Inspection on 18/09/06 for Queens Park Nursing Home

This inspection was carried out on 18th September 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 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 Nursing Home 17/09/07

Queens Park Nursing Home 30/04/07

Queens Park Nursing Home 09/02/06

Queens Park Nursing Home 23/05/05

Queens Park Nursing Home 02/11/04

Queens Park Nursing Home 10/05/04

Queens Park Nursing Home 09/02/04

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

CARE HOMES FOR OLDER PEOPLE Queens Park Nursing Home 37 Queen`s Park Parade Kingsthorpe Northampton Northants NN2 6LP Lead Inspector Stephanie Vaughan Unannounced Inspection 18th September 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 Nursing Home DS0000012635.V311237.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 Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queens Park Nursing Home Address 37 Queen`s Park Parade Kingsthorpe Northampton Northants NN2 6LP 01604 719982 01604 718696 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) Dr Ramalingam Mudaliar Mr Daljit Singh Poone Nigel McGill Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (26), Terminally ill over 65 years of age (26) Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: Queens Park is a home registered to provide care for people over 65 years of age, with a diagnosis of Dementia or Mental Disorder. The home has accommodation for up to 26 Service Users, mostly being provided in shared rooms. The accommodation is located over three floors, which are accessible by a passenger lift. The home has a large sitting room and a dining room, however there is no quiet area for residents to receive their visitors in private. The home would benefit from some redecoration. The home is close to local amenities such as shops and bus stops. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to this statutory inspection, a period of four hours was spent in preparation. This comprised reviewing previous inspection reports and associated requirements and recommendations; the service history, risk assessment, returned residents comment cards and other documentation. Since the last inspection the Commission have received no complaints about the home. However has received one Safeguarding Adults referral, which is addressed in the main body of the report. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of nine and a half hours during which the inspector made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of four residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. The Registered Manager was not present during this visit, however one of the service providers was present for a short period. The current fees range form £353.85 to £380.00 per week with extra charges for chiropody, hairdressing, newspapers, personal and items toiletries. The Certificate of Registration is up to date and accurate. What the service does well: Before residents (or their representatives) decide if they would like to live at the home, they have an opportunity to visit and are provided with the information about the service. The staff assess residents before they are admitted and all residents have an individual plan of care, which are reviewed every month. Residents have access to most health professionals such as General Practitioners. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 6 One resident stated that ‘I am happy with the nursing care, it’s ever so nice here and the people are ever so good’ Residents are able to spend time in their own rooms if they wish and are able to bring in their personal possessions. There is a permanent activities coordinator, who organises a good range of activities for the residents. It is through these activities that the service is able to demonstrate a commitment to Equality and Diversity Staffing levels are good and staff respond appropriately to allegations of abuse. Regular staff training is provided What has improved since the last inspection? What they could do better: Resident’s contracts should be signed by the resident or their representative. Preadmission assessments need to take into account the full range of the residents needs to be sure that the appropriate care is provided. Care plans need to be improved so that they contain the right information to allow the staff to care for the residents in the right way and take into account the wishes of the residents. Staff need to make sure that the residents have the equipment that they need Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 7 The menu needs to be improved so that residents are able to make choices and have a healthy diet. Residents at risk should be referred to a dietician. Medication systems need to be made safe and staff need to have the right checks before they stat working in the home. Care staff should help residents take an interest and participate in activities. Staff holidays should be arranged so that they do not restrict residents’ activities. Information about how to complain should be made easily available to residents and their representatives. The providers should consider making improvements to the residents’ bedrooms Resident’s money should be kept safe at all times. Risk assessments need to be written to keep residents safe from accidents such as falls and other hazards. 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. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4 Appropriate admissions procedures are in place, however the holistic needs of residents are not addressed which places them at risk. The quality in this outcome area is poor; this judgement has been made using available evidence including a visit to the service EVIDENCE: One new resident was admitted to the home during the inspection and the inspector spoke to the relative accompanying her. She was able to confirm that she had had an opportunity to visit the home, meet the staff and view the accommodation available. She was also able to confirm that a member of staff from the home had conducted a preadmission assessment and that she had received the Service Users Guide. Residents had individual contracts placed within a separate file and these contained information about the terms and conditions of residency, the rooms to be occupied, whether it be a double room or a single room and the fees Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 10 charged. The Registered Manager had signed these, however no signature had been obtained from the resident or their representative. Case tracking of four residents identified that each resident had had a preadmission assessment. The assessment