CARE HOMES FOR OLDER PEOPLE
Rushden Park Nursing Home Melloway Road Rushden Northants NN10 6XZ Lead Inspector
Mrs Pat Harte Unannounced Inspection 9th February 2006 10:10 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 DS0000012639.V276872.R02.S.doc Version 5.1 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. DS0000012639.V276872.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rushden Park Nursing Home Address Melloway Road Rushden Northants NN10 6XZ 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) 01933 418777 01933 418666 paul.draper@mha.org.uk www.mha.org.uk Methodist Homes for the Aged Mr Paul Edward Charles Draper Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (64) of places DS0000012639.V276872.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home is permitted to utilize all of its available beds for either nursing care or personal care only. That the home is permitted to admit up to 8 service users in the category of DE(E) on the first floor only That the home is permitted to admit up to 6 service users in the category of TI Date of last inspection Brief Description of the Service: Rushden Park is a 64 bedded, purpose built home on the outskirts of Rushden. The Home is owned by Methodist Homes for the Aged. The Manager is Mr. Paul Draper. The Home provides for elderly People requiring nursing or personal care. There are up to eight places for People with Dementia and up to six places for People who are terminally ill. The Home is situated in a quiet suburb of Rushden and is easily accessible by Public Transport. The premises are over three floors with the top floor devoted to a service area including the Kitchen, Laundry and Staff training room. Service Users are accommodated on the ground and first floors. There is a lift. The majority of accommodation is provided in single rooms with en suite toilet and wash facilities. There are 3 double bedrooms. The Home offers spacious communal facilities including lounge and dining areas on each floor. Service Users have access to a safe and pleasant garden area. DS0000012639.V276872.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Service Users and their views of the service provided. Inspection planning took one hour and consisted of a review of the last Inspection report, previous recommendations and the Home’s service history including notifications and events. The primary method of inspection used was ‘case tracking’ which involved selecting two Service Users and tracking the care they receive through review of their records, talking with them and the care staff. In addition six staff and six Service Users were spoken with to obtain their views. A partial tour of the premises took place, a selection of records was inspected and observations made on care practices. Discussions were held with the Manager. The Inspection took place during the morning and afternoon over a period of five hours and was carried out on an unannounced basis What the service does well:
Service Users felt that they had been provided with a good level of accurate information on the Home’s services and facilities, which had helped them to make informed choices on whether they wished to take up residence. The pre-admission process ensures that the Manager or Deputy visit all prospective Users prior to admission. The assessment process was thorough and ensures that Users can have confidence that the Home can meet their needs. Users spoke very positively about the staff group saying that relationships were good and staff provided them with good care and support. Staff were observed to ensure personal care or nursing tasks were carried out in private ensuring that Service Users Dignity and Privacy was protected. Routines were relaxed and flexible. Service Users felt they were enabled to follow their preferred lifestyle routines and had choice in rising and going to
DS0000012639.V276872.R02.S.doc Version 5.1 Page 6 bed times and were free to choose where and how they wished to spend their time. The Home employs the services of two Activity Coordinators fifty hours a week. Service Users felt that the range of activities was good and in keeping with their wishes and interests. There are also opportunities for trips out and external entertainers visit the Home. Over all Service Users were satisfied with the meal provision and stated that meals were varied and of good quality. They are able to choose what they wish to eat and they stated that alternatives were available to “tempt the appetite”. They felt that their likes, dislikes and special diets were taken into account and respected. Residents felt that staff responded promptly to any health care needs and made arrangements for them to see their General Practitioners and other Health Care Professionals quickly. Residents were very positive on the accommodation provided, which is maintained to a good standard but remains homely. They confirmed that their rooms were comfortable and met their needs. They are enabled to personalise them as they wished. They felt that staff respected their private space and confirmed that they seek permission to enter. Users stated that domestic routines were carried through efficiently without causing interruption to their personal routines. What has improved since the last inspection? What they could do better:
Service Users care plans do not always give staff specific instruction on all the care needs or how to provide the care. This together with the fact that not all staff have seen or work to the care plan results in the potential for care needs to be missed and for a lack of consistency in the way in which the care is provided. This was the subject of a requirement made in the last Inspection report of the 12th of August 2005, which must now be addressed. Arrangements for the testing of fire equipment and for staff fire training were not adequate, posing a potential threat to Users and Staff safety. These areas
DS0000012639.V276872.R02.S.doc Version 5.1 Page 7 were the subjects of requirements made in the last Inspection report of the 12th of August 2005, which must now be fully addressed. 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. DS0000012639.V276872.R02.S.doc Version 5.1 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 DS0000012639.V276872.R02.S.doc Version 5.1 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 & 5 Prospective Service Users are provided with information to enable them to make informed choice regarding their placement. The pre-admission assessment is thorough and effective in ensuring that the needs of people admitted to the home can be met. EVIDENCE: The Home provides prospective Service Users with information on its aims and objectives, services and facilities to enable them to make an inform choice on their placement. A further welcome pack is provided to all Users. The Manager or the Deputy Manager visit all prospective Users and records showed that a thorough assessment is undertaken to ensure that the needs of any User admitted to the Home can be met. It was clear that Users wishes on their preferred routines and lifestyles were taking into account and respected. Specific and professionally recognised risk assessment tools were used to identify risk areas such as Pressure care.
