Inspection on 01/10/08 for Queens Park Court

This inspection was carried out on 1st October 2008.

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

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

Other inspections for this house

Queens Park Court 17/06/08

Queens Park Court 19/06/07

Queens Park Court 07/11/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Queens Park Court Goldington Cresent Billericay Essex CM12 0XR Lead Inspector Michelle Love Unannounced Inspection 1st October 2008 09:30 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 Queens Park Court DS0000067527.V372572.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. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queens Park Court Address Goldington Cresent Billericay Essex CM12 0XR 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) 01277 630060 01277 634660 Rushcliffe Care Limited Mrs Carole Ann Stockbridge Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (7), Old age, not falling within any other category (40) Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Personal care to be provided to no more than forty (40) Older People over the age of 65 years (OP). Personal care to be provided to no more than twenty (20) service users with Dementia (DE). Personal care to be provided to no more than seven (7) service users with a Mental Disorder who were accommodated at the home at the time of registration. No new service users with a Mental Disorder diagnosis to be admitted to the home. 17th June 2008 Date of last inspection Brief Description of the Service: Queens Park Court is a large detached purpose built care home providing care and accommodation for 40 older people, some of whom may be diagnosed as having dementia. The home is situated in a residential area of Billericay and the town centre is a short distance away. Rushcliffe Care Ltd owns the home and the registered manager is Carole Stockbridge. Accommodation consists of 40 single bedrooms each with en-suite facilities. People at the home are accommodated in four separate bungalows, each with its own kitchen and living/dining area. There are a number of garden areas around the home, which are secure for residents’ safety. There is a large central dining/lounge available for community activities and this can also be used as an alternative dining facility. The central communal area is shared with the people living in the attached Sheltered Housing complex. There is a main kitchen, which prepares meals for those living in the home and additional meals for tenants living in the sheltered housing. The kitchen’s main function is meal preparation for the residents within the home. There are adequate car parking spaces at the front of the home for visitors. At this inspection the manager advised that the weekly fees for accommodation are £452.48 (all contracted beds). Items considered to be extra to the fees include private chiropody, hairdressing, toiletries and newspapers. CSCI inspection reports are available from the home and our website at www.csci.org.uk Queens Park Court DS0000067527.V372572.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 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection. The visit took place over one day by two inspectors and lasted a total of 8.45 hours, with all key standards inspected. Additionally, a pharmacist inspector was also present to inspect the home’s medication practices and procedures. The manager’s progress against previous requirements from the last key inspection was also inspected. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment (29/4/08). This is a self-assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Surveys were provided for staff and residents representatives, for completion and forwarding to us. What the service does well: The manager carries out regular audits of medication and records associated with medication. Of those staff who administer medication, they had received a good standard of training. Visitors to the care home are made to feel welcome. Food provided to people is of a good quality and comments from residents relating to meals provided, was positive. There is a varied menu and various alternatives are available if required. The care home provides people with a safe and homely environment that meets their needs. Staff, have a good rapport with residents and interact well. There is a safe system in place to safeguard residents’ monies. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Queens Park Court DS0000067527.V372572.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 Queens Park Court DS0000067527.V372572.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all prospective residents can expect to be assessed by the home prior to admission, and therefore are not assured that their needs can be met at this home. EVIDENCE: There is a formal corporate pre admission assessment format and procedures in place. This ensures that a prospective person is assessed prior to admission and that both the management and staff team are able to meet the prospective person’s assessed needs. In addition to this, supplementary information is sought from the individual resident’s placing authority and/or hospital. On inspection of four care files for those people newly admitted (1 respite and 3 permanent), records showed that a pre admission assessment was completed by the management team for those people admitted to the care Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 9 home on a permanent basis, prior to their admission to the care home. Information recorded was noted to be detailed and informative. Records for the person admitted