elizabeth Park 23/11/04

Queen Elizabeth Park 24/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Queen Elizabeth Park 1-72 Hallowes Close Guildford Surrey GU2 9LL Lead Inspector Mary Williamson Key Unannounced Inspection 27th June 2006 10:00 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 Queen Elizabeth Park DS0000054733.V301873.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. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queen Elizabeth Park Address 1-72 Hallowes Close Guildford Surrey GU2 9LL 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) 01483 531133 info@qepcarehome.fsnet.co.uk Care Base (Guildford) Ltd Katarina Parr Care Home 77 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (51) of places Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 Brief Description of the Service: Queen Elizabeth Park is a new purpose built care home registered to provide care for up to 77 older people, including the care of 26 Service Users with dementia, 26 with nursing needs and 25 requiring residential type care. The home is divided into three units and the accommodation is set out on three floors. All rooms are single occupancy with en-suite facilities. The current range of fees charged is £650 to £900 per week. The home is situated in a residential are of Guildford. There is a garden to the rear and the side of the property and there are adequate parking facilities within the grounds. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was undertaken by Mary Williamson who is a Regulation Inspector. The registered home manager Katarina Parr was present for the duration of the inspection. The home administrator (Locum) Mrs Chapman welcomed the inspector into the home. The inspector also spent time with Karen Benham head of the dementia care unit, Kelly Snow head of the residential care unit, and Shinimol Joseph the staff nurse in charge of the nursing unit during the day. Service users were spoken to on all the units, some in more detail than others. Positive feedback was received on all aspects of care. One service user stated that she enjoyed the activities provided particularly the quiz afternoons. Another stated that the staff were very kind. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were examined. These included needs assessments and care plans, which are well maintained. Staff employment and training files were also sampled. The kitchen was visited and nutritional needs of service users are well met. There was a display of items on the dementia unit relating to Wimbledon, including tennis rackets, trophies, match fixtures and photographs on players to help service users follow the tournament, which was taking place. The lounge on the middle floor was decorated in the world cup theme, which was also taking place. The inspector would like to thank the service users, relatives, staff and the management for their hospitality and input into the inspection process. What the service does well: The home provides care and support for service users with varying needs in a kind and respectful manner. The service users who were spoken to were very complimentary of the staff and the care they provide. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 6 The activities coordinator is very aware of the different needs of service users and provides activities to meet individual and collective needs accordingly. The standard of accommodation is very good and several service users and relatives made positive comments regarding their rooms. What has improved since the last inspection? 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. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 7 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 Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3, 5, and 6 Quality in this outcome area is good. Judgement has been made using information available including a visit to the service. Prospective service users have the information required to help them make an informed choice about living at the home. Need are assessed prior to admission. Intermediate care is not provided. EVIDENCE: The home has a statement of purpose and service user guide in place. All prospective service users and their relatives have access to a copy of this. During the inspection prospective relatives were viewing the home and were observed to have copies of this information. Service users have contracts of occupancy in place, which include the type of care provided, the room to be occupied and the fees payable. A signed copy of this document is retained on individual files. All prospective service users have a pre admission needs assessment undertaken by the manager of a senior member of staff qualified to undertake this assessment. Needs assessments were seen for JT, SF, FW, KP, IJ, and BD. These are detailed and also include a health needs assessment to determine Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 9 the type of care required and the suitability of the home to meet the assessed needs. Trial visits are encouraged whenever possible. Intermediate care is not provided in this service. Queen Elizabeth Park DS0000054733.V301873.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, and 10. Quality in this outcome area is good. Judgement has been made using information available including a visit to the service. Arrangements in place to meet the health and personal care needs of service users are satisfactory. Individual care plans outline in detail the care to be provided. EVIDENCE: Individual care plans are in place and are well maintained. Care plans were seen for JT, SF, FW, KP, IJ, and BD. This was a snapshot of the care being provided for service users accommodated on three floors with very different care needs. The care plans are well written based on the pre admission needs assessments, and input from service users and their families, and health needs assessments. The care plans are reviewed on each unit by the care team and updated. All care plans include a service user profile, daily records, and risk assessments for example falls management, Waterlow score for skin care, manual handling, nutritional needs, and for the use of bed rails. All service users are registered with a local GP. Two service users stated that they see the doctor “often”. Chiropody treatment is available every six weeks and dental treatment is also available. Physiotherapy is arranged on request. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 11 One relative stated that when a service user has to attend outside appointments or a visit to hospital than the home provides an escort. Medication is managed over three floors with three treatment rooms and three medicine trolleys in place. The home has a policy in place for the administration of medication. This is available on all three units. The medication procedure was inspected on the dementia unit. Boots the chemist supplies the medication to the home mainly in blister packs. The medication recording charts were sampled and were well maintained. There is an audit trail of all medicines received onto the unit and for the disposal of medication. All staff who are responsible for the administration of medication have regular training. There was a notice on the wall outside the nurse’s station inviting all care staff to a talk by GP Dr. Oliver Franks on “Medication use in Dementia” on 05/07/06 followed by refreshments. The unit leader stated these talks are very popular with staff. Privacy and dignity is respected and care staff were observed to knock on service users doors prior to entering individual bedrooms. All rooms are single occupancy with en-suite facilities. Two service users stated that they liked to have their bedroom door open during the day for “company”. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 12 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, and 15. Quality in this outcome area is good. Judgement has been made using available information including a visit to the service. Service users individual and collective leisure and social activities are catered for. Nutritional needs are being met. EVIDENCE: There is a list of activities available on each floor. One service user on the residential unit was able to give an account of what she likes to do, which includes an organised quiz from The Times newspaper some afternoons, watching an old film in the lounge, reading her newspaper, writing letters and looking forward to receiving post. The team leader on the dementia unit had made a wonderful Wimbledon display with input from the service users including a silver shield, a cup, a list of match fixtures, photographs of individual players tennis rackets and tennis shoes to help involve the service users in the tennis tournament on television. She is also the activities coordinator for the home and organises events to celebrate Burns Night, St Valentines Day, St. George’s day, and individual birthdays. Family links are maintained and one relative confirmed that the home is “very supportive of relatives” and that she has been involved in care planning and is Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 13 kept informed of changing needs. One service user stated that her family visit and take her out. Facilities are available for relatives to take a meal with service users if they wish. Spiritual needs are supported and visits from the local clergy can be arranged. The catering arrangements in the home are satisfactory and generally meet the nutritional needs of service users. There are two cooks employed in the home covering seven days. They plan the menus with feedback from service users meetings, and input from the team leaders on all floors. Lunch was observed on the first floor and consisted of hot pot, a selection of vegetables and potatoes, or cauliflower cheese. This was well presented and appetising. Staff were observed offering assistance to service users who required help with feeding. One service user stated that the food was “horrible”. This service user is a vegetarian, and it was agreed that she would plan her own menus weekly and send them to the kitchen. The cook agreed with this arrangement. The kitchen is well organised and well equipped. The last EHO (Environmental Health Officers) visit was two weeks prior to the inspection and was satisfactory. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 14 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, and 18. Quality in this outcome area is good. Judgement was made using available information including a visit to the service. The complaints procedure in place is available to all service users. Systems are in place to protect service users from abuse. EVIDENCE: The home has a complaints procedure in place and a copy of this is available to all service users and their relatives, which is included in the service user guide. One member of staff spoken to was aware of what to do if a service user or a relative made a complaint. Service users spoken to were also aware of the complaints procedure. There has been one complaint since the last inspection, which has been solved with a satisfactory outcome. The home has an abuse awareness policy in place and all staff have training in this procedure during induction training. The home also has a copy of Surrey’s Multi Agency Policies and Procedures in safeguarding Vulnerable Adults in place and the manager had attended a meeting the previous day involving a current service user using these procedures. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 15 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, 20, 24, and 26. Quality in this outcome area is good. Judgement has been made using information available including a visit to the home. The home is suitable for its intended purpose, well maintained, clean and hygienic. EVIDENCE: Accommodation is arranged over three floors with ample communal facilities provided on each floor, which includes well furnished dining rooms and lounges. All bedrooms are single with en-suite facilities. Individual accommodation is comfortably furnished and service users can bring their own furniture and possessions into the home with them. The home is clean and hygienic. The laundry is located in the basement, and is well equipped and staffed. The laundry assistant on duty was aware of the infection control policy and had the facilities to implement this. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 16 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, and 30. Quality in this outcome area is good. Judgement has been made using information available including a visit to the service. The staff duty rotas were examined. They demonstrated that the number and skill mix of staff on duty was sufficient to meet the service users needs. The recruitment policy in place protects the service users. EVIDENCE: The staff duty rota was seen and demonstrated that four staff are on duty on each floor during the day. Two staff are allocated to each floor for night duty. Following previous inspections it was required that the manager undertook a risk assessment to detail if there was any potential risk to service users on the residential floor by allowing the second member of staff to help on the nursing floor between 4am and 6am. This is now in place and the duty rota also indicated that one member of the day shift commences duty at 7am to provide additional cover avoiding any potential risks. The department manager on the dementia unit is the training coordinator for the home. She also undertakes the dementia training for the unit. Currently there are sixteen staff undertaking NVQ awards and the home manager stated that the home was only one interview away from their “ investors in people award”. Training records are kept on each floor. Several carers working in the home are qualified nurses in their country of origin and one of these nurses has Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 17 applied to the NMC (Nursing and Midwifery Council) to undertake her adaptation training. The recruitment procedures are good. Employment records were examined for SJ, MH, FM, BT, and RS. These are well maintained and contained all the relevant documentation including employment history, two written references and CRB (Criminal Records Bureau) disclosure. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 18 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, 36, and 38. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. The home is managed in the best interest of the service users. Health and safety is promoted. EVIDENCE: The management structure within the home is good. The registered manager is a qualified nurse and also has a master’s degree in business management. Each floor has a department manager all of whom have the appropriate experience to manage the units. Regular audit checks are undertaken for health and safety, medication, quality of care, wound care, and food. Satisfaction survey questionnaires are completed at least twice a year and results are shared with service users during meetings, and published in the minutes. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 19 Staff have formal supervision every two months. This is recorded and retained on individual personal files. There is a wide range of health and safety policies and procedures available in the home and these were sampled during the inspection. Staff confirmed that they received basic induction in these policies on commencement of employment, and training in these procedures is ongoing. This was evident in staff training files. Required safety certificates are in place to ensure so far as reasonably possible, the health, safety, and welfare of service users and staff. The fire safety records were seen and are well maintained. Fire alarms are tested and recorded weekly. Contracts are in place for the maintenance of fire fighting equipment. A fire drill was undertaken during the inspection and the staff response to this procedure was impressive. The procedure for recording accidents is satisfactory. Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 20 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 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 X 3 X 3 Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Queen Elizabeth Park DS0000054733.V301873.R01.S.doc Version 5.2 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!