Inspection on 30/04/07 for Queens Park Nursing Home

This inspection was carried out on 30th April 2007.

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 18/09/06

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 30th April 2007 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.V335517.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.V335517.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.V335517.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th September 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 and there is a quiet area for residents to receive their visitors in private. The home would benefit from some redecoration and refurbishment. The home is close to local amenities such as shops and bus stops. Information about the fees were provided during the inspection, these currently range form £366:94 to £480.00 per week with extra charges for Nursing Care, chiropody, hairdressing, newspapers, personal and items toiletries. Queens Park Nursing Home DS0000012635.V335517.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 six hours was spent in preparation. This comprised reviewing previous inspection reports and associated requirements and recommendations; the service history, risk assessment, and other documentation. The pre-inspection questionnaire was not received in time to inform the inspection process. The Acting Manager confirmed that this had been delayed because of staff sickness. Prior to the inspection nine comment cards were returned from residents and five comment cards were received from relatives. In general respondents demonstrated a good level of satisfaction with the service provided. The comments made have been taken into account throughout the inspection process. However one of the comment cards raised several concerns about the service and the findings are included within the body of the report. Since the last inspection the Commission have received no complaints about the home. There have been no further allegations regarding the Safeguarding of Adults. One potential Safeguarding Adults incident was identified during the last key inspection, this has been fully investigated and was found to be unsubstantiated, however the service has made improvements to the monitoring of residents well being and record keeping as a result of this enquiry. The Commission have a focus on the outcomes of key standards for residents, Equality and Diversity and these are addressed in the main body of the report. This site visit to the home was conducted over a period of nine hours during which the inspector made observations and spoke to residents, relatives 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 three residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. A significant number of residents have Dementia, as such their ability to recall and communicate their experiences are limited, in these circumstances observations, discussions with relatives and staff as well as the information received on comment cards is used to inform the inspection process. The Acting Manager was present during this visit, however one of the partners was present for a short period. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The assessment and care planning process has improved and now ensures that staff have the right information to care properly for the residents. Following the last key inspection a Statutory Regulation Notice was served for non-compliance with a requirement to ensure that residents had appropriate risk assessments for the prevention of hazards such as falls. This was followed up with a further random inspection in December 2006 and a meeting with the providers. All residents are now assessed for the risk of falls, falls from the bed, use of bedrails, pressure, nutrition and movement and handling. Staff have had training in the development of risk assessments. The management have complied with the Statutory Regulation Notice. Resident’s life histories are now recorded and contain detailed information about the resident’s life, preferences and routines. Individual plans of care are now reviewed on a regular and timely basis. The menu has been improved and now offers a balanced diet, a range of choice and individual preferences are catered for. A small quiet room on the first floor has been made available to residents and two bedrooms have been decorated. Three further rooms are scheduled for decoration and new furniture has been ordered for the sitting room. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 7 The deployment of staff has been reviewed to ensure that residents are not inconvenienced during peak holiday periods. Since the last inspection staff have had all of the required training, including Basic Food Hygiene. Staff files are now in order and show that the right checks are being done before staff start working in the home. The providers have arranged for a senior nurse to act as the manager. This has made sure that the home is being managed properly and that improvements are made to the service received by residents. What they could do better: The Statement of Purpose and Service Users Guide are out of date and need to be revised to make sure that residents and their relatives have up to date information about the home. Risk assessments need to have more information about the best way to prevent accidents and keep residents safe. Care plans need to be improved to make sure that residents have and are able to use their equipment such as hearing aids and spectacles. Systems should be developed to make sure that residents property is not lost and that if it is lost the right records are kept. The staff need to make sure that the residents are referred to the right health care specialists to maintain their health, independence and quality of life. Medication systems need to be reviewed to make sure that staff have a record of medicines that are received in to the home. The staff need to make sure that they protect the residents privacy and dignity when they are providing care in the communal areas. The management have agreed to make arrangements for staff to have further training in the English language to help with communication. The providers need to make sure that they have a permanent manager in post who is qualified and able to seek registration with the Commission for Social Care Inspection as soon as possible. Staff supervision and residents satisfaction surveys need to conducted. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 9 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.V335517.R01.S.doc Version 5.2 Page 10 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 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s needs are appropriately assessed prior to moving into the home, ensuring that their health care needs can be met. EVIDENCE: Relatives commented that they had had opportunities to visit the home before deciding whether it was the right place for their relative to live. They also confirmed that they had received information about the home to help them in their decision. However the Statement of Purpose and Service Users Guide have not been reviewed for some time, this means that the information supplied to existing and prospective residents is now out of date and could be misleading. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 11 Information received prior to the site visit also evidenced that residents have contracts in place; these are currently being reviewed and reissued to cover changes, such as increases in the fees charged. Two of the residents selected for case tracking purposes were both recent admissions. Admission documentation evidenced that residents are assessed prior to admission to ensure that the home is able to meet the resident’s needs and this is done by the Acting Manager. Staff confirmed that arrangements are in place to help the new residents settle in and a member of staff takes responsibility for this. Residents were unable to recollect their personal experiences of the admission process, however relatives spoken to during the inspection were able to confirm satisfaction with the admission process and also that their relative had settled in well, this was also confirmed through observations made during the inspection. Queens Park Nursing Home does not provide intermediate care. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvements have been made to the management of heath and personal care, however shortfalls continue to adversely affect outcomes for residents. EVIDENCE: Each resident has an individual plan of care and the standard of these have been much improved since the last inspection. In general care plans now contain good information and instruction to staff about the residents health, personal and social care needs. Residents now have risk assessments in place for the management of pressure, nutrition, Movement and handling, falls and falls form the bed. The Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 13 risk assessments for falls need to be further developed to ensure that they contain information on the best practice in the prevention of falls for example making sure that residents are wearing appropriate footwear. Risk assessments for falls form the bed also need further development to make sure that the hazards associated with the use of bedrails such as entrapment are included. There was some evidence that residents preferences were taken into account when planning care such as times of rising and retiring to bed, food preferences and activities. There was evidence that residents have care plans for sensory impairment, however there was little evidence that residents are supported to manage equipment such as hearing aids and spectacles, which are necessary to maximise their quality of life. It appears that items such as hearing aids and spectacles are mislaid, lost or are unused. For example one of the residents care plans indicated that he had a hearing aid, however there was no record of it being listed in the inventory of property. There is no policy for dealing with resident’s lost property except for money and therefore there was no record of this having been lost. The residents relative had commented that the hearing aid had been lost soon after admission. Through discussion with staff it was established that they did not remember the resident having this, and staff confirmed that they were able to communicate with the resident as long as they were in close proximity. There was no evidence that the resident had been referred to the Audiology Service for a replacement. Failure to manage the provision and use of this personal equipment has a direct impact on the resident’s ability to spontaneously participate in every day activities and therefore impacts on the quality of life. Care plans are regularly reviewed and there was some evidence that residents or their representatives are involved with the care planning process. Care plans for the management of pressure and appropriate pressure relieving equipment is provided. Care plans for nutrition are in place and there is evidence that residents are weighed on a regular basis, however it was noted that one resident had had a significant weight loss during a short period. Although this resident had been referred to the hospital, there was no evidence that guidance had been sought form the dietician. Residents are now assessed for their oral health and appropriate instructions are provided to staff about the residents’ oral care needs. Each resident is now assessed regarding their continence needs and requirements, however one resident commented that he did not like the continence aids that had been provided. There was no evidence that his views about this had been taken into account and there had been no referral to the Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 14 continence advisor to establish whether there might be an alternative solution, which would be more acceptable to him. Individual plans of care for residents with challenging behaviour were much improved. These contain information to staff about the type of behaviour that might be exhibited and the means of managing it. However there