Inspection on 07/11/06 for Queens Park Court

This inspection was carried out on 7th November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Queens Park Court 01/10/08

Queens Park Court 17/06/08

Queens Park Court 19/06/07

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 Mrs Sharon Lacey Unannounced Inspection 7th November 2006 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.V318965.R03.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.V318965.R03.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.V318965.R03.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. First Inspection since Registration. Date of last inspection Brief Description of the Service: Queens Park Court is a large established home providing care and accommodation for 40 older people, some of whom may be diagnosed as having dementia. Queens Park Court has recently had a change of ownership and is now owned by Rushcliffe Care. The home is situated in a modern residential area of Billericay and the town centre is a short distance away. It is a detached property comprising of 40 bedrooms with en-suite facilities. Residents 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; some are more secure than others. There is a large central dining/lounge available for community activities and this can also be used as an alternative dining facility. The communal area is shared with the Sheltered Housing complex, which is attached to the home. There is a large kitchen, which prepares meals for those living in the Sheltered Housing and the home. Externally there is a small car park at the front of the home for visitors. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, Unannounced Inspection, which took place over nine hours. Two Regulation Inspectors conducted the Inspection. One toured the home, observed residents, spoke to staff and relatives and looked at care plans; whilst the other inspected relevant records and documentation. This Inspection was the first key inspection of Queens Part Court under new ownership. Four previous ‘Random’ inspections had already taken place since the change of ownership, due to concerns received from staff, relatives and other health care professionals. Two immediate requirements have also been issued, one for staffing levels (before this inspection) and the other for personal protective clothing for staff (since this inspection). The Registered Manager and Senior Manager were present during the Inspection. Areas looked at during the day included information given to residents before being admitted to Queens Park Court; information gained when residents first come into the home; how information is given to staff on the care required; medication, the facilities and environment of the home; and any complaints/concerns that may have been received since the last inspection. Also staffing and management of the home were inspected. During the tour of the home eight residents and five relatives/friends were spoken to about their life and experiences at Queens Park Court. Observations were completed on those residents who were unable to express their thoughts and feelings. All staff members were spoken with during the Inspection and this feedback has been included as part of the report. Questionnaires were also sent out to relatives and twenty were returned. Two GP’s, a District Nurse, an optician, a chiropodist and five Social Workers also returned questionnaires regarding their experiences of the home. At the end of the day the Inspection was discussed with the Manager and Senior Manager and advice and guidance was given regarding the findings. What the service does well: Rushcliffe Care are in the process of identifying training needs of staff so appropriate courses can be arranged for 2007. The Manager has also arranged for staff to attend training with the local Primary Health Care Trust. Twelve staff have achieved their NVQ 2 and four the NVQ 3. Training that had been completed included infection control, record keeping and care plans, COSHH, challenging behaviour, dementia care and drug management. Staff spoken to on the day of the inspection confirmed they had received some training. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 6 The staff within the home are very hard working and try to meet the residents needs. Much of the feedback received from relatives and residents was positive regarding the care staff. What has improved since the last inspection? What they could do better: As stated previously this was the home’s first inspection under new ownership. There are a number of areas that need attention. More in-depth information can be found in the body of the report. The Statement of Purpose needs to be updated and amended. On viewing this document it provides incorrect information on the homes registration and the services it provides. This had already been brought to the management’s attention at the Registration stage and also a previous inspection. An amended copy had been sent to the CSCI but this was not available in the home. The home has a set assessment form, which includes all the information listed in the National Minimum Standards 3.3. The files of the three most recently admitted residents were inspected, but none contained a completed Rushcliffe Care assessment form. All three did contain a Rushcliffe Care ‘dependency level’ form, but this only provided brief details. Rushcliffe Care has a written Contract and details of their Terms and Conditions could be found in the Service Users Guide. On viewing the document this contained the required information, but none of the files inspected contained evidence of a completed Contract regarding the room allocated and fees to be paid. Rushcliffe Care is in the process of implementing new care plans. The new format consists of a standard template with written statements, but it did not go into any detail