document was of a comprehensive format and in general contained the appropriate information to ensure that the service was able to meet the needs of the resident. One resident had stated ‘ I am not happy here. I do not fit in and would like to be more independent’ Case tracking identified that the resident had a level of need that required a significant level of support. His concerns were discussed with one of the providers who confirmed that they were aware of his views and were currently reviewing the alternatives. One resident’s pre admission assessment contained minimal information about the resident’s diagnoses. Those listed in the main referred to his mental health issues. Individual plans of care had been developed for Personal Hygiene, Double Incontinence, Mental Health Problems, Restricted Mobility, Inappropriate Behaviour and Hot Weather Protection. However another file kept within the treatment room contained a separate list, which included further information about the resident’s medical diagnoses Individual plans of care had not been developed for these conditions and therefore the full range of this residents needs are not being met. For example there was no care plan for angina, an entry was made on the 11/09/06 that the resident had swollen legs. There was no follow up to this and the residents weight record had indicated a significant increase of approximately 10Kg over the last two months, which might be indicative of fluid retention and associated congestive cardiac failure. There was no instruction to staff as to how this condition was to be managed for example, observation, elevation of the legs and medical referral. In addition there was no specific information about the residents diet as to the benefits of a low fat, low sodium diet. This was discussed with the cook who confirmed that the only special diets that were currently being provided were for the diabetics and the provider confirmed that there is no current access to dietetic services. The Service does not offer intermediate care Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 The management of heath and personal care is not proactive and therefore fails to ensure that resident’s needs are met. The quality in this outcome area is poor; this judgement has been made using available evidence including a visit to the service. EVIDENCE: All residents’ case tacked had an individual plan of care, which in general sets out the needs and associated instruction to staff about the care that is required. A new format has been introduced and the content includes basic information regarding personal care. However significant omission were noted examples include; specific instruction to staff about oral care, personal preferences about routines, social contacts, specific detail about movement and handling and life histories. These are necessary to enable staff to communicate appropriately with residents suffering from dementia. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 12 A requirement was made at the previous inspection in relation to risk assessments for the management of falls. Individual plans of care contained some reference to the history of falls and a potential risk. However the information was very basic and failed to demonstrate how the identified risks were to be reduced or managed. This requirement is therefore unmet. Individual plans of care evidenced regular monthly review, however there was no recent evidence that the individual plans had been drawn up with the resident or their representative or that they were involved in the review. Individual plans of care evidenced that residents have appropriate access to health professionals including General Practitioners, district nursing services, podiatrists, opticians and hospital services. One resident stated that ‘I am happy with the nursing care, it’s ever so nice here and the people are ever so good’ One of the residents had indicated concerns regarding his speech difficulties and the individual plan of care evidenced that he had been offered recent access to the Speech and Language Therapist, which had been declined. All residents case tracked had assessments for the risk of pressure, which were regularly reviewed. Two were noted to be at risk and one was noted to be at high risk, however there was limited information regarding the management and no reference to the provision any of pressure relieving equipment. In addition residents were assessed for nutritional risk and these were reviewed on a monthly basis. However two of the residents were assessed as being cause from concern. One of these was recorded in the care plan as being in receipt of a normal diet with increased high-energy protein foods. However there is no evidence that this is available under the current catering arrangements. Two other residents were assessed as having a high nutritional risk and no interventions were recorded. Staff spoken to confirmed that guidance form a registered dietician has not been sought for these or any other of the residents. There was evidence that residents have access to the Continence Advisor in which in one instance has not been followed in accordance with the wishes of the resident’s representative. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 13 However comments from the resident himself indicate that this may not be in the best interests of the resident and further guidance should be sought from the continence advisor and the representatives should be provided with the appropriate information to enable them to make an informed decision. Another resident stated I am always getting bruises and the staff take no notice. Daily records evidenced two occasions where the resident had complained about pain/ bruising to his arms. On both these occasions staff had checked it out and provided medication. However there was no record made on the body map within the care plan. Without collecting this information in an accessible format it is difficult for staff to monitor the frequency, severity, location of bruising and cause. This means that they are unable to make a judgement about whether the bruising is a result of random injury; A potential Safeguarding Adults issue or as a result of a medical condition. Whichever the case it is necessary to establish the cause in order that appropriate referrals can be made and risk assessments developed. Medication is generally managed well and stored appropriately; a standard monitored dose system is used. Medication administration records were signed appropriately and cross-referenced with the remaining balance to indicate that the medication had been