Inspection on 17/06/08 for Queens Park Court

This inspection was carried out on 17th June 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 01/10/08

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Queens Park Court Goldington Cresent Billericay Essex CM12 0XR Lead Inspector Michelle Love Unannounced Inspection 17th June 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Queens Park Court DS0000067527.V366640.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.V366640.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.V366640.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. 19th June 2007 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 Carol 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 Sheltered Housing and the people at 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.V366640.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 10 hours, with all key standards inspected. Additionally, 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. This is a self-assessment document detailing what the home does well, what could be done better and what needs improving. 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. At the time of the site visit, surveys for relatives were left at the home for people to complete and return to us. Where surveys have been returned to us, comments have been incorporated into the main text of the report. The manager, care manager and other members of the staff team assisted both inspectors on the day of the inspection. Feedback on the inspection findings were given throughout and summarised at the end of the day with both the manager and care manager. The opportunity for discussion and/or clarification was given. As a result of concerns relating to medication practices and procedures, inadequate care planning/risk assessing and insufficient dementia training for staff, two Immediate Requirement Notices were issued. What the service does well: Residents are formally assessed prior to admission so that care staff, are able to meet the needs of the prospective person. Rapport between staff and residents was observed to be positive. Visitors to the home are made to feel welcome. Food provided to residents is of a high quality and comments from residents relating to meals provided, was positive. There is a varied menu and various alternatives are available if required. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 6 The home is homely and comfortable for residents. Residents spoken with during the inspection were satisfied with the home environment and their personal space. There is a safe system in place to safeguard individual’s monies. What has improved since the last inspection? What they could do better: Practices and procedures for the safe handling, administration and recording of medicines must be improved to ensure that residents are protected. Further development is required in relation to care planning and risk assessing processes, so as to ensure that individual plans of care are comprehensive, up to date, reflective of people’s current care needs and ensure that the care provided to residents, meets their specific requirements. People living at the care home and/or their relatives need to be more involved in the care planning process. The social care needs for people at the home and specifically for those people who have dementia/complex needs must be improved. The deployment of staff at the home needs to be reviewed so as to make sure that residents needs are met at all times and are in line with people’s dependency levels. Further training and personal development is required for staff to ensure that they have the skills and competence to meet resident’s needs and to deliver good care. Particular attention must be provided for those conditions associated with the needs of older people and dementia. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 7 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.V366640.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect that they will be properly assessed prior to admission and assured that their needs can be met at this home. EVIDENCE: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective resident’s needs. In addition to the formal assessment procedure, supplementary information is sought from the individual resident’s placing authority and/or hospital. On inspection of three care files for those people newly admitted to the care home, evidence indicated that pre admission assessments were completed by the management team of the home prior to the person’s admission. Information recorded was observed to be detailed and informative. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 10 Of the three care files examined, there was limited information recorded to indicate that the pre admission assessment had been undertaken with either the resident and/or their representative and that people were provided with the opportunity to visit the care home prior to admission. The Annual Quality Assurance Assessment under the heading of `how we have improved in the last 12 months` details, “Pre admission assessment form updated; now includes if statement of purpose given, when and if prospective residents/relatives invited to view the home”. Additionally, confirmation from the management team to the resident and/or their representative verifying that it can meet the person’s needs was not available for all people case tracked. The home does not provide intermediate care. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents can expect to have an individual plan of care in place, however significant shortfalls in actual care planning, risk assessing and medication practices means that residents cannot be assured that their needs will always be met or that their health and wellbeing will be maintained or proactively managed. EVIDENCE: At this inspection, a random sample of 4 care files were examined in full and 1 care file was examined in relation to the person’s healthcare needs. There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by care staff, however information recorded was seen to be basic and lacked detail. Additionally formal assessments are to be completed in relation to dependency levels, manual handling, falls, pressure area care and nutrition. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 12 Three out of four files examined were observed to contain basic information relating to Activities of Daily Living, Quick Reference Care Plans and Social Recreational/Meaningful Activity Care Plans. Evidence showed that individual resident’s needs are not fully recorded, do not include the interventions required so as to ensure the appropriate delivery of care and are not regularly reviewed to reflect individual resident’s changed needs and how this affects their daily life. Of the 4 care files examined in full there was no plan of care for 2 people and one person’s care file only contained brief information relating to their diabetes. As a result of the above, an Immediate Requirement Notice was issued. The care plan for another person was examined and this evidenced no care plan and/or risk assessment had been devised in relation to the resident’s challenging behaviours, yet daily care records and other monitoring charts as far back as November 07 evidenced that at times the person was unsettled, confused, was un-cooperative and displayed aggression towards both staff and other residents. No guidelines were available providing proactive measures for staff as to how to deal effectively with the person’s inappropriate behaviours and several entries recorded that the only measure taken by staff was to take the resident to their room. This is inappropriate and shows a lack of knowledge and understanding by staff and the management of the home around dealing with residents’ physical and/or verbal aggression. Records of healthcare professional visits recorded the GP as visiting in September 07 and a referral to a Community Psychiatric Nurse in April 08 in relation to the person’s inappropriate behaviours. No information was recorded pertaining to the latter to indicate this had been followed up and/or pursued. Daily care records for the same person also recorded them, on occasions, as refusing their medication and having a poor appetite. No care plan and/or risk assessment was devised for either area. In relation to the individual’s poor appetite, the nutritional assessment detailed that the person’s weight should be checked and recorded every 1-2 weeks. There was no evidence to support this action being undertaken as detailed above and records showed that the person’s weight was monitored monthly. Of those care plans inspected there was little evidence to suggest that these had been devised with the resident and/or their representative. The Annual Quality Assurance Assessment under the heading of `what we could do better` records, “Review all care plans monthly ensuring that residents/relatives input recorded. Continue to involve residents and/or their representatives in the care planning process”. The document also states that within the next 12 months improvements will be made to consult with residents and their representatives and record outcomes. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 13 Records showed that residents have access to a range of healthcare professional services such as chiropody, optician, District Nurse services and GP as and when required. However, records relating to professional visits are inconsistently completed and do not always include details of the outcome from the visit. This needs to be improved so as to evidence healthcare interventions provided to individual residents. One care file was examined in relation to one aspect of their healthcare needs. Records indicated that specific recording charts, which should have been in place, were not and the care plan relating to this specific care need, lacked detail and clarity. Records were evident of 2 care plan audits having been undertaken by one of the registered provider’s senior manager’s in February 08. These confirmed that the senior manager had identified shortfalls pertaining to care plan recording. Of those residents spoken with, people confirmed they were happy living at Queens Park Court and that their care needs were being met. Relatives surveys returned to us documented mixed comments in relation to `do you feel that the care home meets the needs of your friend/relative`. One survey recorded “not always”, one survey recorded, “usually” and one recorded, “basically yes, but we must not be complacent about things-there is always room for improvement”. Staff, were observed to interact positively with residents e.g. with respect and dignity and evidenced a good rapport with individual people. The majority of medication is managed through a monitored dosage system (blister pack). Storage systems within the home were appropriate, and temperatures for the storage room and the fridge used to store medicines were regularly recorded and noted to be satisfactory and within recommended guidelines. Actual administration of medication to residents was observed during the inspection and this was observed to be satisfactory, however during the inspection the medication trolley on one bungalow, was noted to be left open and unattended for a timed period, with medication easily accessible to residents, staff and others. This is unacceptable and could result in other people helping themselves to the medicines available and residents having access to the medication and possibly overdosing with serious consequences. Medication records were not up to date, with gaps in recording and information. This refers specifically to no record of some medicines having been given to the resident when they were due, as the entries on the MAR (Medication Administration Record) record had been left blank and not signed/initialled by staff. Where the prescriber’s instructions state 1 or 2 tablets to be administered, the actual dose administered was not always recorded. The MAR record for some people showed medication was not Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 