regarding how care should actually be provided. The care plans seen were not personalised or individual and still needed further development. Regular reviews had not taken place on all residents. Some areas in medication need to be addressed. Good practice was observed administering medication to residents. However one resident that required eye drops had their lunch disrupted because they were administered when the resident was eating their meal. During observation there was clear evidence of staff generally speaking to residents, but there was little evidence of individual chatting or personal Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 7 intervention. Residents commented that the staff were ‘nice’ and ‘very caring’, however they were often ‘hurried and rushed’. A number of complaints have been received about the home since the change of ownership. Relatives, Health Care Professionals and Staff have all contacted the CSCI since May 06 to voice their concerns about the home. These have largely been around the reduction of staff and the impact this has had on the care provided to the residents. Feedback from relatives, residents and also through general observation at the home during the inspections, is that routines within the home are not always flexible and choice cannot always be provided due to the current staffing levels and the layout of the home. Some staff had received training on the Protection of Vulnerable People (POVA), but others either needed training or updates. Relatives raised concerns about the cleanliness of the home adding ‘cleanliness standards have dropped’, ‘there has been a drop in standards’, and ‘there is a deterioration in the cleanliness of the rooms’. On the day of the unannounced inspection it was considered that the home was ‘odour free’. It was noted during the unannounced inspection that personal care gloves were not freely available for staff on the units. This was brought to the Managers and Senior Manager’s attention for action. 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.V318965.R03.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.V318965.R03.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): 1, 2, 3, 4, 5 and 6. Quality in this outcome area is poor. The home does not provide prospective residents with the correct information about the home to help them choose. There is an admission process, but insufficient written information is gathered to assist in ensuring they can provide appropriate care. The home has written Contracts, but these are not routinely completed. This judgement has been made using available evidence, including several inspections to this service. EVIDENCE: The home has a Statement of Purpose and Service User Guide and these documents were available in the home’s foyer. On viewing the Statement of Purpose, it was noted that it stated that the home offered ‘optional day-care’ (which it does not) and listed the wrong registration categories of the home. This incorrect information had already been brought to the new owners attention at the Registration stage and also a previous inspection to the home. An amended copy had been sent to the CSCI, but this was not available in the home. The Manager stated that prospective residents are given copies of these documents during the assessment process, but this is not routinely evidenced on residents files. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 10 Queens Park Court are Contracted with Essex County Council. The Manager confirmed that either she or the Care Manager would do the assessments of any new residents. There is a set form, which includes all the information listed in the National Minimum Standards 3.3. Three files of recently admitted residents were inspected, but none contained a completed Rushcliffe Care’s assessment form. All three did contain a Rushcliffe Care ‘dependency level’ form, but this only provided brief details. Prospective residents do not at present receive written confirmation whether the home is able to meet their needs. The manager confirmed that the home offer trial visits and during the Inspection a prospective resident arrived with their Social Worker. Rushcliffe Care has a written Contract and details of their Terms and Conditions could be found in the Service Users Guide. On viewing the document this contained the required information, but none of the three files inspected contained evidence of a completed Contract regarding room allocated and fees to be paid. The home is registered to take up to 40 residents. Those who are presently at the home have a variety of abilities and care needs; some are very dependent. Rushcliffe Care are in the process of identifying training needs of staff so appropriate courses can be arranged for 2007. The Manager has also arranged for staff to attend training with the local Primary Health Care Trust. Queens Park court does not provide intermediate care. Queens Park Court DS0000067527.V318965.R03.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, 10 and 11. Quality in this outcome area is poor. The plan of care did not provide sufficient information on the care required and how this was to be delivered. Residents have access to health care services to meet their needs. Some areas of administration and the recording of medication required attention. This judgement has been made using available evidence including several inspections to this service. EVIDENCE: Of the eight residents spoken to during the inspection, five care plans were checked. Of these five, two residents had signed the care plan. The care plan for residents was a standard template with written statements that did not go into any detail regarding how care should be actually provided. The care plans were not personalised or individual, one did not have the resident’s name written onto the documentation and another resident did