given as prescribed. However the Medication administration Records are currently filed in a ring binder and it was noted that the hole punch had obliterated the name of one drug and the dose of another. This was pointed out to the nurse in charge who took immediate action to record the necessary information. In order for medication to be administered safely the system of storing the medication administration sheets must be reviewed. The privacy and dignity of residents is currently compromised by the layout of the premises, particularly in the communal areas. This was subject to a recommendation at the last inspection and as a result the provider has commissioned an assessment of the premises by an Occupational Therapist. The provider is now awaiting a full report from the Occupational Therapist and plans to make improvements to the premises based on the recommendations of the report. Individual plans of care contain inconsistent and limited information about the residents’ wishes or their representative’s views about the arrangements to be made regarding terminal care and death. However the management have arranged training for staff in the management of terminal care and death (Liverpool Care Pathway and Gold standards Framework which is due to be conducted in the near future). Queens Park Nursing Home DS0000012635.V311237.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15, Meaningful interaction with residents is not consistent amongst all staff; routines are not sympathetic to the needs of residents and meals and mealtimes fail to meet the needs of residents. The quality in this outcome area is poor; this judgement has been made using available evidence including a visit to the service EVIDENCE: One of the resident case tracked preferred to spend most of his time in his own room and was supported to do so. However, there is little evidence that routines are flexible and varied. Some staff were constantly busy with routine care such as toileting rounds and serving and assisting residents with meals. Others were noted to fulfil a supervisory role, often just sitting observing residents rather than interacting with them. One of the residents had commented that he had made complaints in the past and nothing had happened. On further enquiry it was established that his concerns related to the time that he was assisted to get up in the morning and that he had wanted to stay in bed longer. One member of staff confirmed this and stated that she had raised it on several occasions and nothing had been done. There was no evidence of this Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 15 residents concern in either the care plan or the complaints file and the care plan had not been amended to accommodate resident’s wishes. There is a permanent activities coordinator, who organises a good range of activities for the residents. These events are displayed in the home and include visiting entertainers on a monthly basis, seasonal events, themed days such as an Afro Caribbean day and an Irish day. Also group activities such as quizzes, bingo and memory games and individual activities such as shopping trips general conversation and outings to the pub. It is through these activities that the service is able to demonstrate a commitment to Equality and Diversity. One resident commented ‘they need more staff so that I can go out. I like to go out but there is never enough staff. I do not like to be in a group’ On further enquiry it was established that some of these activities had had to be reduced during the summer months due to the pressure of staff holidays. This was discussed with one of the providers who was present for a short period during the inspection who confirmed that this had been the case. A form has been developed to capture information about resident’s interests and past history in order that personalised activities can be developed. This is of particular importance for residents with dementia when their long-term memory is better than their short-term memory. These have been circulated to the representatives of existing residents and are be included as part of the assessment process for new admissions. This will provide staff with the information that will enable them to make improvements to the individual plans of care and interact appropriately with individual residents. Occasional visitors were noted to come and go freely. One visitor confirmed that he was satisfied with the care that was provided to his relative although the distances in location prohibited him from day to day involvement. The lunchtime service was viewed; the meal comprised a meat casserole with potatoes and vegetables, followed by a fruit flan. The meal appeared to be well presented, of adequate proportion and to be nutritionally balanced. Residents requiring a soft diet had their food appropriately presented. Residents requiring assistance were sensitively supported by staff who wore the appropriate apparel, consistent with good food hygiene practices. However one of the residents was observed who did not eat any of her main course and no assistance was given. This course was removed and the desert provided. This also was removed without any of it having been eaten. During this period she was frequently shouting out, eventually she was then provided with some biscuits Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 16 On enquiry the inspector was informed that this was her normal behaviour and that the staff had tried to encourage her, which only caused further distress. The inspector was informed that this is documented within the care plan, that she regularly ate her breakfast and that she would probably eat something later. A sample of the menus were submitted to the Commission prior to the inspection and seemed to offer a varied and balanced diet, although there was no evident choice of meals at the lunch time service. It became evident during the inspection that the sample menus are no longer adhered to; a member of staff spoken to confirmed that this was because the kitchen staffing hours had been reduced. At the present time residents have access to one cooked breakfast a month comprising a bacon sandwich. The remainder of the time the choice is between cereals, sandwiches or toast. In addition the teatime service has also been reduced, currently no hot alternatives are available. On the day of the inspection the cook prepared the tea before she left which comprised jam sandwiches of brown and white bread, sausage rolls and cake. On enquiry the inspector was informed that there were tins of spaghetti in the cupboard if residents wished to have an