was no evidence that residents who’s behaviour presents high-risk have appropriate risk assessments in place to reduce and manage the risks. However, there was evidence that staffing levels had been adjusted to cater for individual supervision needs, that care management reviews had been conducted in appropriate circumstances and the involvement of the General Practitioner and Community Psychiatric Nurse. Residents have access to hospital, ophthalmic and chiropody services. One relative commented ‘I feel very confident at all times that my mother is safe and well cared for. They are very quick to act if she has any medical problems and doctors are called straight away’. One resident commented ‘I receive good care and support from the staff, staff usually try their best to help me’ Medication systems were reviewed, these were seen to be in good order, medication was stored appropriately and there were systems in place for safe disposal. A spot check of medication corresponded with appropriate Medication Administration Records and controlled drug records. Medication Administration Records were in good order. Systems are now in place to ensure that when medication is discontinued authorisation is obtained in writing for the prescriber. However there was little information recorded as drugs were received into the home, records seen comprised a diary entry and staff signature. There was no information relating to specific medication, dose, quantity or the resident for whom it was. An accurate record of this is necessary to maintain an accurate audit trail. One relative had commented that her father had complained that he had not been receiving his medication at night or that he had received it too early, which had meant that he had not been able to sleep. Through discussion with the night staff it was established that the medication was given as prescribed and recorded in the Medication Administration Records. There was also evidence that analgesics had also been prescribed to enable the residents to get comfortable enough to fall asleep. The individual plans of care contained reference to the resident’s claims not to have been given medication at the right time. On further enquiry it was established that the resident wished to be in bed before having his medication. This was specified within the individual plan of care and evidenced that his wishes had been taken into account. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 15 The privacy and dignity of residents is compromised by the limitations of the environment. Most of the bedrooms are shared and vary in size and lack ensuite facilities, however appropriate screening is provided. There is only one sitting room and the shape dictates the layout and positioning of residents. Immobile residents are transported to the sitting room by use of a wheelchair and are then hoisted into an armchair however there is no screening used during this process. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 16 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& 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for residents living in the home. EVIDENCE: Daily life and social activity is managed well at Queens Park Nursing Home. However one of the relatives had stated that her father had said that he was go up too early – at about six o’clock. The inspection commenced at six thirty AM, four residents were already up the night staff demonstrated a good understanding of these resident’s routines and individual needs. The resident who had raised concerns about being got up too early was still in bed and came down to the sitting room after his preferred time specified in his individual plan of care. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 17 Individual plans of care evidence that residents, routines and personal preferences are recorded and taken into account. All residents now have individual life histories which contain a wealth of information about the residents earlier lives, including a family tree with photographs, previous lifestyles, career likes and dislikes, routines and interests. These enable the staff to understand the residents backgrounds, to communicate with them about their past and to develop activities that are of interest to them. A karaoke machine was being purchased on the day of the inspection to enable residents to participate in singing and entertainment activities. There is an activities coordinator who organises outings, in house activities and one to one sessions. One resident stated that he would like to go out and get a newspaper in the mornings and the staff agreed to make the appropriate arrangements. During the inspection residents were seen to be participating in games such as dominoes and ball games. One relative commented ‘the activities are very good with a lot of opportunities to go out on a number of trips but also entertainment comes to the home. The home has a good friendly atmosphere and staff welcome you day and night’. Another relative commented ‘They treat the residents as individuals and make the home a real home with respect and love’. Another commented ‘They are excellent at helping her keep in touch with her sons who live abroad, via e mail and photographs’. One resident commented ‘I like to go out to the pub - I usually go out once a week’. Another commented ‘ I am happy here I go to the shop with the staff’. Following a Requirement made at the last Key inspection menus have been reviewed and changes made to ensure that residents have a wider choice. The menus have been approved by a dietician as being balanced, nutritious and healthy. All food is freshly prepared and corresponds with the menu displayed. The lunchtime service was viewed; residents were able to eat in the dining room, the sitting room or their own room. The meal comprised homemade beef stew and dumplings, with cauliflower, swede and mashed potatoes, followed by rice pudding with jam. A fish alternative was specified on the menu and other desert alternatives were available. One resident commented that the cooked meal was too heavy for him at lunchtime and that he wanted a light meal such as a salad. Staff arranged for a salad sandwich to be provided and confirmed that the menu was now being reviewed in response to the warmer weather and residents’ preferences. Meals appeared of adequate proportion, well presented and were appropriately processed for residents requiring soft diets. Resident’s requiring assistance were supported with patience and sensitivity by the staff. Good food hygiene practices were evident. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 18 Comment cards received from residents indicate that residents usually like the meals that are provided. One resident commented ‘If I do not like the food I have something else to eat’. One relative commented ‘ The tea time meals could improve, the fillings in the sandwiches are not very nice, no choice and the cake often seems to be the same’. This was discussed with the Acting Manager who confirmed that the owners were currently recruiting another cook to work in the evenings and at weekends in order to improve the quality of the food at these times. Residents are supported to practice their faith, should they wish to do so, and maintain links with the local community. One resident recounted his wartime experiences and the staff have agreed to arrange contact with agencies able to support and share in these recollections. Residents are able to receive their visitors in the communal areas, in their own rooms or on the small quiet room that has recently been established. Visitors were seen to come and go freely and were made welcome by the staff. One relative commented ‘I have visited the home where my father is a resident, on different days of the week and at different times of the day and have always received a friendly welcome. The home is always clean and the staff caring’. The development of resident’s life histories and individual plans of care demonstrate that residents are supported to make choices about their daily routines, activities, and food preferences. Resident’s rooms evidenced that they are able to bring their personal possessions into the home. Care Plans evidence that care is now becoming more individualised and this promotes residents Equality and Diversity, however there are currently no formal polices and procedures to inform staff about how this is to be achieved at Queens Park Nursing Home. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a robust complaints procedure and good staff awareness and attitudes regarding the safeguarding adults so that residents felt safe and were protected. EVIDENCE: Since the last inspection there have been no complaints about Queens Park Nursing Home, the complaints policy contains the right information and is accessible being included in the Service Users Guide and displayed in the dining room. Most residents who responded to the comment cards indicated that they knew how to complain and most relatives commented that they were aware of the complaints policy. On respondent commented ‘They will listen if I have any comment to make on a friends care’. One of the residents commented ‘I receive good care and support from the staff’ Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 20 Since the last inspection there have been no Safeguarding Adults allegations, staff spoken to were able to confirm access to recent training in the Safeguarding of Adults and were able to demonstrate an appropriate level of understanding. One Safeguarding Adults incident was referred to in the last key inspection report regarding unexplained bruising, this has been fully investigated and found to be due to the prescribed medication appropriate risk assessments and records are now maintained. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 21 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 7 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The layout and use of the building provides residents with a safe place to live however the lack of space and privacy impacts on their quality of life. EVIDENCE: The premises are suitable for their stated purpose, although most of the bedrooms are shared, accommodating two people, however appropriate fixtures and fittings, including screening and call bells are provided. Two of the bedrooms have recently been decorated and three more are scheduled to be done in the near future. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 22 There is an L shaped communal sitting room, which does present some difficulties regarding the layout and available space to move around. There are currently no arrangements for ensure the privacy and dignity for residents requiring the use of the hoist staff, the use of portable screening should be explored. Discussion with the Acting Manager identified that the owners are currently considering the possibility of extending part of the lounge into the small garden area outside. Since the last inspection the management have allocated a small room on the first floor that can be used a quiet area or a room to meet with relatives in private. No hazards were identified and the premises were generally clean and hygienic. The carpets in the main lounge and on the stairs were stained in places, the acting manager confirmed that these were generally cleaned on a monthly basis, however quotes are currently being obtained with a view to replacement. New furniture has been ordered. One relative commented ‘The home provides a safe, warm, friendly and caring home, which is always very clean – always’. Another commented ‘Rooms have been decorated and they are constantly updating things to help everything run smoothly’. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 23 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, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are employed in sufficient numbers and are trained to ensure that residents are in safe hands. EVIDENCE: The staff duty rota indicates that staffing levels are good. The home operates with the Acting Manager, one staff nurse and five carers throughout the day. There is extra provision for residents requiring increased supervision. There are also good levels of support staff including an administrator, activities coordinator Housekeeper, cleaner and cook. During the night there is one nurse and two care staff. Staff files were reviewed and found to be in good order. Recruitment practices have been improved since the last key inspection, all staff now have appropriate Criminal Records Bureau Clearances and written references. Staff spoken to confirmed appropriate recruitment practices. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 24 Staff have access to appropriate induction and other mandatory training. Since the last inspection staff have had training in Basic Food Hygiene, Movement and Handling, Fire Safety, Infection Control, and Health and Safety. Other training has been provided in the management of residents with dementia, wound care, and risk assessment. However, two of the comment cards contained reference to communication difficulties with staff particularly associated with the use of the telephone. One relative commented ‘ Lots of misunderstandings have occurred because some staff do not understand what we say to them either on the phone or in person’. This was discussed with the Acting Manager who confirmed that seven members of staff out of a total of thirty-one were from overseas and had some difficulties with comprehension and pronunciation. In the main these are nurses who have been in England for approximately three years and having done their conversion training to work as Registered Nurses. In order for them to undertake this training the applicants have to demonstrate a prescribed level of competence in the English Language. Nevertheless it is acknowledged that the staff identified would benefit from further training, which the Acting manager has agreed to organise as soon as possible. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has stabilised under the leadership of the acting manager, which has resulted in improved outcomes for residents. EVIDENCE: The Registered Manager resigned his employment six months ago, since then the home has been managed by an Acting Manager. The Acting Manager is a Registered Nurse who is currently developing her management experience and intends to apply to do the Registered Managers Award; she is also considering Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 26 seeking registration with the Commission. Staff spoken to confirmed confidence in the Acting Manager saying that she was supportive and had made significant improvements in the home since she had taken over. Quality Assurance practices are being developed within the home with the appointment of a staff member with specific responsibility for this in the near future. Currently quality assurance activities include – • • • • • • Audits of the accident records Audits of residents money, held for safekeeping Medication audits Annual review of policies and procedures Suggestion box House keeping tasks are now audited The annual residents satisfaction survey and staff supervision has lapsed over recent months, however new supervision formats are being developed, based on staff job descriptions for use in the near future. The service holds small amounts of resident’s money. This was checked and found to be appropriately stored, in a safe and within individual wallets. There was evidence of expenditure in the form of receipts and an appropriate record of money received and spent. The amount money remaining in the wallets checked corresponded with the recorded balance. No environmental hazards were identified, staff have access to appropriate training and appropriate accident records are maintained. Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation Schedule 1 Requirement The Statement of Purpose and Service Users Guide must be reviewed to ensure that existing and prospective residents have up to date and accurate information. Risk assessments for falls, falls from the bed and the use of bedrails must be further reviewed to ensure that they are in line with current best practice in order to ensure the health and safety of residents. Individual plans of care must be reviewed to ensure that residents are supported in their use of equipment necessary to maintain their independence and quality of life. Residents must be referred to external specialist services such as the Audiology Service, Dietetic Service and the Continence service, to ensure that their health care needs are met, in accordance with their needs and wishes. Residents who’s behaviour presents high-risk must have DS0000012635.V335517.R01.S.doc Timescale for action 01/07/07 2. OP7 13(4) 01/07/07 3. OP8 13 01/07/07 4 OP8 13 01/07/07 5. OP8 13 (4) 01/07/07 Queens Park Nursing Home Version 5.2 Page 29 6. OP9 13(2) 7. OP10 12 (4) appropriate risk assessments in place to reduce and manage the risks and to ensure the Health and Safety of residents Medication systems must be reviewed to ensure that an accurate record of medication received into the home is maintained, in order to ensure an appropriate audit trail and management of medication. Improvements must be made to the care practices associated with residents being hoisted in communal areas to ensure their privacy and dignity. 01/07/07 01/07/07 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 OP8 Good Practice Recommendations Policies and procedures should be developed to ensure that residents are supported to manage their property, necessary for maintaining their independence and quality of life. Policies and procedures should be developed to support the Equality and Diversity of residents. The Acting manager should seek registration with the Commission for Social Care Inspection. Annual Residents satisfaction surveys should be re introduced Staff supervision should be resumed. 2. 3. 4. 5. OP14 OP31 OP33 OP36 Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Extracts may not be used or reproduced without the express permission of CSCI Queens Park Nursing Home DS0000012635.V335517.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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