on respite showed that since March 2007, the person has had several stays at Queens Park Court for short periods of time. Following discussions with the manager, we were advised that no pre admission assessments are undertaken for those people who are admitted on respite. The manager stated that the management team of the home make the decision to admit people for short-term care based solely on the placing authority’s assessment. An assessment by the home is carried out if it is felt that a problem may occur. This does not concur within the Statement of Purpose, which states under the heading of admission, “Prior to admission the manager from the home will carry out an ‘Assessment of Need’. A prospective resident will only be accepted if the manager feels confident that the home can adequately meet those needs”. This is seen as inappropriate practice as prospective people, irrespective if they are permanent or admitted for short-term care should have a need’s assessment undertaken by the provider to evidence it can meet the individual’s care needs. It was positive to note that confirmation from the management team to the resident and/or their representative verifying that it can meet the person’s needs was available for all permanent people case tracked. The AQAA details that all prospective people and/or their representatives are given the opportunity to visit the care home prior to admission. Two residents spoken with confirmed the above. The home does not provide intermediate care. Queens Park Court DS0000067527.V372572.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living at Queens Park Court cannot be safe in the knowledge that their individual care needs will be clearly recorded and met by support staff. EVIDENCE: As part of this inspection, 6 care files were randomly examined. As stated previously, there remains a corporate formal care planning system in place to help staff identify the care needs of individual residents and to provide care in line with individual’s care needs and personal preferences. In addition to the above, formal assessments are to be completed in relation to dependency levels, manual handling, falls, nutrition and pressure area care. It was positive to note that the care plan/risk assessment for one person pertaining to the use of oxygen has now been devised since the last key inspection. The document was examined by the pharmacist inspector and observed to be appropriate. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 11 Of 6 care files examined, all were noted to have a plan of care devised, however these continue to vary in content and detail. Care plan recording was seen to be inconsistent with some elements of recording giving a reasonable level of detail whilst other areas were seen to be basic and remain not person centred. The care plan for one person newly admitted to Queens Park Court only made reference to their sleep/night time routine. The person’s assessment from their placing authority detailed they were at risk of self harm, at risk of falls, could be anxious, at risk of malnutrition, was underweight, experiences memory loss and confusion and had been subject to financial abuse. Although care plans examined made reference to individuals’ dementia, more information is required detailing how the persons’ dementia impacts on their ability to undertake activities of daily living. Following discussions with the manager, the care file for one person who exhibits aggression and/or inappropriate behaviours was examined. No care plan was devised in relation to the individual’s aggression and/or inappropriate behaviours, detailing how this manifests, known triggers and guidelines for staff as to how to deal proactively with the above so as to provide appropriate support to the named resident and others. Two members of staff spoken with confirmed that the resident’s aggression and/or inappropriate behaviours had been frequent over a significant period of time. Staff confirmed that the care file did not record any specific guidelines or instructions for staff to follow, however if a situation should arise they would “deal with it as best they could”. Formal recording systems were in place to record specific incidents, including what was happening prior to the incident, the behaviour exhibited, people involved and interventions provided. Records showed that incidents of aggression and/or inappropriate behaviours were frequent and both staff and other people living within the home were targeted. Records showed that the only measure in most cases taken by staff was to take the resident to their room. This remains inappropriate and shows a continued lack of knowledge and understanding by staff and the management team of the home around dealing with residents’ physical and/or verbal aggression. There was evidence to show from inspection of the Interagency Notes, that in the past the resident’s GP was consulted in relation to the above, however there was no evidence to show this had been followed up recently. We acknowledge following the inspection that efforts have been made by the management team of the home to seek advice and further involvement from external healthcare professionals. It was positive to note that since the last key inspection, a risk assessment for the above, had been devised and implemented by the manager (5/8/2008). Further development is required to ensure that the risk assessment is Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 12 comprehensive in detailing the specific nature of risk, how this manifests and clear guidelines for staff as to how to minimise the risk. Although we recognise