not have a care plan at all, although the individual had quite complex needs. The documentation of care for another resident was poor. The manual handling risk assessment had not been updated with the resident’s change of need. For example a resident cared for in bed still had an old manual handling risk assessment based on old need and not updated. There was no care plan Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 12 detailing how care was to be delivered for example how personal hygiene is administered and how frequently turns should be carried out. Some charts were in place for turning and bathing, but these were not completed regularly and had gaps of days between them. Another resident was recovering from a chest infection, the staff were aware of this but there was no update of the care plan reflecting the resident’s condition. Two of the care plans had been evaluated with the residents whilst the others looked at had not. Staff spoken to during the inspection stated that they did not find the format of the care plans helpful and found they did not have time to read them. The home tries to keep residents for as long as they are able to provide the appropriate care. There is a set form to complete regarding managing death and dying within the home for individual residents, and it is also part of the assessment form. None of the three files inspected contained any evidence of this information. It was noted during a tour of the home that some of the residents were very dependent and some were actually cared for in bed. It was noted that the charts in the bedrooms for fluid or turns had not been routinely completed and there were large gaps. Also due to current staffing levels on the units these residents had little social or physical contact. Only a few staff had received training on palliative care. A staff member was observed giving medication. The staff member demonstrated good practice when administering the medication to the residents. However the resident that required eye drops had their lunch disrupted because they were administered when the resident was eating. Medication keys were held together with the house keys. This is not good practice, as they should be held on a separate bunch. The controlled drugs book was checked and it was found that a second member of staff did not witness these drugs at the time of giving. For good practice it was suggested that the name and address of the supplier of the controlled drugs is entered on to the drugs register. During observation there was clear evidence of staff generally speaking to residents, but there was little evidence of individual chatting or personal intervention. Residents commented that the staff were ‘nice’ and ‘very caring’, however they were often ‘hurried and rushed’. Residents also commented that they did not see many staff in the evening. One resident reported that when they used the call bell for help, staff would come to turn the bell off and then go away again due to attending to someone else; they would then “forget to come back”. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 13 Complaints that have been received about the home since the change of ownership have largely been around the reduction of staff and the impact this has had on the care provided to the residents. Relatives expressed their concerns around staffing in the questionnaires returned. Comments included ‘not enough care staff’, ‘insufficient staff to toilet when needed’, ‘lack of stimulation’, ‘there is an acute shortage of staff in the evenings between 6pm and 9pm’, and ‘not enough staff on day and nights’. Others added ‘it is difficult to track down staff’, ‘my mother was ready in her nightdress at 4.00pm and when asked why was advised it was due to lack of staff’ and ‘staff are kind and polite, the only fault is that there is not enough of them to provide good care’. During a tour of the home it was noted that unused incontinence pads had been left in the kitchen area, this practice was discussed with the Manager and Senior Manager. It was stated that this was not good or normal practice and staff would be spoken to regarding this. During the inspection it was noted that residents looked clean and tidy. There was clear written evidence that the home ensure residents have access to health care services. A District Nurse spoken to during the Inspection reported that there is good communication with staff and management. They found the staff ‘welcoming’ and ‘caring’ and they had found no evidence of neglect. The Manager and staff always called her in when there was a problem. They added that they felt the care was the same at the weekend as through the week. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 14 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. Daily routines are not always flexible and the home does not always promote resident’s independence and choice. Visiting arrangements are fairly open. There was a good choice of food and this was well balanced. Some routine activities are either organised in the Units or as a larger group in the communal lounge. This judgement has been made using available evidence including several inspections to this service. EVIDENCE: The home has a part time activities coordinator who spends her time between the four units. The home has a set activities programme, and details of this was available on each unit. Residents confirmed activities took place and there was written evidence on resident files. One resident spoken to during the inspection stated they were knitting, as there was ‘nothing else to do’. Relatives also reported that they did not feel there were enough activities in the afternoon and it was ‘limited’. There is some restriction for visiting. The Service Users Guide states no visiting before 9.00am or after 9.00 pm without prior arrangements. Residents can see visitors in either their own room or private areas around the home, including the communal lounge. The home has a visitor’s book to be signed by relatives or visitors on entry and exit. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 15 Routines within the home are not always flexible and choice cannot always be provided due to the current staffing levels and the layout of the home. One relative stated that ‘my mother’s choice is compromised by the lack of staff’ and another that their mother should be bathed one a week, but due to current staffing levels she has often been left for ‘several weeks’. The lack of bathing was also an issue raised by a Social Worker when having a residents review. Issues around current staffing levels and whether appropriate care is being provided has been raised during the four random and one Key unannounced inspections to the home. Staff stated ‘there is no time to chat to residents’ as they are too busy providing ‘task orientated care’. Many of the residents need the assistance of two staff members and if the ‘care manager’ is not available then staff members from the other units have to be used, leaving that unit with no staff. Many of the residents would not able to raise help if required and would have to rely on observation of the staff for their care needs. It was stated that the home had completed a survey with residents regarding choice of food within the home. There is at now a four-week menu and residents receive a choice of at least two hot meals at lunchtime. Menus were clearly visible on ‘whiteboards’ in each of the units. There is good space in the dining area for those with mobility problems to sit comfortably and eat. It was observed during the unannounced Inspection that condiments were not routinely placed on the table for residents and residents commented that they would like sauces or mayonnaise with their salad. Cordial drinks had also been provided with lunch despite some residents preferring water. It was noted that those residents who needed a ‘pureed’ diet had all the contents mixed together in a ‘soup’ consistency. On the day of the Inspection there was a choice of fish and chips or steak and kidney pie. The meals looked well presented. Comments regarding the food at the home were mixed. Residents reported that the food was ‘lovely’, ‘the vegetables were undercooked’, meat was of ‘poor quality’, there were ‘lumps in the mashed potato’ and it was ‘often cold’. Others spoken to described the food as ‘plain but nice’. One resident stated a salad consisted of a lettuce leaf and a piece of cucumber. Another complaint from residents was that they did not get an early morning cup of tea since Rushcliffe Care took over and another stated that the cups of tea ‘were not as nice’. Residents also commented how the evening cup of tea was closely followed by a cup of Horlicks. Whilst observing during the inspections, it has been noted that many of the residents need assistance with eating their meals. Due to current staffing levels on each unit, sufficient help is not always available to ensure residents received their meal whilst still hot. Complaints and concerns have been submitted to the CSCI by relatives regarding mealtimes. Relatives raised Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 16 concerns around ‘not enough support around at mealtime’ and ‘I cannot always be confident that my mother feeds herself as she needs encouragement’. On one unit it was observed that only one resident had been placed at the dinner table to eat their meal, whilst the rest of the residents were in their lounge chairs. The staff member on the unit was assisting another resident to eat their meal. It was not established whether the residents had chosen to remain in the lounge. On discussion with the Manager and Senior Manager regarding this incident, it was established that many of the residents in that unit could have eaten at the table and did not need to remain in the lounge area. The Manager advised the inspector that due to the high number of residents who require assistance with eating, she often assists during mealtimes. The Inspector was advised that in the past the ‘home’s administrator’ had also assisted in this area of care. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 17 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, 17 and 18. Quality in this outcome area is adequate. The home gives good information on making complaints and contacting the CSCI. Staff need Protection of Vulnerable Adults training. The homes POVA procedure needs to reflect actual practice. This judgement has been made using available evidence including several inspections to this service. EVIDENCE: There is clear written guidance in the home’s Service Users Guide and Statement of Purpose on how relatives and residents can make complaints. The home also has set forms to record the complaint, investigation and outcome. The Manager stated that no complaints had been received. The CSCI had received a number of comments of concern from relatives, health care professionals and staff since the change over of ownership. Complainants were advised to raise these with Rushcliffe Care. A number of unannounced random inspections were also conducted to the home and Immediate Requirement Notices issued for staffing levels and providing sufficient personal protective clothing. The Manager stated that residents who wished to vote either completed postal votes or were taken to the polling station. It was also confirmed that letters received by post are either given directly to residents or kept for relatives. The home has clear policies and procedures in place to ensure the protection of residents. It was noted that the POVA policy present at the home did not refer to the Local Authority Guidelines until some way down. It was discussed with the Senior Manager that their policy should reflect the home’s actual Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 18 practice. The home had not had any POVA incidents since the change of ownership. Some staff had received training on the Protection of Vulnerable People (POVA), but others either needed training or updates. Staff spoken to during the inspection confirmed they had not received POVA training. The home has a Whistle blowing policy. No new staff had been recruited since the change of ownership, so evidence of safe practice was not available. The home does not have a recruitment policy, but on discussing their procedure with the Senior Manager it was established that appropriate checks would be carried out to ensure new recruits are suitable to work within the home. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 19 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, 21, 22, 23, 24 25 and 26. Quality in this outcome area is good. Queens Park Court is a purpose built home. and its location and layout is suitable for its stated purpose. It is a pleasant home with a homely feel and well maintained. It is clean and free from offensive odours. This judgement has been made using available evidence including several inspections to this service. EVIDENCE: The home has four separate units, each having its own dining room and lounge area. There are security locks between the four units and the main part of the building and exits are alarmed to ensure service users with dementia are safe. The communal areas have exits to the Sheltered Housing scheme, which potentially increases the risk to those service users with dementia, however keypads have been put in place to reduce the risk. The Manager’s office and care staff office is located away from the four units, but there is contact via a telephone in each unit. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 20 Queens Park Court is a large home. Each Unit has sufficient seating and dining areas for the service users and there is also a large lounge, activities room and seating around the corridors. There are toilets and bathrooms within each unit and they are a good size and well laid out, although very clinical. All bedrooms are single and have en-suite facilities. Some bedrooms would not be suitable for wheelchair users or those needing moving and handling equipment due to their size. Service users are encouraged to bring in personal belongings and many of the rooms were personalised with furniture and belongings. Residents may have keys to their rooms if they require. Each room seen had opening windows with restrictors fitted. Each resident’s bedroom was centrally heated with a radiator with thermostatic control. One resident spoken to raised concerns that their room was cold. Regular checks are completed on water temperatures to ensure they are safe and this is recorded. The home offers accommodation to service users with a variety of abilities. On touring the home it was noted that there were hoists, wheelchairs and bathing equipment around the home. The home has a call bell system in every room, although this was not tested. Queens Park Court has its own laundry facilities and residents stated they were happy with the service. All residents seen during the inspection were noted to be clean and well presented. It was noted during a tour of the home that the laundry door had been left open and this is an issue that has been raised with the Manager under previous ownership, due to the health and safety of residents. The home also has a number of sluices and it was noted that one had been left unlocked (Kent Unit) and there was access to cleaning materials. Relatives raised concerns about the cleanliness of the home adding ‘cleanliness standards have dropped’, ‘there has been a drop in standards’, and ‘there is a deterioration in the cleanliness of the rooms’. On the day of the unannounced inspection it was considered that the home was ‘odour free’. It was noted during a tour of the home that personal care gloves were not freely available for staff on the units. One unit visited had five residents who were incontinent and two residents in bed, but the staff member only had two pairs of gloves. One staff member stated that there was a ‘discrepancy over protective clothing regarding the use of gloves and shortage of gloves’. This was discussed with the Manager and Senior Manager and action requested. It was also noted during a tour of the home that some bathrooms did not have liquid soap. One bedroom did not have access to hot water and also one of the kitchens did not have any hot water; this was discussed with the Management. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 21 A telephone call was received a couple of days later from the Essex Health Protection Unit raising concerns that staff did not have sufficient access to gloves. A further visit to the home was conducted on the 23rd November 2006, where evidence was found that staff still did not have access to personal protective gloves. An Immediate Requirement Notice was issued. It was noted that during this visit that the tap in the kitchen had still not been repaired. There are secure garden areas around the home and some of the gardens would be accessible to wheelchair users. Queens Park Court DS0000067527.V318965.R03.