14 administered, as this was not available and staff had failed to ensure a sufficient supply of medication. Additionally the MAR record evidenced for some people that `O`(other) was recorded, however there was no evidence on the reverse of the MAR record as to the rationale. The MAR record also evidenced in some cases that those people who are prescribed painkillers, are having this medication administered not in line with the prescriber’s instructions. As part of good practice procedures, several handwritten MAR records were observed to not be double signed by staff, so as to evidence that information recorded was correct and accurate. Also handwritten MAR records did not always include the quantity of medication received, who by and the date commenced. A discrepancy for one person was noted relating to one of their prescribed medications. This refers specifically to the quantity of medication recorded as received and the number of signatures recorded on the MAR record not tallying. During the inspection it was observed that one resident requires oxygen. No care plan and/or risk assessment was devised in relation to the person’s use of oxygen and/or their breathlessness. Additionally there were no warning signs in place on their door advising that oxygen was being utilised. As a result of the above shortfalls and areas of concern, an Immediate Requirement Notice was served to ensure that residents are protected from harm by having their medication administered safely and in accordance with the prescriber’s instructions. Training records showed that all but one member of staff who is named as administering medication to residents had attained up to date medication training. There was limited evidence to show that staff, have undertaken competency assessments so as to ensure that their practice remains appropriate and in line with regulatory requirements and guidelines. This is seen as good practice and should be considered for the future. Queens Park Court DS0000067527.V366640.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 adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the activities programme at the home, for those people with dementia, means that some residents do not have their social care needs met. People can be assured of receiving a varied diet and that their nutritional needs will be met. EVIDENCE: The manager confirmed that activities are provided to residents on Tuesdays, Thursdays and Fridays and on Monday mornings a local church group provide a themed activity programme. Additionally once a month a church service is held and all denominations are welcome to attend. A list of activities for the week was displayed on a white board. Both the manager and care manager were advised to consider a larger print and/or pictorial format, so as to enable residents to make an informed choice. On inspection of a random sample of resident’s care files, not all were observed to have their social care needs/personal preferences, likes and dislikes documented. Additionally there was limited evidence of actual activities Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 16 offered and/or undertaken, recorded for individual resident’s within their care files. One person’s care file made reference to their participating in sing-along, dominoes, manicure and a chat with another resident. There was limited evidence to indicate that the social care needs of those people with dementia are proactively managed and/or pursued. The Annual Quality Assurance Assessment under the heading of `what we could do better` details, “To ensure we maintain an accurate record of residents involvement in programmes offered”. A small number of residents were observed on the day of the site visit to participate in chair exercises. Residents were observed to enjoy this particular activity. It was disappointing to note that this was the only activity provided throughout the day and for those people with complex needs and/or dementia there was very little stimulation provided by care staff. Two relatives surveys returned to us recorded, “The residents could do with more stimulation and one-to-one conversation. Its not good to have the radio and television on all day and just have them fall asleep” and “In an ideal world it would be nice if some time was given to taking patients out on an occasional outing. This would be so nice for them, just to give them a break from the home environment. One other thing about having more staff perhaps they would be able to spend a little more time actually talking to the patients”. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. The manager advised both inspectors that residents are 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. Both the manager and care manager were advised to consider devising the menu in larger print and/or pictorial format so as to enable residents to make an informed choice. There is a rolling four week menu and this evidences that residents are provided with three hot meals a day, including a cooked breakfast. The lunchtime meal was observed by both inspector’s, within 2 bungalows. Tables were observed to be attractively laid with condiments readily available, vase of flowers and serviettes. Meals provided to residents were attractively presented and portions of food seen to be plentiful. Where residents required assistance to eat their meal, staff, were observed to provide appropriate support that was both respectful and sensitive to individual resident’s care needs. It was positive to note that residents were asked about their personal preferences in relation to food/drinks, people were offered the choice of more food and asked if they had finished their meal before plates were removed. People, who require a soft/pureed diet, were presented with an attractive plate of food, with each item of food portioned separately. Residents’ comments relating to the quality of food was positive and comments such as, “the food is lovely”, “I enjoy the food provided” and “its very good” Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 17 were made to the inspectors. Where some residents were unable to verbally express an opinion, they were seen to enjoy the food provided. Queens Park Court DS0000067527.V366640.