that ‘control measures’ and an ‘action plan’ were recorded, it was evident and confirmed by staff that they have not had an opportunity to read the risk assessment. Some elements recorded within the ‘action plan’ are not appropriate and not in line with the person’s care needs. This refers specifically to the ‘action plan’ detailing that the person should be supported and encouraged with “known preferred daily activities” and to “explore possibility of more activities”. The Social Recreational and Meaningful Activity care plan was also examined and this did not concur with the above, as it stated that the resident prefers to chat with staff, to not interact with other residents but has attended sing-a-longs more frequently. Following discussions with staff, the inspector was advised that one resident is “resistant to care”. A care plan for the above was devised and it was noted to provide staff with a reasonable level of information and guidance. Staff spoken with demonstrated a good understanding of the individual’s care needs in relation to the above. However, daily care records also recorded that the resident could become agitated and was low in mood on occasions since their admittance to the care home (05/08). It was unclear as to why a care plan for the above was not devised until 10/9/08. Daily care records also detailed that they regularly refused meals/had a poor appetite. We recognise that the care plan made reference to the person having a “very poor appetite” and “needs lots of encouragement”, however the care plan had not been updated to reflect that the person could refuse their meals on occasions. No risk assessment was devised for the above. The care file for another person who exhibits aggression and/or inappropriate behaviours was also examined. The risk assessment was noted to contain the same wording as the risk assessment detailed above. The risk assessment was noted to be generic and not person centred/individualised. Daily care records and formal recording documentation to record specific incidents did not correspond and there were some gaps. The care file for another resident recorded them as being at high risk of falls. Records showed that the person sustained a fall and was admitted to hospital for a short period of time. The evaluation recorded that once admitted back to the care home “will reassess then”. At the time of the site visit there was no evidence to show this had been undertaken. Additionally no care plan/risk assessment had been devised pertaining to falls and how this care need was to be met and minimised. Inspectors were advised that following the last key inspection the care manager and care team leaders had received care planning training, however staff spoken with stated that they were given conflicting and confusing information and four different explanations as to how to compile/complete care plan documentation. Some advice was provided by inspectors to staff with Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 13 regards to regulatory requirements and National Minimum Standards pertaining to care planning and risk assessing. Of those care plans inspected there remains little evidence to suggest that these had been devised with the resident and/or their representative. The AQAA details under the heading of ‘what we could do better’, “review all care plans monthly ensuring that residents/relatives input recorded” and “continue to involve residents and/or their representatives in the care planning process”. Records showed that residents continue to have access to a range of healthcare professional services such as chiropody, optician, District Nurse services, GP and Community Psychiatric Nurse as and when required. Professional visit records were observed at this site visit to contain more detailed information and to include outcomes. Residents spoken with confirmed that they receive regular personal care from staff and that staff treat them with respect and dignity. Of those residents spoken with, people confirmed they were happy living at Queens Park Court and that their care needs were being met. Staff, were observed to interact positively with residents. Interactions were noted to be sensitive, with respect and dignity and staff were noted to have a good rapport with individual residents. Many staff have been employed at the care home for many years and know intuitively the care needs of people who have lived at Queens Park Court for a significant period of time. Residents spoken with confirmed that they receive regular personal care from staff and that staff treat them with respect and dignity e.g. staff knock on their bedroom door before entering, personal care is provided in private etc. A pharmacist inspector examined practices and procedures for the safe use and handling of medicines. The home has good written policy and procedures in place for staff to follow, but these are corporate documents and do not reflect current practice within the home. Consequently there are some areas, which are not followed by staff and so they need updating to protect people who use the service. Medicines are stored centrally in a locked room and also in small locked cabinets in each of the bungalows. All areas were secure. The temperatures of the areas where medicines are stored on each bungalow are recorded regularly but that of the main storage room is not. It is of some concern that the temperature of the refrigerator used to store medicines had been recorded outside the recommended range on several occasions without action taken to investigate the performance of the fridge or the quality of medicines stored there. The failure