Inspection on 19/06/07 for Queens Park Court

This inspection was carried out on 19th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 17/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Queens Park Court Goldington Cresent Billericay Essex CM12 0XR Lead Inspector Brian Bailey Key Unannounced Inspection 10:00 19 June, 24 July & 22nd August 2007 th th 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.V341682.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.V341682.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.V341682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. Personal care to be provided to no more than forty (40) Older People over the age of 65 years (OP). 7th November 2006 3. 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 owns the home and the registered manager is Carol Stockbridge. Accommodation consists of 40 single bedrooms each with WC en-suite facilities. People at the home are accommodated in four separate units, each with its own kitchen and living/dining area. There are a number of garden areas around the home. 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. As at 26th July 2007, the home advised that the fees for accommodation ranged from £434.63 to £650.00per week. 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.V341682.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection looking at the core standards for the care of older people. This report is based on a range of information that has been accumulated from our inspection records, site visits to the home that took place on 19th June at 10.00am, 25th July at 10:20am and 22nd August 2007 at 11.30am, tours of the property, discussions with the senior manager at Rushcliffe Care, the home’s registered manager and care manager, administrator, staff, people that live at the home, relatives, and information from survey forms issued by CSCI, records kept at the home and the home’s annual quality assurance assessment, which was returned to us in July 2007. The home is registered to provide accommodation and care to 40 people, although at the time of the first site visit there were 36 people in residence. It is now just over a year since the home was taken over by Rushcliffe Care Ltd. This period of transition has been difficult for some people owing to changes in systems, policies and some procedures that often occur when there is a change of owner. Many of the issues found at the previous inspection visits had been addressed and the atmosphere throughout the time spent at the home in June and July was calm, relaxed and there was a noticeable level of humour and good natured banter present on several occasions. The home’s self-assessment report outlines what needs to be done to improve the service during the next year and from observation, the objectives appear to be realistic. Feedback from health care professionals was excellent, relatives and people living at the home was generally positive but a few people, mainly relatives, had concerns about the number of staff available on duty. What the service does well: There is a homely and welcoming environment in four small group living units that have good outlooks and access to the garden areas. Spacious communal rooms and private sittings areas for visitors to use are available. Peoples’ money looked after for safekeeping is secure and records are well maintained. Effective systems are in place to ensure medication is kept secure and that staff are trained to administer medication correctly. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 6 Feedback to us from people at the home, their relatives and health care professionals indicated that staff are considered to be polite and helpful and courteous, which the homes own surveys also found. 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.V341682.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.V341682.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): 1, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving into Queens Park Court could be confident that the home would not admit them without being able to confirm and demonstrate that the service could meet their needs. EVIDENCE: The home has a Statement of Purpose that sets out the objectives and philosophy of the service. The home’s Service User Guide details what service and facilities prospective individuals can expect. These had been updated since the last inspection although an amendment is required concerning the information about CSCI’s involvement in complaints. See the section in this report under the heading “Complaints and Protection”. There was no evidence on the files seen to confirm that information about the home and the service had been provided to each person. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 9 Admissions are not made into the home until a full needs assessment has been undertaken, unless there is an emergency admission. Where a person is admitted with a Care Management Assessment, the home still undertakes an independent assessment and these two documents form the basis of the individual’s plan of care. The manager was in the process of planning a visit to an individual in hospital the following day to carryout an assessment using the home’s procedures and appropriate forms. Visits are offered to people considering making Queens Park Court their home so they can ‘get a feel’ of what it would be like to live there. Three care files inspected revealed assessments had been obtained for two people, although the third person was admitted as an emergency and information was gained subsequently. The manager stated that written confirmation as to whether the home is able to meet an individual’s needs is provided and evidence of this was available. Information was also available to show that one of the three people case tracked did take the opportunity to visit the home prior to admission. Queens Park Court does not provide intermediate care. Queens Park Court DS0000067527.V341682.