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. Although there is an appropriate complaints procedure and system for logging complaints, not everyone feels their concerns are taken seriously and acted upon. EVIDENCE: There is a copy of the home’s corporate complaints procedure available, however this was not displayed. The manager was advised that the procedure should be displayed so that interested parties have the information required should they need to make a formal complaint. Of those relatives surveys returned to us, all stated they knew how to make a complaint. It was of concern that one survey recorded “no point” and advised that following relatives meetings, they had not received answers to the concerns raised. It was positive to note that several records of compliment regarding the care provided at the care home were readily available. One record of compliment stated, “Thanks to you all for looking after [name of resident] so well”. The Annual Quality Assurance Assessment details over the past 12 months, the management team of the home have received two complaints. On examination of records, a record of each complaint was available and included details of the investigation, however information was not available for one complaint relating to the action taken and outcome. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 19 No safeguarding issues have been highlighted since the last key inspection. Policies and procedures relating to safeguarding are readily available within the home. Staff spoken with demonstrated an awareness and basic understanding of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge of the shift. Following discussions with the manager, the manager confirmed that she did not have current updated information relating to local safeguarding procedures and protocols but would look into this. On inspection of the training matrix, this evidenced not all people has having up to date safeguarding training. Additionally the training matrix recorded only 5 people as having training relating to dealing with people’s aggression/challenging behaviour. As stated previously, the care plan for one person detailed that they exhibited challenging/inappropriate behaviours on occasions. Records monitoring this person’s behaviours detailed the use of restraint was used by a member of staff. It was of concern that no record identifying the type of restraint used, the timeframe and outcomes were recorded. Queens Park Court DS0000067527.V366640.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. The environment enables residents to live in a safe, well maintained and comfortable environment. EVIDENCE: A partial tour of the premises was undertaken throughout the day by both inspectors. The home provides accommodation for residents within four bungalows, each of which has a lounge, dining area, kitchen and communal bathrooms. Each resident has their own bedroom, which has en-suite facilities. We recognise that there is some signage around the home, however this is minimal and needs to be improved so as to aid orientation for people residing at the home. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 21 A random sample of residents’ bedrooms, were inspected and all were seen to be personalised and individualised with many personal items on display. Of those residents spoken with, all confirmed that they liked their personal space and found the home environment to be satisfactory. The home was observed to be odour free, clean and tidy and no health and safety issues were highlighted at this inspection. The laundry system within the home was observed to be organised and well run. A maintenance person is employed at the care home 3 days a week. The Annual Quality Assurance Assessment details, there is an on-going programme of maintenance at the home and there is a programme of redecoration in place. Over the next 12 months it is hoped that the redecoration programme will continue and to respond proactively to ideas and requests from residents and/or their representatives where identified. A random sample of safety and maintenance certificates showed that equipment in the home has been serviced and remain in date until their next examination. There was evidence to show that weekly checks are undertaken for the homes emergency lighting and fire alarm system. Records relating to fire drills for staff evidenced that the last one conducted was in September 07. The manager was advised to ensure that staff, participate in regular fire drills for the future. The staff, training matrix evidences that the maintenance person has received training relating to health and safety, COSHH (Control of Substances Hazardous to Health), fire training, infection control and manual handling. Queens Park Court DS0000067527.V366640.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 advised the inspector that staffing levels at the home are 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 are supernumerary to the staff roster. Both inspectors were advised by staff that one carer is allocated to each of the 4 bungalows in the morning and the care team leader acts as a `floater` and assists staff/residents where required. In the afternoon one carer is allocated to one of 3 bungalows, however inspectors were advised that no staff are allocated to 1 bungalow (Kent) between 14.30 p.m. and 16.00 p.m. The above information was confirmed by both the manager and care manager. Dependency levels, recorded by the manager, for this bungalow were Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 23 inspected from January 08 to May 08 inclusive and these evidenced that the majority of residents fell in the category of having either medium to high care needs. The above arrangements are seen as inadequate and insufficient, potentially placing people at risk and require urgent review. The Annual Quality