to store medicines at the right temperatures may result in people receiving medication that is not effective. It is expected that this will be managed by the home without the need to make a requirement at this stage. There is no dedicated storage controlled drugs that complies with the relevant regulations, although this is required by the company policy. Again it is expected that this will be managed without the Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 14 need for a requirement. The decision not to make requirements despite there being shortfalls is based on the confidence that the management team will put the necessary remedial action in place. Records are made when medicines are received into the home, given to residents and when they are disposed of. This provides a reasonably clear audit trail to account for medicines in use. It was sometimes difficult to completely audit the medication as the date of opening for some medication wasn’t recorded despite this being in the home’s policy. The manager carries out regular audits of medication records and this is good practice. The records made when medicines are given to residents have improved and there were very few discrepancies but for some people the time recorded when medication was given was not accurate and could mean people are given medication too close together and for one person whose inhaler was prescribed to be used twice a day, the record showed it sometimes only used once a day. No explanation for this variation in use could be found in the care records. We observed some medicines being given to residents at lunchtime by a senior member of staff and this was done safely and taking into account residents preferences and dignity. Only suitable trained staff are permitted to administer medicines to residents and the quality of training and competence assessments is evidenced in staff training files. Queens Park Court DS0000067527.V372572.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their social care needs will be met and that they will receive a varied diet that meets their needs. EVIDENCE: The activities co-ordinator advised inspectors that she is employed for 16 hours per week, Tuesdays, Thursdays and Fridays. On Monday mornings a local church group provide a themed activity programme and once monthly a church service is held at the care home. The activities co-ordinator has undertaken dementia awareness training in July 2008 and has previously attended specific training for their role. It was clear from discussion with the activities co-ordinator that she has a good understanding of some residents personal social care preferences. Inspectors were advised that there is no budget from the registered provider to purchase items for activities e.g. board games, books, nail varnish etc. The activities co-ordinator stated that she often buys these herself and/or other staff members donate items. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 16 A list of activities for the week was displayed on a white board. Consideration should be given to provide a larger print and/or pictorial format, so as to enable residents to make an informed choice. This was highlighted at the previous key inspection to the home. On inspection of 4 weeks activities programme, the choice of activities available for residents include sing-a-long, manicures, bingo, dominoes, ball games, quiz, group discussion, external entertainers, crosswords etc. On the day of the site visit 22 people were observed to enjoy a sing-a-long and dancing during the morning. Further development is required to ensure that those people who have a poor cognitive development/dementia are provided with a programme of stimulated activities that meet their needs. The AQAA details under the heading of ‘what we could do better’, “to ensure we maintain an accurate record of residents involvement in programmes offered”. On inspection of care records for those people case tracked, further information is required, specifically detailing individual’s personal preferences relating to their social care needs. Information relating to activities undertaken by individual residents is recorded, however there is limited information recorded in some cases to reflect how those people with dementia/complex needs are actively supported to have their social care needs met. Additional information is required detailing whether or not the activity was actually enjoyed and/or whether or not the person engaged in the activity. Residents spoken with confirmed they are able to make choices as to whether or not they participate within the activity programme, what time they get up in the morning, the time they retire in the evening and where they choose to eat their meals. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. It was evident during the site visit that residents are actively encouraged and supported to maintain contact with family and friends. The menu was recorded on a white board both within the main dining room and within each bungalow. Consideration should be given to provide a larger print and/or pictorial format, so as to enable residents to make an informed choice. This was highlighted at the previous key inspection to the home. There is a rolling 4 week menu and this showed that residents have the option of 3 hot meals a day, including a cooked breakfast. The lunchtime meal was observed within all 4 bungalows and food was provided within each bungalow via a hot food trolley. Residents are given the option of having their meal in the dining area/lounge within each bungalow or within their own bedroom. Tables were attractively laid with