Inspection on 25/05/06 for South Park

This inspection was carried out on 25th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

South Park 19/09/07

South Park 11/01/07

South Park 01/12/05

South Park 08/06/05

South Park 16/11/04

South Park 29/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE South Park Gale Lane Acomb York North Yorkshire YO24 3HX Lead Inspector Jo Bell Key Unannounced Inspection 25th May 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 South Park DS0000027981.V295027.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. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service South Park Address Gale Lane Acomb York North Yorkshire YO24 3HX 01904 784198 01904 785234 south.park@fshc.co.uk 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) Ringdane Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Post vacant Care Home 102 Category(ies) of Dementia - over 65 years of age (49), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (49), Old age, not falling within any other category (53) South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home also provides 8 day care places plus 8 day care beds. Service users in the category of OP are 60 years plus - Jorvik Unit. Service users to include up to 49 DE(E) and up to 49 MD(E) up to a maximum of 49 service users - Ebor Unit. 1st December 2005 Date of last inspection Brief Description of the Service: South Park Care Home is part of the Four Seasons Health Care Group. The Home accommodates up to 102 older people who require general nursing care and mental health nursing care. The current scale of charges for local authority placements is £473-£483, and for those who are self funding £520-525. This information was provided on 15th May 2006. Additional charges are made for the hairdresser, chiropodist, aromatherapy and for newspapers/magazines. The Home is a two storey building in its own grounds with gardens to the side and back of the home. There is level access to the home and a passenger lift to the first floor. The Home operates two distinct units under one registration, Ebor is for service users with mental health needs, and Jorvik is for general nursing care. The home also offers day care for up to 8 service users. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The 1st key inspection of the year took place on Thursday 25th May 2006. Two inspectors spent eight hours in the home. Ninety two service users were residing in the home. A peripatetic manager was available to assist with the inspection as the registered manager’s post is vacant. The deputy and regional manager were also available. Prior to the inspection a pre-inspection questionnaire was obtained. Surveys were sent out to healthcare professionals and to relatives. Nineteen in total were returned (two from GPs, seventeen from relatives). Information was gathered from Commissioners (City of York Council), Regulation 37s, complaints and verbal input from relatives. Previous requirements and recommendations were discussed at the inspection and during the day a range of service users, relatives and staff were spoken with. A tour of the premises took place and twenty two key standards were examined in detail. Four Seasons are planning a refurbishment to parts of the home as they are aware of environmental issues which need to be addressed. What the service does well: What has improved since the last inspection? Adult protection training for staff has continued to take place, medication audits and care plans audits have been maintained. This ensures that any improvements can be made and the needs of service users can be met. The standard of care on the dementia unit has improved, service users appear more relaxed and their behaviour is managed effectively. Radiator covers have been fitted on Ebor Unit to reduce the risk of scalds to service users. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 6 What they could do better: Poor communication between the catering and care staff is having a detrimental effect on service users regarding meeting their nutritional needs. Surveys completed suggested that the meals provided were not adequate. This was evident through observation and speaking with relatives and staff. The communication system in the home generally needs to be more robust. The environment in the home is generally poor (especially on Jorvik Unit). This is due to be addressed over the next few months, however it does remain an issue with service users and staff. Jorvik Unit Service users are not consistently enabled to be autonomous. This is particularly noticeable at mealtimes with service users not given a choice where to dine. i.e. lounge/conservatory/dining room/own room. Therefore often service users are sat in one place for a long period of time without exercise or change of environment. The medication system needs to be more robust. The drug trolley was left unattended which service users had access to. Service users were also put at risk by staff administering out of date medication. Ebor Unit The sluice area is extremely dirty, infection control procedures are not adhered to and service users are able to wander into this area as it is not kept locked. They have access to soiled continence pads, dirty commodes and urinals and service users are at risk of cross contamination. A formal ‘serious concern’ letter was issued. Water temperatures are variable, and on occasions too high. The downstairs bathroom hot water supply was 53 degrees centigrade. Service users are at risk of scalds when the temperature is too high. A formal ‘serious concern’ letter was issued. (this was also issued at the previous inspection). Service users in discussions said their laundry often went missing, this was evident in surveys and when speaking with families. Wishes of service users and their families must be maintained in relation to dealing with advice from the emergency GP. Please contact the provider for advice of actions taken in response to this South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. South Park DS0000027981.V295027.