DS0000012639.V276872.R02.S.doc Version 5.1 Page 10 Reviews are held at the end of a trial period to determine the Service User’s wishes in relation to permanency. Contracts are provided to all Users detailing the terms and conditions of the placement. Leaflets on Independent Advocacy services are now made available to Service Users. DS0000012639.V276872.R02.S.doc Version 5.1 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 Care plans do not provide sufficient detail on all areas of need nor instructions on how the care is to be carried through. Not all staff are fully familiar with the care plans leading to potential risks that areas of need can be missed and the consistency of care may be affected. EVIDENCE: Two care plans were inspected. Whilst the formats for assessing and recording needs were thorough the plans themselves did not identify all areas of need. For example references to hair, dental and foot care were not detailed. There was a reference to a User having depression but no instructions were listed to guide staff on how she was to be supported. One plan clearly documented the nursing and physical needs but no reference made to User’s social and emotional needs. Whilst references were made to personal care, such as bathing and continence programmes, full instructions for staff with timings were not detailed. The approach to using the care plans as working documents varied greatly and discussions with carers showed that they did not necessarily refer to the plans for guidance. On the first floor Residential section the carers confirmed they had viewed the plans and saw these as providing them with guidance and
DS0000012639.V276872.R02.S.doc Version 5.1 Page 12 instruction on both the needs and how the care was to be carried through. However one carer on the ground floor of the Home stated that she had never seen the plans and therefore had no real knowledge of the needs or how they were to be met. The Deputy Manager stated that all care staff were “encouraged” to view the plans, which were accessible to them, but there did not appear to be a system to ensure that all staff used them as working documents. It was clear that there is a verbal handover system, which alerts staff to any changes, but the lack of familiarity with the care plans, by some staff, has the potential for areas of care to be missed. This lack of knowledge can also lead to an inconsistent approach. This is an area for on going development. Service Users health care needs were recorded and records together with Users comments showed that staff were prompt to refer areas of concern to the relevant Medical Professionals. Users confirmed that they received visits from Medical Professionals in private. Service Users felt that staff were careful to protect their privacy and dignity by ensuring that personal and nursing care tasks were carried out in private. The Home’s medication system was inspected and found to be in good order. Medication is safely stored and the required records were well maintained. The Home provides care for Service Users who are terminally ill. Their wishes after death are discussed with them or their relatives, as appropriate, and are recorded. DS0000012639.V276872.R02.S.doc Version 5.1 Page 13 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): Social activities and meals are both well managed and provide variation and interest for the people living in the home. EVIDENCE: Service Users felt that routines were relaxed and flexible and that respect was paid to their lifestyle routines and wishes such as rising and going to bed times. They stated that they had freedom of choice in how and where they wished to spend their time. Records showed that Users’ hobbies and interests are noted and staff provide assistance and support to help them pursue their interests. The Home employs two Activity Coordinators for 50 hours per week. Service Users were positive in their comments about the group activities provided such as craftwork, games, quizzes and Bingo. External entertainers also visit the Home. The Manager has set up a “Dream fund” with money raised by staff. Any User or staff member can apply to the fund for special activities or for additional items for the comfort for the Users. Examples given were for such events as individual trips out or a special meal for Users celebrating a special occasion. The Home has an open visiting policy and observations confirmed that Visitors were made welcome and offered hospitality. Staff made themselves available to discuss the progress of individual Users with their relatives.