tablecloths, condiments readily available, vase of flowers and serviettes. Meals provided to residents were attractively presented and portions of food seen to be plentiful. It was positive to note that where residents required assistance and support to eat their meal, staff, were observed to provide good support that was both respectful and sensitive to individual resident’s care needs. Residents were Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 17 asked about their personal preferences in relation to food/drinks, people were offered additional helpings of food and asked if they had finished their meal before plates were removed. People, who require a soft/pureed diet, were provided with an attractive plate of food, with each item of food portioned separately. Residents comments relating to the quality of food was positive and included, “the food is alright, no flavour but the meat was tender”, “I like the meals, there are plenty of choice”, “the food is lovely” and “oh the food is always very good”. It was evident that the dining experience for people living at Queens Park Court is positive. Queens Park Court DS0000067527.V372572.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an appropriate corporate complaints procedure and system for logging complaints and guidelines for staff in relation to safeguarding. People cannot be assured that staff working in the care home, have the skill and knowledge to deal with their challenging and/or inappropriate behaviours. EVIDENCE: The corporate complaints procedure is available but as highlighted at the previous key inspection to the home, this was not displayed. The manager and registered provider should consider displaying the procedure so that interested parties have the information required should they need to make a formal complaint. A copy of the document was located within the Statement of Purpose and Service Users Guide on the visitors’ notice board, however this recorded the incorrect contact details of the Commission for Social Care Inspection. Residents advised that if they were unhappy with an issue or had an area of concern, they would discuss this with a member of staff or the registered manager. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 19 The manager advised that since the last key inspection, no complaints have been received at Queens Park Court. Several compliments were noted and these included a thank you to all staff for their kindness and support, thank you for the care and support provided to someone who had received short term care, and a letter expressing appreciation for the kindness and care provided by “excellent” staff. Policies and procedures relating to safeguarding are readily available within the home. The manager advised that no safeguarding issues have been highlighted since the last key inspection. Several members of staff spoken with demonstrated a good understanding and awareness of safeguarding procedures and advised that should an issue arise, information would be passed to either the care team leader, care manager or manager. The current training matrix showed that 9 people have undertaken safeguarding training since the last inspection. This is seen as positive, however on inspection of the previous training matrix and the current records, this still shows some people as not having up to date training relating to the above. The AQAA details under the heading of ‘what we could do better’, “provide more regular abuse training for all staff, and gain staff compliance regarding attendance”. The document also details under the heading of ‘our plans for improvement in the next 12 months’, “regular abuse training for all staff and ensuring opportunities for all staff to attend”. It remains of concern that few members of staff have undertaken training relating to dealing with people’s aggression/challenging behaviours. We acknowledge that on the day of the site visit a senior manager from within the company was due to provide this training to some members of staff, however a decision was made to cancel this and to reschedule. Queens Park Court DS0000067527.V372572.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained and comfortable environment, which ensures their safety and wellbeing. EVIDENCE: A partial tour of the premises was undertaken throughout the day by both inspectors. Accommodation is provided to people within four bungalows, each of which has a lounge, dining area, kitchen and communal bathroom. Each resident has their own bedroom, which has en-suite facilities. Each bungalow has a telephone which residents are able to receive incoming calls. There is also a portable pay phone available for residents use. As highlighted at the previous key inspection to the home, we recognise that there is some signage around the home, however this is minimal and needs improving so as to aid orientation for people residing at the home. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 21 This was highlighted at the previous key inspection to the home and remains outstanding. On the day of the site visit, the home was observed to be odour free, clean and tidy. No health and safety were highlighted at this inspection. The laundry system within the home continues to be well run and organised, however the laundry door was noted to be wedged open on occasions, despite a notice on the door stating that the door is to be kept closed. When discussed with the laundry person, they advised that the laundry environment can become very hot and that was the rationale for keeping the door open. A random sample of residents’ bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display. The AQAA details under the heading of ‘what we do well’, “encourage residents to personalise their rooms”. Fire records showed that the last fire drill conducted at the care home was September 2007. This requires reviewing so as to ensure that staff, are aware of fire drill procedures. Records of emergency lighting testing and fire alarms were seen to be undertaken regularly. A fire risk assessment for the home was noted to be in place. Records of hot water temperatures from residents wash hand basins’, communal wash hand basins and baths were noted to be tested monthly and within recommended safety guidelines. Queens Park Court DS0000067527.V372572.