Assurance Assessment under the heading of `what we do well` states, “Dependency levels are recorded on a monthly basis, and staffing levels reviewed accordingly”. On inspection of 3 weeks staff rosters these evidence that staffing levels as detailed above have not always been maintained. We have not received any Regulation 37 notifications advising us of the staffing shortfall and measures undertaken to deploy staff to the home. Three relatives surveys provided to inspectors recorded, “In my mind I feel additional staff are needed. Additional staff with additional qualified staff. If this was taken on board it would help the existing staff and balance the load. The existing staff are super”, “Due to staffing levels since privatisation, individual one-to-one care has been reduced” and “The bungalow is often left unattended for long periods of time. They are expected to be in two places at once. Bungalows often left with no staff at all for quite a length of time”. The Annual Quality Assurance Assessment details that 11 people require assistance of two or more staff to help with their care throughout the day and night. Staff spoken with during the inspection provided mixed comments relating to staffing levels at the home. This refers specifically to some staff stating that staffing levels were appropriate and others advising that the needs of residents within the home were predominantly medium to high needs and at key times during the day additional staff were required. The management of the home need to be able to demonstrate that the staffing levels are appropriate to meet the needs of people living at the home. The manager advised inspectors at the site visit that there are no staff vacancies at present. The staff files for 2 newly employed people were examined. The majority of records as required by regulation were evident, however gaps were noted in relation to no recent photograph for either employee, full employment history not explored for one person and no start date of employment for either person. Evidence of staff induction was available for both people. The manager advised that new employees are issued with an induction workbook. This was seen to be comprehensive and in line with Skills for Care. One member of staff spoken with was able to confirm that they had received an induction and that this had been detailed. The Annual Quality Assurance Assessment details that 15 people have completed NVQ Level 2 or 3. The training matrix for 2007 and 2008 were inspected and these evidenced training deficits for some members of staff in relation to core areas such as food hygiene, infection control, fire awareness, Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 24 health and safety, safeguarding and those conditions associated with the needs of older people. The main area of concern was in relation to dementia training for staff. At the previous key inspection to the home, a requirement was highlighted detailing that “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”. The report details this is a repeat requirement, with the last timescale of 31/3/07 not met and a revised timescale of compliance 1/12/07 recorded. It is of concern at this site visit, following discussions with the manager and from inspection of the training matrix, no members of staff have undertaken dementia awareness training since the last inspection and the above requirement remains outstanding. It remains disappointing that training relating to dementia is not seen to be a priority by the management of the home and/or registered provider and yet the home is registered to provide accommodation to people who have a diagnosis of dementia. This means that some members of staff may not have the necessary skills and competence to meet the specific care and management needs of a person with dementia and potentially places people at risk of not having all of their care needs met. As a result of the above, an Immediate Requirement Notice was issued. Additionally the training matrix also details that only 5 people have training relating to challenging behaviour. At this site visit it was evident that there are some people at Queens Park Court who display aggression/inappropriate behaviours. Queens Park Court DS0000067527.V366640.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, 32, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements in the home are adequate and shortfalls identified throughout this report could adversely affect outcomes for residents. EVIDENCE: The manager has many years experience in working with older people and people with dementia. The manager has attained NVQ Level 4 in Care (July 05) and there was evidence that she has in the past undertaken training relating to core subject areas, however at this site visit it was noted that much of the training was out of date and had not been updated since. The manager confirmed her awareness that much of her training was out of date and required renewing. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 26 Staff spoken with were very complimentary about the manager and confirmed that she was approachable and provided good support. There are clear lines of accountability within the home and the manager is supported on a regular basis by a senior manager, from within Rushcliffe Care Ltd. The Annual Quality Assurance Assessment under the heading of `what we do well` states, “work as a team, providing clear lines of accountability”. It is evident from this inspection that insufficient progress has been made to address previous identified shortfalls in relation to care planning and dementia training for staff. Areas highlighted at this inspection, which require further development relate to care planning/risk assessments, ensuring medication practices and procedures for residents are safe, staffing levels appropriate to meet residents dependency levels and needs, sustained training and development of staff particularly around those conditions associated with the needs of older people and core subject areas. The Annual Quality Assurance