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. The home does not have sufficient staffing to meet the needs of the residents. Some staff training has been provided but further training is needed to ensure staff have the skills and knowledge to provide the appropriate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rotas were observed and copies taken. Details of staff on duty were clearly written in the hallway of the home. Relatives, staff and also residents have raised concerns that there are not sufficient staff to provide the care required and what impact this has had on individual resident’s lives. Feed back included ‘insufficient staff to toilet when needed’, ‘no staff to be seen’, ‘difficult to track down staff as they are carrying out duties on other bungalows’ and ‘ staff are working hard but just not possible to cover the jobs properly’. Another added ‘I would like to say that the care given by those available is of a high standard, but they are being pushed to their limits’. Staff were observed during the inspections providing ‘task orientated care’ and going from one task to another. As many of the present residents need assistance from two staff, they often had to wait for another staff member to assist. During several of the inspections it has been observed that some units are left unattended whilst this occurs. One staff member commented that there was ‘very little quality time with the residents’. Another stated she had ‘not stopped this morning’, the time was 13:45 pm and she stated she had not Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 23 had a relief break. She was also witnessed leaving the unit to gain the assistance of another staff member due to four of the residents on her unit needing two carers. An Immediate Requirement Notice was issued at the home in May 2006 requiring staffing numbers to be appropriate to the service user’s assessed needs. A meeting also took place in June 2006 with Rushcliffe Care to discuss staffing, and it was agreed by the Director that staffing levels should be sufficient to ensure that bungalows are not left unattended for considerable amounts of time. On the day of the inspection it was noted the rota on Windsor Unit stated that one staff member went off at 14:15 pm, but her replacement was not on the rota until 15:30 pm. On York unit the staff member was observed finishing her shift at 14:30 pm, but her replacement did not come on until 15:00 pm; leaving two units with no staff present. It was noted on previous inspections to the home on 13th July, 30th August and 11th September 2006 that there were also gaps between the staffing hours and units were sometimes left without staff supervision. This was brought to both the Manager’s and Senior Manager’s attention. Twelve staff have achieved their NVQ 2 and four the NVQ 3. Rushcliffe Care are in the process of identifying what training staff require. Some training has been organised by the Manager including diabetes and moving and handling. Training that has been completed includes infection control (8 staff), Record keeping and care plans (3 staff), COSHH (6 staff), Challenging behaviour (3 staff), Dementia care (3 staff) and Drug Management (3 staff). Staff spoken to on the day of the inspection confirmed they had received some training. None of the staff had completed fire safety training. No new staff had been recruited at the home since Rushcliffe Care took over. Due to this it was not possible to check the home’s recruitment practice. A copy of Rushcliffe Care Recruitment policy/procedure was requested, but this was not available. The process was discussed with the Senior Manager to ensure it met with the National Minimum Standards and Regulations. The home provides new staff with an induction, which on discussion appears to be in line with the Skills for Care requirements. Evidence of induction was not available due to any new staff having been recruited. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 24 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, 34, 35, 36 37 and 38. Quality in this outcome area is poor. The Manager is qualified and competent to run the home and has achieved her NVQ 4. Contact with relatives, residents and staff indicated that they felt the ethos of the home has changed since the new ownership. This judgement has been made using available evidence including several inspections to this service. EVIDENCE: The Manager is qualified and competent to run the home and has achieved her NVQ 4. She has many years experience in working with residents with dementia and old age. There are clear lines of accountability in the home with care staff, shift leaders and Care Manager. Some staff have had their role changed since the change of ownership. The manager has had the removal of administrative work from her responsibilities, but now provides some hands on care if needed. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 25 Contact with relatives, residents and staff indicated that they felt the ethos of the home has changed since the new ownership. Relatives stated ‘the atmosphere in the home quite stressful’ and ‘I have found the carers and senior staff members under a great deal of pressure’. Others added that ‘the Leaders are good, but quite stressed’ and ‘the home has dropped in standards since the change… leaders are good but stretched’. Some relatives raised concerns that there had been few meetings either before or since the change of ownership. One relative added ‘there have been a couple of meetings for families, but I am in opinion that they listen, prevaricate and do not always act’. Previously paperwork requested by the CSCI has not always been provided. A pre inspection questionnaire was sent out to the Manager to complete before the unannounced inspection. This information is used to help identify areas to be inspected. A deadline was given for this to be returned, but this was not achieved. An extension was granted but after contacting the Manager one week after the due date the document was still not submitted. Although it was requested on the Inspection day, the CSCI has still not received this information. Action was also requested on the day of the inspection regarding protective clothing for staff, but on a visit to the home one-week later, this still had not been fully implemented and an Immediate Requirement Notice issued. Issues around staffing have been raised on previous visits to the home, but