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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The level of staffing/staff deployment restricts the ability of the service to deliver person centred care and to ensure that people’s needs, can be met and that they are safe. Shortfalls in training means that residents are not fully safeguarded and staff working at the care home may not have the necessary skills to meet the assessed needs of residents. EVIDENCE: The manager confirmed that staffing levels at the home remain at 4 care staff, plus a care team leader and care manager (morning), 3 care staff (until 16.00 p.m.) then 4 care staff, plus a care team leader (afternoon) and 2 waking night staff and 1 senior member of staff (night). In addition to the above, ancillary staff are utilised at the home (cook, kitchen assistant, housekeepers). The manager’s hours remain supernumerary to the staff roster. Arrangements as highlighted at the last inspection relating to the deployment of staff within the care home remain in place. It was felt at the last inspection that the above arrangements were inadequate and insufficient within one bungalow (Kent), whereby between 14.30 p.m. and 16.00 p.m. no staff are rostered to provide support to 10 people. This continues to potentially place people at risk and requires urgent review. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 23 Dependency levels recorded by the manager for this bungalow for July 08 to September 08 inclusive, evidence that some people continue to have medium to high needs. Staff spoken with confirmed that they felt current staffing levels were inadequate. On inspection of accident records, these showed that two residents who live in Kent bungalow experienced a number of falls, some of which occurred between 14.30 p.m. and 16.00 p.m. and were not witnessed by care staff. On inspection of 3 weeks staff rosters these show that staffing levels as detailed above have been attained. The manager stated that no agency staff are currently being used at the care home. Residents were generally complimentary about staff working at the care home and comments included, “oh the staff are wonderful”, “the girls are very good” and “staff are mostly ok and nice, some forget who they are and think they are in control”. Another resident spoken with, stated they need to consider the time of day they request assistance, as at times staff are scarce. Staff spoken with confirmed they have little time to spend with residents as a result of tasks and routines within the home. It was evident from discussions with staff that they found this difficult and upsetting. The AQAA details under the heading of ‘what we could do better’, “maintain an adequate level of staff in all domains in order to ensure a continuous and consistent standard”. No new staff had been recruited to Queens Park Court since the last key inspection. A random sample of 2 staff employment files were examined at this site visit and records showed that all records as required by regulation were in place. Records provided by the manager showed that 13 members of staff have attained NVQ Level 2 and 3 people have achieved NVQ Level 3. Additionally the manager has attained both NVQ Level 3 and Level 4. The current and previous training matrix showed that only 7 members of staff have received training relating to dementia awareness (4 since the last key inspection). It is of concern that the above has been highlighted as a statutory requirement since 31/3/07 and remains outstanding. Whilst we recognise that 4 members of staff received this training since the last key inspection, 23 members of staff (as listed on the training matrix) have not received this training. It remains disappointing that training relating to dementia is not seen to be a priority by the management team of the home and/or the registered provider and yet the home is registered to provide accommodation to people who have a formal diagnosis of dementia. This means that some members of staff may not have the necessary skills and competence to meet the specific and/or demanding care and management needs of a person with dementia and potentially places people at risk of not having all of their care needs met. The Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 24 AQAA details under the heading of ‘what we could do better’, “encourage and assist staff to attend training sessions provided”. Training records also showed that since the last key inspection 9 members of staff have undertaken training relating to manual handling, 1 member of staff had undertaken training relating to palliative care, 4 members of staff had received training relating to health and safety, COSHH (Control of Substances Hazardous to Health) and fire awareness and 4 members of staff undertook training relating to food hygiene and infection control. From inspection of both training matrix’s, these continue to show training deficits for some members of staff in relation to core areas such as food hygiene, infection control, fire awareness, health and safety and those conditions associated with the needs of older people. The training matrix does not record those members of staff who have attained basic first aid training. The Statement of Purpose records “there will be a training first aider on duty in the home 24 hours a day”, however this was unable to be determined from the records provided. Queens Park Court DS0000067527.V372572.