DS0000012639.V276872.R02.S.doc Version 5.1 Page 14 The Home employs a Catering firm, Catering plus, to provide the meals from the premises. It was clear from staff and User’s comments that the catering team is regarded very much as a part of the overall staff team. Service Users confirmed their overall satisfaction with the food provided. They stated that their likes and dislikes were respected, that they were offered choices and alternatives and could choose to eat in their rooms if they wished. They were asked to submit ideas for the menus. The midday meal was efficiently served and nicely presented. Observations confirmed that staff were on hand to give assistance as necessary. The use of food and fluid charts was discussed with the Deputy Manager as it was noted that a Service User was not eating. It was clear that she was being monitored and offered supplements but a record of intake was not maintained to measure the risk. The Deputy Manager agreed that this area would receive attention. DS0000012639.V276872.R02.S.doc Version 5.1 Page 15 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 Systems are in place to ensure that complaints are listened to and acted upon and that Service Users are protected from abuse. EVIDENCE: Service Users confirmed that they had been provided with the Home’s complaints procedure and felt able to raise any concerns or complaints with staff. The Complaints record showed that 2 complaints have been received from Relatives since the last Inspection concerning resuscitation and staff telephone manner. The Manager showed, through the record systems, that the complaints had been investigated and appropriate action had been taken to resolve the issues. The Protection of Vulnerable Adults procedures was discussed with three staff members including the second Nurse on duty. They demonstrated their understanding of the types of abuse that can occur and showed that they would report any allegations or suspicions to the Manager who has overall responsibility to report to the relevant Authorities. DS0000012639.V276872.R02.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23,24, 25 & 26 Service Users are provided with a safe and well-maintained environment. EVIDENCE: The premises were in good order, safe, warm, comfortable and well maintained. Selected areas including bathing and toilet facilities were inspected. All areas of the home seen were well decorated and furnished to a high standard. Action had been taken to eliminate unpleasant odours identified on the last inspection and standards of domestic and hygiene maintenance were viewed as good. Service Users rooms were bright and airy and there was evidence of personalisation in the form of pictures, ornaments and small items of personal furniture. DS0000012639.V276872.R02.S.doc Version 5.1 Page 17 Users have access to spacious communal areas and a pleasant landscaped garden. DS0000012639.V276872.R02.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 Staffing levels are sufficient to meet the needs of the Service Users but the failure to ensure updates in staff Fire training puts Service Users at potential risk. EVIDENCE: Service Users spoken with said that the staff were very kind, committed and caring. Relationships between staff and Residents were good. Staff were observed to respond quickly to User’s needs. Staffing levels are calculated according to the Residential Forum Guidance and are based on the dependency levels of the residents. Each floor of the Home is staffed separately. Rotas showed that on daytime shifts from 8am to 2pm 2 Registered Nurses and 5 care staff are deployed to the ground floor with 1 Nurse and 4 carers deployed between 2pm and 8pm. 1 Nurse, 1 senior carer and 5 carers are deployed to the first floor between 8am and 2pm with the number of care staff reducing to 3 in the afternoons and evening. The deployment of staff to specific areas of the Home ensures that Users are constantly monitored. Staff training records in relation to Fire prevention were viewed. 8 staff were still in need of training updates. This area was the subject of a previous requirement made in the August 05 Inspection report which remains unmet. DS0000012639.V276872.R02.S.doc Version 5.1 Page 19 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, 32, 33 32 & 38 The testing of the Home’s fire alarm system and emergency lighting has not been carried out at the intervals recommended by the Fire Officer and this puts Users and staff at potential risk. EVIDENCE: The Manager and Deputy Manager are supernumerary to the shift system and have time to devote to their managerial responsibilities and to the development of the service. Service Users felt the Manager was readily available to them. They commented that regular Residents meetings were held and that the Manager also sought their individual views. They felt that their opinions were listened to, valued and acted upon and that they had trust and confidence in the staff group as a whole. DS0000012639.V276872.R02.S.doc Version 5.1 Page 20 Staff spoken with felt that the Manager and Deputy Manager was easily accessible to them and was willing to discuss any issues and guide them in practice. The systems for the safekeeping of moneys and valuables was in good order with receipts maintained for any items or services purchased by staff on behalf of residents. The Home pays special attention to obtaining equipment needed for the care and comfort of the Service Users. Attention has been paid to ensuring that where bedsides are needed for safety reasons these are appropriately padded. The general approach to health and safety at the Home was viewed as good and no hazards were observed. However the inspection of fire records showed gaps in the testing of the overall system and the emergency lighting. These were not carried out at the intervals recommended by the Fire Officer. Without adequate testing there is a danger that faults may develop in the systems and remain unnoticed. This area was the subject of a previous requirement made in the August 05 report and remains unmet. DS0000012639.V276872.R02.S.doc Version 5.1 Page 21 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 DS0000012639.V276872.R02.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1,2c) Requirement Timescale for action 30/04/06 2. OP38 23(4c) 43 OP38 23(4d) Care plans must be developed to ensure that all resident needs are identified and that guidance on specific individual requirements is provided. Evidence that residents have been consulted in the formulation and review of these plans must be available. This area was the subject of a previous requirement with a timescale of 01/10/05 Fire alarms and emergency 17/03/06 lighting must be tested at the required intervals and records of these tests must be available for inspection. Copies of the test records are to be forwarded to the Commission to evidence compliance. This area was the subject of a previous requirement with a timescale of 11/ 09/05 All staff must receive fire training 17/03/06 at least once a year. A copy of the fire training record must be submitted to the Commission to evidence compliance. This area was the subject of a previous requirement with a timescale of
DS0000012639.V276872.R02.S.doc Version 5.1 Page 23 01/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000012639.V276872.R02.S.doc Version 5.1 Page 24 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
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