alternative. However comments received form residents indicate that this is not readily available. It is of concern that the resident who did not eat her lunch would have no fruit or vegetables on that day and as this appears to be an ongoing issue may have an adverse effect on her nutritional status. Healthy alternatives should be available and residents at nutritional risk must be referred to a Registered Dietician. Three of the four residents who responded to the comment cards referred to the food provided in the home and these are as follows: ‘I would like a choice of food, I do not like the lunch time food but the evening tea is very good’ ‘I like the breakfast. I would like to see more choice at lunch and tea. There are always sandwiches at teatime’. ‘I like the breakfast; I do not like the dinner and tea. I would like a choice’. The complaints file was viewed and seen to contain two complaints for the current year. One was related to the provision of the teatime food and the frequency of sandwiches, which were of low nutritional value. Queens Park Nursing Home DS0000012635.V311237.R01.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Staff respond appropriately to concerns about Safeguarding Adults; however practices within the home do not enable residents and their representatives to consistently address their concerns. The quality in this outcome area is adequate, this judgement has been made using available evidence including a visit to the service EVIDENCE: The Commission for Social Care Inspection have received no complaints about this service in the period following the last inspection. The Service Users Guide is issued to prospective residents and their representatives prior to admission. This document contains information about how to make a compliant. However one resident commented that he has never been told how to make a complaint. It is recognised that this information may have been provided but lost or forgotten since admission. However the inspector viewed the notice boards within the home and could find no information that informed either the resident or their representative how to make a complaint. On enquiry the inspector was informed by staff that they did not exactly know where it was displayed yet they were sure that it was there somewhere. Staff did agree to explain the process and reissue the Service Users Guide to the residents who did not know how to complain and the information should be displayed in a prominent position within the home. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 18 The complaints file was viewed and seen to contain two complaints for the current year, one related to poor movement and handling techniques, the investigation found the complaint to be upheld and appropriate correspondence to the complainant was evident. The second was received two months ago relating to the food served at teatime, however there was no evidence that this complaint had been acknowledged, investigated or a response sent to the complainant. The Commission for Social Care Inspection have been notified of one Safeguarding Adults incident, which occurred in July this year. The staff and management have taken the necessary steps to ensure the protection of other residents in the home and have made the appropriate referrals. The police have been making enquiries and have been unable to trace the alleged perpetrator. One of the providers who was present for a short time during the inspection has agreed to make a provisional referral to the Protection Of Vulnerable Adults List held by the Secretary of State to ensure that other vulnerable adults are protected. Queens Park Nursing Home DS0000012635.V311237.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Some progress has been made towards the improvement the environment for residents. The quality in this outcome area is adequate, this judgement has been made using available evidence including a visit to the service EVIDENCE: Following a recommendation made at the last inspection the providers have initiated an assessment of the premises by an Occupational Therapist. The final report has yet to be received and this will be used to inform the development of the premises. The providers are also aware of the need to refurbish bedrooms and to replace carpeting. At this point it would also be advisable to review the space requirements and layout for residents who share double rooms. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Existing recruitment practices do not ensure that residents are in safe hands at all times. The quality in this outcome area is poor; this judgement has been made using available evidence including a visit to the service EVIDENCE: Information about staffing levels was submitted to the Commission prior to the inspection. An analysis of this information indicates that staffing levels in the home are good. During the busiest times the ratio of staff to residents is 1:5. Each shift is covered by at least one Registered Nurse. Care staff are supported by additional domestic support. However staff holidays have impacted on the resident’s routines during the summer. The service has achieved the Department of Health target of 50 of staff having obtained the National Vocational Qualification in Care level 2. The most recent staff member commenced employment in July this year and as yet an appropriate Criminal Records Bureau Clearances or povafirst has not been received. Discussion with staff identified that there have been unusual circumstances associated with this application that have caused delay. Staff in the home have been proactive in dealing with this through consultation with Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 21 the Criminal Records Bureau. Nevertheless this member of staff should not have been allowed to commence employment without an appropriate Clearance or povafirst check. In addition some of the files evidenced that appropriate written references had not been obtained. On enquiry the inspector was informed that in some cases verbal references only had been obtained. A requirement was made at the last inspection to ensure that staff recruitment and records reflect all the information required as detailed in Schedule 2. This requirement is therefore unmet. Staff files evidenced access to appropriate training including Fire safety and First Aid. Staff spoken to were also able to confirm training in Movement and Handling, Safeguarding Adults, Infection Control and Wound Care. However some staff also confirmed that they had not had access to Basic Food Hygiene training. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Management systems do not consistently ensure the health and safety of residents. The quality in this outcome area is poor; this judgement has been made using available evidence including a visit to the service EVIDENCE: The Registered Manager has achieved National Vocational Qualification in Care level 4 and the Registered Managers Award, however is currently working his notice and due to leave at the end of September. The Providers are currently advertising for a replacement and have agreed to supply the Commission with written information about the arrangements for the management of the home in the interim. The current Registered Manager has internal Quality Assurance processes in place and conducts regular residents satisfaction surveys, the results of the Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 23 last survey dated March 2006 were not available for inspection. Regular audits are also conducted on medicine administration systems, care plans, the environment and the quality of food. The service holds small amounts of money for some residents; this is stored appropriately, in individual wallets within the safe. Receipts are obtained for purchases and these are logged in an appropriate record containing the details alongside the balance and two staff signatures. A random check was conducted and the wallet contained a deficit of £ 3:80 pence. Following further investigation it was established that the deficit was due to the payment for hair dressing that had been provided that day but not yet recorded. However this then showed that there was an excess of 20 pence, the administrator agreed to check all the other residents’ cash as it was considered likely that this may belong to another resident having been put into the wrong wallet. The records are regularly audited. Staff have access to mandatory training, although one member of staff confirmed that she had not had Basic Food Hygiene Training. Case tracking identified that the management of Health and Safety is unsafe due to the lack of appropriate risk assessments to reduce and manage risks. Examples of these omissions include: 1.The risk of falls 2 The storage and self-administration of mouthwash 3 The risk of residents falling out of bed 4 The risks associated with the use of bed rails 5 The risks for residents with a history of self harm 6 The risks of physical and verbal aggression between residents. Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 1 Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 Requirement The assessment process must take into account the full range of a resident’s health, personal and social history to ensure that their needs can be met. Individual plans of care must be reviewed to ensure that the full range of a resident’s health, personal and social history are documented and appropriate care plans developed Care plans must be reviewed to ensure all residents are assessed for the risk of falls, which detail how the risk is to be managed in line with current best practice and the guidance issued by the Health and Safety Executive Outstanding requirement 31/03/06 Residents assessed as being at nutritional risk must be referred to a Registered Dietician. Appropriate records must be maintained to enable staff to make judgements about the cause, frequency, location and severity of bruising. DS0000012635.V311237.R01.S.doc Timescale for action 01/12/06 2 OP4 12 01/11/06 3 OP7 13(4) 17/11/06 4 5 OP8 OP8 14 12 01/12/06 01/12/06 Queens Park Nursing Home Version 5.2 Page 26 6 7 8 OP9 OP15 OP15 13(2) 16 (i) 16 (i) 9. OP29 19 10 OP38 13(3) Medication systems must be reviewed to ensure the safe administration of medication Residents who do not eat the food provided must have an appropriate alternative provided The menu should be reviewed to ensure that it provides a variety of nutritious food that the residents like and provides them with the opportunity for making a choice. The Registered Person must ensure that staff recruitment and records reflect all the information required as detailed in Schedule 2. Including evidence of an up to date Criminal Record Bureau clearance and written references Outstanding requirement 31/03/06 All staff involved in the preparation, serving or assisting residents with food must have timely and accredited Basic Food Hygiene training. Meaningful risk assessments must be developed for the risks identified in the body of this report, based on the guidance issued by the Health and Safety Executive, to ensure the health and safety of residents. 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 11 OP38 13(4) 01/12/06 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 Refer to Standard OP2 Good Practice Recommendations Residents contracts should be signed by the resident or their representative DS0000012635.V311237.R01.S.doc Version 5.2 Page 27 Queens Park Nursing Home 2 OP7 3 4 5 6. 7. 8. 9 10 11 12 13 OP7 OP8 OP8 OP11 OP12 OP12 OP16 OP16 OP23 OP31 OP35 Individual plans of care should be reviewed to ensure that resident’s preferences and preferred routines are established, recorded and are provided in accordance with the plan. Individual plans of care should evidence the residents or their representative’s involvement in the development and review. Individual plans of care should evidence that residents at risk from pressure have the appropriate pressure relieving equipment. The continence advisor should be further consulted regarding the management of a residents care when the current care deviates from what has been recommended. Cars plans should be reviewed to ensure that they contain meaningful information about the resident’s wishes regarding terminal care and death. All staff should be encouraged to use their time effectively with residents providing activities and stimulation. The deployment of staff should be reviewed to ensure that residents are not inconvenienced during peak holiday periods. Information about the Complaints Policy should be made accessible to residents and their representatives. Complaints should be managed in accordance with the criteria listed in Standard 16 of the National Minimum Standards The lay out of resident’s rooms should be reviewed to take into account the space requirements and the use of double rooms. The Commission for Social Care Inspection should be informed about the arrangement for managing the home whilst the position of manager remains vacant. Residents money should correspond with the recorded balance at all times Queens Park Nursing Home DS0000012635.V311237.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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