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 adequate. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to have a plan of care to help meet their needs, to be treated with respect and that their medication will be administered safely, but they can not be certain that they will be consulted about their care plan and when they are reviewed. EVIDENCE: The care records of three people were checked. These contained a needs assessment and a care plan. Assessments are obtained from the placing authority and there was evidence that the manager is now using the appropriate Rushcliffe Care initial assessment form, which includes risk assessments and is adaptable to meet needs of each person. There was evidence on one of the three files checked that staff had sought the wishes of the person in respect of care they would want during illness and following death. Care records included information of visits by health care professionals, Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 11 a photograph, a monthly record of weight, reviews and details of all key people such as relatives, social worker and GP. Care plans seen varied in content but did so based on the assessed needs of each person. Reviews of care plans were not always being carried out on a monthly basis and more evidence of consultation with people is required. From observation in a variety of locations and at different times of the days, it was evident that staff treated people with respect and acknowledged their right to privacy. People were seen to come and go as they please. A number of people chose to spend time in their bedrooms where they were not disturbed unnecessarily by staff. Those people that wanted company sat in their units or in the communal areas, where care staff and the cook were observed to spend some time chatting with people. Staff were observed as patient, cheerful and attentive. The home continues to use a Monitored Dosage System for the administration of medication. Appropriate security and administrative procedures were in place to ensure medication is kept safe. The Medication Administration Record (MAR) sheets seen were up to date and the record reflected the medication available in the blister packs. Staff had recorded the opening date on all packets and bottles of medication. The care manager confirmed that only designated staff that have received appropriate training are permitted to administer medication. Records were available to show that staff training included a check of their competency to carryout the duties. Controlled drugs were recorded in a register, which contained two signatures and a running total of the balance, which equated with the actual medication remaining. This medication is an appropriate cupboard secured to the wall. Unwanted medication that is returned to the pharmacist is being recorded and signed for. A list of staff names with their signatures was available to enable easy identification of staff from the MAR sheets. Medication was observed being taken to the four units by the care manager at lunchtime. This was carried out efficiently and effectively. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. People who use this service can expect to be encouraged to maintain contact with family and friends, to be offered meaningful activities and to have a balanced diet. EVIDENCE: The home employs an activities coordinator. The staff member described the usual activities that take place, which are aimed at groups and individuals. People spoken with confirmed that activities took place and there was written evidence on files. The homes own assessment includes plans to develop further the range of activities that are available for people with dementia during the next year. Relatives and friends were observed visiting at all times of the day and to make themselves at home. Good food stocks were observed. Up to date information was available in each unit to show the choices that were available for the meals. From observation Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 13 and discussion with people at the home and staff, choices are always available and should a person prefer an alternative to the main choices, this does not present a problem. Evidence was available to show what each person had selected. The portions of a liquidised meal had been separated to try and improve appearance. The meal observed was well presented and with sufficient portions. Two people spoken with considered the food to be rather bland because of a lack of salt but in general, people liked the food and considered it to be well cooked. The cook stated that it was for health reasons the use of salt is limited in food preparation. It was noted however that salt and pepper were available on dining tables. Staff spoke of people being able to have a cooked breakfast; lunch and a hot meal in the evening and records confirmed this is the case. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to have their complaints taken seriously. People living at the home also benefit from the home having procedures to protect them from abuse and staff are appropriately trained. EVIDENCE: The complaints procedure as detailed within the statement of purpose and the service user guide provide clear information as to how a complaint would be processed. However an amendment is required in relation to the advice being given that a complaint can be made direct to CSCI to investigate, which is incorrect. Complaints should be made direct to the home’s manager or person in charge or to Rushcliffe Care Ltd. This is because CSCI does not have a statutory duty to investigate complaints about a service. The manager stated that the home or Rushcliffe Care had received no complaints in 2007. Concerns raised by people about a lack of disposable gloves and aprons, which caused CSCI to inspect the home in August, September and November 2006 appears to have been resolved with a plentiful supply available. Worries expressed by people about staffing levels also seem to be less. The home has clear policies and procedures in place to ensure the protection of people living at the home. The home had not had any POVA incidents in the Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 15 past year. It was evident from the records that training on POVA had been provided in May and in August 2007. Staff spoken with during the days of inspection visits confirmed they had received POVA training. The home has a Whistle blowing policy. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 16 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, 20, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is satisfactorily maintained, providing people with a homely, safe and hygienic environment that suits their needs and lifestyles. EVIDENCE: Queens Park Court is a purpose built home based on four separate group living units, each having its own dining room/lounge area, bathroom and kitchenette facilities. Security locks are fitted between the four units and the main part of the building and exits are alarmed to ensure people with dementia are safe. The communal areas have exits to the Sheltered Housing scheme although keypads have been put in place to reduce the risk of accidents. Each Unit has sufficient seating and dining areas and there is also a large lounge, activities room and seating areas around the corridors. All bedrooms are for single use and have en-suite WC facilities. People at the home are encouraged to bring in personal belongings and many of the rooms seen were personalised with furniture and belongings. People can have keys to their Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 17 rooms if they wish and a person spoken with confirmed they like to make use of this facility. Each bedroom is centrally heated with a radiator and thermostatic control valves. One person spoken with said they liked their room; they thought it was very comfortable and enjoyed being able to organise the room in the way they liked. Regular checks are completed on water temperatures to ensure they are safe and this is recorded. The home offers accommodation to people with a variety of abilities and has appropriate equipment and facilities such hoists, which were being serviced during this inspection visit. The home has a call bell system in every room, which was working on the days of the site visits. There is a well-equipped laundry and central kitchen. Access to these rooms is via security keypads and is restricted to designated staff only to ensure people living at the home are safe from accidents. The laundry is a very hot room to work in and staff were observed to leave the door open to improve ventilation. Staff did confirm however that they shut the door when they leave to prevent people gaining access to the equipment and cleaning materials. . The standard of cleanliness throughout the home was good and odour control was well maintained. There are secure garden areas around the home, which are attractive, well laid out and welcoming to people living at the home and visitors. Visitors were observed making use of the garden facilities. Some of the gardens were accessible to wheelchair users. Feedback from one relative indicted the need for improved telephone facilities for people to enable them to make from their unit/bungalow more easily. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. A team of caring and experienced staff supports people at this home, although they may be placed at risk if some staff have not been provided with training in all the areas that their work requires. EVIDENCE: Of the twenty care staff currently employed; eight have completed a National Vocational Qualification at level 2. This means that the home falls short of the recommended target of 50 of care staff being qualified. As no staff are due to take the training, the manager will have to plan as to how and when this is to be achieved. Staff training has taken place in 2007 on topics such as POVA and some health and safety but up to date records of which staff had received training in 2007 were not readily available. The manager had a record log of training provided in 2006. Three staff files were inspected to see that the necessary recruitment checks had been carried out. There was no information regarding references or Criminal Records Bureau (CRB) disclosure checks. Discussions took place with the registered manager around ensuring the appropriate documentation is available to confirm that all the necessary checks are made to ensure the health, safety and welfare of people living at the home are made before new Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 19 staff commence work there. The manager stated that this information is kept at Rushcliffe Care headquarters and had not been confirmed and/or transferred to the manager. The Rushcliffe human resources department were able to confirm to the manager subsequently that all necessary checks had been made and had provided confirmation. The manager also subsequently confirmed that the information had been received at the home. The home’s annual assessment states that dependency levels of people at the home are recorded on a regular basis and the staffing levels are adjusted accordingly. The levels of dependency figures for August showed that the number of care staff and senior support staff available for duty were in accordance with the Department of Health guidance for staffing levels. The manager also confirmed that they were considered to be sufficient to meet the needs of people at the home. As two relatives have expressed some concerns during a recent survey about an apparent lack of staff, the manager should give some consideration to providing information to relatives and people at the home as to how the home calculates the staffing levels and determines that these are sufficient. 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. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality assurance processes ensure that the views of people at the home are sought and acted on. Good health and safety practices were evident although people may be placed at risk, as some staff had not received all of the relevant health and safety training. EVIDENCE: The Manager is qualified and competent to run the home and has achieved a National Vocational Qualification at level 4. The manager has many years experience in working with older people and people with dementia. From observation and discussion, the manager is clearly involved in all aspects of the home and works well with the care manager and senior support team. There are clear lines of accountability in the home with care staff, shift leaders and the care manager. A senior manager from Rushcliffe Care attends the Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 21 home regularly to provide support for the manager and staff and completes a report of the visit as required by Regulation 26 of the Care Homes Regulations 2001. The home’s administrator looks after any money held for safekeeping on behalf of people living at the home. The money was kept secure and a system for maintaining separate accounts was observed. The accounts of three people were checked. These were up to date and accurate with receipts available for all expenditure, which reflected those items considered as extra to the fees by the home and as stated in the statement of purpose. One person had chosen to look after their own money. The home has a Quality Assurance system that includes surveys being carried out to seek the views of people living at the home and their relatives. The most recent survey had been summarised and the results were available in the home. A total of fifteen questionnaires were returned from thirty-nine that were issued. Overall the home scored well although the manager has acknowledged that there are areas that can be improved on. CSCI also issued surveys to gauge what people think of the service. Fifteen surveys were retuned from people that live at the home, three from relatives and two from health care professionals. The activities coordinator supported the majority of the people at the home to complete their questionnaires, which is recognised as a valuable way of obtaining the views of people at the home. It would however been of greater value if an advocate rather than an employee was given this task in terms of objectivity. Of the surveys returned, four people considered the meals to be always liked, six people felt that meals were usually liked, four people stated sometimes and one person stated never and one relative stated, “The catering side could be improved”. With regard to staffing levels, three relatives considered there were insufficient care staff. One relative stated “they need more staff as it’s lost its friendly atmosphere and staff no longer have time for little chats to stimulate the residents”. Twelve people living people at the home however, considered there were sufficient staff usually to meet their needs. Other positive feedback included the opportunities for people to participate in activities, that staff listen and act on what is said, the home is fresh and clean and all but two people knew how to make a complaint. Overall the feedback was positive. Feedback from relatives was also generally positive although two people considered more staff were required. Feedback from health care professionals was excellent. Staff spoken with and three staff records checked confirmed that supervision is provided on a regular basis. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 22 The Manager is aware of her health and safety responsibilities. The home has clear policies on health and safety matters. Information provided by the manager confirmed that equipment and services are serviced at the appropriate intervals and are up to date. There was some evidence that fire, moving and handling, infection control, food hygiene, first aid and COSHH training had been provided but it was not possible to determine whether all staff had received this training. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 23 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 24 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(2)(b) (c) (D) Requirement Timescale for action 01/12/07 2 OP29 19 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. For the protection of the people 01/11/07 living at Queens Park Court, evidence must be made available to show that checks are carried out on all new staff before they start work at the home to be sure they are safe to work with vulnerable people. 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. This is a repeat requirement; the last timescale of 31/03/07 was not met. The manager must ensure that all staff are Health and Safety trained in order to make sure DS0000067527.V341682.R01.S.doc 3 OP30 18(1) (c) (i) 01/12/07 4 OP38 13(4)(a) 01/12/07 Queens Park Court Version 5.2 Page 25 people living at the home are safe at all times. 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 4 5 Refer to Standard OP1 OP15 OP20 OP28 OP33 Good Practice Recommendations The manager should record a note on the file for each person to show when they were provided with information about the home and the services provided. The manager should endeavour to meet the needs of all people in terms of how they like their food cooked. The manager should review the feasibility of extending the telephone service to each unit to enable people to make calls more easily. The manager should prepare a plan to show how the recommended level of 50 of staff more staff trained to a National Vocational Qualification standard can be achieved. When supporting people at the home to complete surveys, the manager should try to secure the services of an advocate to assist. Queens Park Court DS0000067527.V341682.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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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