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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst management arrangements in some areas are good, shortfalls identified could potentially affect positive outcomes for residents. EVIDENCE: The manager has many years experience in working with older people and people who have a formal diagnosis of dementia. As stated previously the manager has attained NVQ Level 3 and 4 in Care, City and Guilds 325/3 and has in the past undertaken training relating to core subject areas. As stated previously much of the manager’s training was noted to be out of date and not updated. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 26 It is evident at this site visit that some progress has been made to address previous identified shortfalls, however further development continues to be required in relation to care planning/risk assessing, staffing levels appropriate to meet residents dependency levels and needs, dementia training and training for those conditions associated with the needs of older people and core subject areas. Several statutory requirements highlighted at this inspection are repeat requirements. Should these continue to be highlighted at future inspections to the home, enforcement action may be taken. The AQAA details under the heading of ‘what we could do better’, “maintain and improve on current standards. Comply with legislation and identified statutory requirements and/or recommended good practice”. Staff spoken with continue to be complimentary about the manager and confirmed that she is very approachable and provides good support. As stated at the previous key inspection, the outcome from the September 07 quality assurance survey remains unavailable and outstanding. On inspection of a random sample of staff employment records, these showed that staff, are receiving regular formal supervision. A random sample of monetary records for individual residents was examined and seen to be satisfactory. Records of staff and resident meetings undertaken since the last key inspection were examined. Staff meeting minutes for July 08 showed that only 5 members of staff were present and planned senior night care/night care meetings were cancelled. The last resident meeting was held in September 08 and it was positive to note that 14 residents attended. Residents’ accident records were inspected and these continue to be well maintained and documented. As stated at the previous inspection there is a health and safety policy available within the home. Random safety and maintenance certificates were examined in June 08 and these were noted to be up to date. Health and safety audits are completed every 6 months. Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) (b)(c)(d) Requirement Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and ensure that these are regularly updated/reviewed to reflect the most up to date information. Previous timescale of 1.12.07 and 1.8.08 not met. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Previous timescale of 1.8.08 not met. Ensure that the health and welfare of individual residents is promoted and proactively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to recognise when to contact healthcare professionals and to provide appropriate interventions. Previous timescale of 1.8.08 not Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 29 Timescale for action 01/12/08 2. OP7 13(4) 01/12/08 3. OP8 12(1)(a) 01/10/08 4. OP18 13(6) fully met. Ensure that all care staff, receive appropriate training relating to safeguarding and dealing with people’s aggression/challenging behaviour. This will ensure that staff, have the skills and competence to manage people’s behaviours and to provide appropriate care. Previous timescale of 1.9.08 not fully met. Ensure there are sufficient staff on duty at all times, and that the deployment of staff is appropriate to meet the needs of residents and to ensure their safety and wellbeing. 01/02/09 5. OP27 18(1)(a) 01/10/08 6. OP30 18(1)(c)& (i) Previous timescale of 17.6.08 not met. Ensure that staff, receive 01/02/09 appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people and core areas. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. Previous timescale of 1.10.08 not fully met. The manager must ensure that all staff are provided with training on understanding and caring for people with dementia so that they can provide appropriate support. Previous timescale of 31.3.07, 1.12.07 and 21.8.08 not met. 7. OP30 18(1)I&(i) 01/02/09 Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP12 Good Practice Recommendations Pre admission assessments should be devised for all prospective people admitted to the care home. Consider devising the activity programme in larger print and/or pictorial format so as to enable people to make an informed choice. Consider devising the menu in larger print and/or pictorial format so as to enable people to make an informed choice. Outcomes of surveys/quality assurance should be available. 3. 4. OP15 OP33 Queens Park Court DS0000067527.V372572.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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