on the day of the inspection there were still gaps in the rota and units were still being left without staff. The home has a Quality Assurance system, which approaches residents and relatives. A questionnaire has recently been sent out and once returned the responses will be collated and a report written. Regulation 37 forms submitted do not provide all the information required and it was noted that the guidance to staff on the back of the form is incorrect. Most relatives assist with resident’s finances, but the home does assist with ‘personal allowances’ and support can be gained for those service users without relatives if required. Receipts are given for any monies spent or received. Three residents monies were checked and these were found to be in order. Rushcliffe Care has a clear supervision policy, however evidence of supervision taking place was very limited. Many staff had received only one supervision since the change of ownership. Three staff spoken to on the day of the inspection confirmed that they had not received any one to one supervision or attended any meetings. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 26 The Manager is aware of her health and safety responsibilities. The home also has clear policies on health and safety issues – but these were not reviewed during this inspection. When looking at the home’s safety certificates not all of these were in order. The homes electrical certificate was missing and there was no evidence of the gas or chlorination certificate. There was evidence of food hygiene training and COSHH training. Rushcliffe Care’s accounts are audited annually. certificate was viewed and in order. The home’s insurance Queens Park Court DS0000067527.V318965.R03.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 2 2 1 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 2 3 3 3 2 1 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 3 1 3 2 Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 OP1 Regulation 4(1) Requirement The Registered person shall compile in relation to the care home a written statement (in these regulations referred to as ‘the Statement of Purpose’, which shall consist of a statement as to the matters listed in Schedule 1. This is in connection to ensuring the Statement of Purpose provided accurately reflect categories of registration, so that future residents and relatives receive appropriate information. 2 OP3 14(1)(a) The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so the needs of the service users have been assessed by a suitable qualified or trained person and the registered person has obtained a copy of the assessment. 31/03/07 Timescale for action 31/03/07 Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 29 This is in connection in ensuring assessments are completed for all prospective service users at the admission stage to ensure the home are able to meet the individuals needs. 3 OP4 14(1)(d) The registered person shall not 31/03/07 provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so. The Registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. This is in connection to writing to individuals who have been assessed by the home to confirm you are able to meet their needs or not. 4 OP4 18(1)(c) (i) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that person employed by the registered person to work at the care home receive training appropriate to the work they perform. This is in connection to ensuring staff have the training and skills to meet the resident’s needs. 5 OP7 15(1) The registered person shall, after 31/03/07 consultation with the service user or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. DS0000067527.V318965.R03.S.doc Version 5.2 Page 30 31/03/07 Queens Park Court This is in connection to generating a care plan from a comprehensive assessment. This should be drawn up with the service users and provide the basis for the care to be delivered. It should clearly set out in detail the action, which needs to be taken by care staff to ensure all aspects of health, personal and social needs of the individual are to be met. 6 OP7 15(2)(b) (c) (D) The registered person shall make 31/03/07 the service users plan available to the service user, keep the service users plan under review, and where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and notify the service user of any such revision. This is in connection to ensuring residents are involved in the care plan process. Their care plans are regularly reviewed and any changes clearly recorded and made known to staff and residents. 7. OP9 13(2) The registered person shall make 31/03/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is in connection to staff providing medication at appropriate times (eye drops whilst resident eating dinner). Ensuring controlled drugs are double signed for. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 31 Recording the details of the Pharmacists. 8. OP10 12(4)(a) The registered person shall make 31/03/07 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. This is in connection with ensuring sufficient staff are available to provide the care required at all times. Ensuring residents receive assistance with eating when needed, not being put in nightclothes during the day, being able to get assistance to the toilet when needed and not being ‘forgotten’, having baths when needed and ensuring those residents with high needs are given both social and physical contact. 