Assessment details under the heading of `our plans for improvement in the next 12 months`, “Maintain and improve on current standards. Comply with legislation and identified statutory requirements and/or recommended good practice”. All sections of the Annual Quality Assurance Assessment were completed and gives a reasonable picture of the current situation within the service. The evidence to support the comments made is satisfactory, however more supporting evidence would have been useful. A random sample of monetary records for individual residents was examined and seen to be satisfactory. The manager advised inspectors that a quality assurance survey was undertaken by the registered provider so as to seek the views of residents and relatives to gauge what people think of the service. This was completed in September 07, however no information relating to the outcomes of the survey were available at the time of the site visit. Records of staff meetings were evident and showed that the last meeting conducted was in May 08, however only 6 members of staff were present. Records indicated that the February meeting was cancelled and the previous records available related to November 07, September 07 and July 07. There was evidence to indicate that additional meetings are held by individual heads of department e.g. housekeepers, night carers. Records of regular resident meetings were available. One relatives survey returned to us recorded that “there have been several meetings with other relatives concerning care/staffing levels. We have never had a proper answer to our concerns, only that it works in other homes. I have never seen any minutes or answers to the concerns raised”. The manager confirmed the above and stated that 2 meetings had occurred between Rushcliife Care Ltd and relatives, however no minutes were available. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 27 A health and safety policy was observed within the home. Accident records were inspected and these evidence that 3 monthly analysis of accidents and incidents are undertaken. Records were seen to be well maintained and documented. A random sample of safety and maintenance certificates, showed that these were up to date. A health and safety policy and procedure was available and there was evidence to indicate that health and safety audits are completed 6 monthly. As stated previously there was evidence to indicate that some staff require training relating to fire awareness, infection control, first aid, health and safety and COSHH. Queens Park Court DS0000067527.V366640.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 3 Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 29 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. People living at the home and/or their relatives must be involved in the completion and frequent review of their care plans to ensure that they are in full agreement with way they are to be supported to meet their care needs. Previous timescale of 1.12.07 for the latter not met. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. 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 DS0000067527.V366640.R01.S.doc Timescale for action 01/08/08 2. OP7 13(4) 01/08/08 3. OP8 12(1)(a) 01/08/08 Queens Park Court Version 5.2 Page 30 4. OP9 12(1)(a) 13(2) 5. OP9 17(1)(a) Schedule 3(3)(i) 6. OP9 13(4) 7. OP12 16(2)(m) and (n) 8. OP16 22 recognise when to contact healthcare professionals and to provide appropriate interventions. Residents must be protected from harm by having their medication administered safely and in accordance with the prescriber’s instructions so as to ensure their health and wellbeing. Ensure that when medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. Ensure that the medication trolley is not left unattended and medication easily accessible to residents and others. This will ensure that unnecessary risks to residents’ health and wellbeing is averted. Ensure that residents receive a varied programme of stimulating and interesting activities both `in house` and within the local community so as to ensure people have their social care needs met. Ensure that all records of complaints note the action that was taken and the outcome. Ensure that people feel confident that their concerns/complaints will be listened to and acted upon. 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. DS0000067527.V366640.R01.S.doc 17/06/08 17/06/08 17/06/08 01/08/08 17/06/08 9. OP18 13(6) 01/09/08 Queens Park Court Version 5.2 Page 31 10. OP27 18(1)(a) 11. OP29 19 12. OP30 18(1)(c)& (i) 13. OP30 18(1)I&(i) 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. Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents. Ensure that staff, receive 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. 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 and 1.12.07 not met. 17/06/08 17/06/08 01/10/08 21/08/08 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 OP3 OP3 OP9 Good Practice Recommendations Information to evidence that the pre admission assessment process has been undertaken with the resident and/or their representative should be recorded. Evidence confirmation that following assessment, the care needs of the resident can be met. As part of good practice procedures, handwritten MAR records should be double signed/witnessed to indicate that DS0000067527.V366640.R01.S.doc Version 5.2 Page 32 Queens Park Court 4. 5. 6. 7. 8. 9. OP9 OP12 OP15 OP18 OP32 OP33 the information recorded is accurate. Staff, who administer medication to residents should undertake regular competency assessments to ensure that their practice remains appropriate. 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. Records of any restraint used on an individual person should include the type of restraint used, the timeframe and outcomes. Consider more regular staff meetings. Outcomes of surveys/quality assurance should be available. Queens Park Court DS0000067527.V366640.R01.S.doc Version 5.2 Page 33 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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