9 OP11 12(1) (b) (3) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. This is in connection to ensuring the wishes of residents are recorded regarding death and dying and appropriate care charts are regularly completed to ensure the care required is being provided Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 32 31/03/07 10 OP11 12 (1)(b) The registered person shall ensure that the care home is conducted so as to make proper provision for the care and where appropriate, treatment, education and supervision of service users. This is in connection to staff being provided with appropriate training on end of life. 31/03/07 11. OP14 12 (2) The registered person shall so far as practicable enable service users to make decision with respect to the care they are to receive and the health and welfare. This is in connection with ensuring residents are offered choice and autonomy in the care they receive. 31/03/07 12. OP15 16(2)(i) The registered person shall having regard to the size of the care home and the number and needs of service users provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may be reasonably be required by service users. This is in connection with ensuring residents who need a ‘soft’ diet have their meal prepared in a suitable manner and not just pureed together, which does not give different textures and tastes. 31/03/07 13. OP18 13(6) The registered person shall make 31/03/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed DS0000067527.V318965.R03.S.doc Version 5.2 Page 33 Queens Park Court at risk of harm or abuse. This is in connection to ensuring the Rushcliffe Care’s Protection of Vulnerable Adults policy reflects the homes actual practice and includes the guidance on when to contact the leading agency/local authority. Also ensure staff are trained in the Protection of Vulnerable adults at induction and also regular updates provided. 14. OP21 12(1)(a) The Registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. This is in connection to ensuring staff close doors to the laundry and sluices due to chemicals and machinery. This is an area that has been raised as previous inspections. 15. OP25 13(3) The registered person shall make 31/03/07 arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This is in connection with ensuring both staff and residents have access to hot water to wash their hands. On the day of the inspection one bedrooms and a kitchen did not have any hot water. It was also noted that not all bathrooms had liquid soap. 31/03/07 Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 34 16 OP26 13(3) The registered person shall make 31/03/07 arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Many of units did not have sufficient gloves available for the present residents to ensure safe infection control procedures were followed. 17 OP27 18(1)(a) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that at all time suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. This is in connection with ensuring there are sufficient staff on duty at all times to provide the care required. 31/03/07 18 OP30 18(1) (c) (i) The registered person shall, 31/03/07 having regard to the size of the care home, statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they perform. This is in connection to ensuring staff receive appropriate training and updates relevant to the care they provide. Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 35 19 OP32 12(5)(a) The registered provider and 31/03/07 registered manager shall, in relation to the conduct of the care home, maintain good personal and professional relationships with each other and with service users and staff. This is in connection with feedback from staff, residents and relatives who feel the morale in the home is very low and some stated they have felt intimidated by the management of the home. 20 OP33 24(2) The registered person shall supply to the Commission a report in respect of any review conducted by him for the purpose of paragraph (1), and to make a copy of the report available to service users. The registered person shall ensure that persons working at the care home are appropriately supervised. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from avoidable risks. This is in connection with ensuring the home has the required certificates to evidence that safety checks have been made and the home is safe. Please submit copies of the certificates identified as missing on the inspection. 31/03/07 21 OP36 18(2) 31/03/07 22 OP38 13(4)(a) 31/03/07 Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 36 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 OP1 OP2 Good Practice Recommendations Recommend a note is made on file when residents receive copies of the service users guide. Ensure that all residents are provided with information relating to the amount and payment of fees and that Contracts issued are fully completed signed and dated. Ensuring safe storage of medication keys. Recommend you speak to residents to establish what sauces or condiments they would like with their meals, as these are not routinely available. Ensure all complaints to the home are clearly recorded. Recommend that residents who required moving and handling equipment are in rooms over 12 sq metres, due to risk to both staff and residents. Ensure all new residents are offered the furniture listed in 24.2 of the National Minimum Standards and this is clearly recorded on their file. Recommend a recruitment policy is produced which clearly describes the home’s practice in the recruitment of staff and is in line with Schedule 2 of the National Minimum Standards and protects both staff and service users. The registered manager will try to ensure that written documentation requested by the CSCI is provided within the written timescale given. Recommend that you also gain views from other people who use are involved in the home, i.e. district nurses, GP’s, Social Workers etc. Recommend staff are supervised at least 6 times a year and written records are made. 3 4 OP9 OP15 5 6 OP16 OP23 7 OP24 8 OP29 9 OP31 10 11 OP33 OP36 Queens Park Court DS0000067527.V318965.R03.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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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