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 South Park DS0000027981.V295027.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): 3 (Standard 6 – the home does not provide intermediate care) Quality in this outcome area is good. Service users benefit from a robust assessment process which has recently been implemented. The judgement has been made using available evidence including a visit to this service. EVIDENCE: The home undertakes pre-admission assessments on all service users. This is carried out by the deputy and previously the registered manager. The home is in the process of changing over from one type of assessment to a more robust system. A new assessment titled ‘Generic pre-admission assessment form and care planning tool’ was inspected and this was extremely detailed, containing information relating to daily life skills, mental health and well-being, multiprofessional input and family and social life. A scoring system was used which identified the type of input needed by staff. This clearly helped to inform the individual care plan. Staff spoken with felt this assessment built up a clear picture of the individual’s needs. The previous assessments used had mostly been archived, however most of the information had been repeated in the initial assessment once the service South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 10 user was in the home. Five of these assessments were checked and were found to contain adequate information relating to social, physical and psychological needs. Service users spoken with confirmed that an assessment had taken place prior to admission, this was either by a care manager and then with someone from the home. The assessment process will be re-inspected more fully when the new assessments are integrated throughout the home. South Park DS0000027981.V295027.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 Quality in this outcome area is adequate. Generally service users care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Jorvik Unit- Five care plans were inspected from this area. All care plans contained specific information relating to each individual. Risk assessments for moving and handling, use of bed rails, prevention of pressure sores and risk of falls were in place. This ensures that service users needs can be met safely. One service user with complex needs had a detailed care plan with a review and evaluation taking place on a monthly basis. One person had a pressure sore that had developed and evidence showed that an assessment had taken place and a pressure relieving mattress had been obtained. Nutritional assessments had been undertaken and service users were weighed on a monthly basis. Whilst this benefited service users further development is needed in this area (see Standard 15 regarding the mealtimes). The Unit has a key worker system in operation, however staff when spoken with felt this did not always work due to time constraints. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 12 Comments from service users and relatives varied, positive comments included ‘the care is excellent’ and staff are ‘helpful and caring’. Whereas the surveys that were completed identified a lack of attention to detail in relation to care. The care plans were user friendly and service users needs could be tracked throughout their stay in the home. Referrals to dentists and chiropody were evident and generally service users needs regarding personal care were been met. Staff were aware of how to access a range of healthcare services, these included tissue viability, infection control and access to the community mental health team. Privacy and dignity in this area were generally maintained. However, there were some service users who had clothes on that were stained with food, and clothes that were creased. One room inspected had very creased clothes stored in the drawers, and the wardrobe. Staff must ensure care is taken when service users clothes are put away. A discussion took place regarding the procedure when a service user dies. The home have a clear policy in place regarding death and dying, this covers practices relating to Buddhism, Christianity, Judaism, Hinduism, Sikkhism and Islam. However, this does not cover the action to take if an emergency GP is called. An occasion was discussed where views of the service user and family were not taken into account as they had not been recorded, and staff were unclear as to what action was the most appropriate. Medication The home have a robust policy in place which was inspected. The medication room environmentally is poor, the window was cracked and the floor covering was dirty. The fridge temperature is recorded daily and the CD book was checked and found to be accurate. The monitored dosage system is used and an audit of the medication charts takes place monthly. The registered nurse was aware of how to dispose of medication following the latest guidance and during the inspection the local pharmacy were auditing the system. It was evident on two separate occasions that the drug trolley was left wide open unattended in the corridor. The nurse was alerted to this and apologised. However the same nurse repeated this on another occasion. The deputy manager was informed of this practice. Whilst medication generally was administered correctly there were two items (eye ointment) that were supposed to be used within 28 days, this time had elapsed and the nurse continued to administer them. Ebor Unit- The new Head of Unit is an experienced RMN this has had a positive effect on the unit and care is delivered in a relaxed but effective manner which service users benefit from. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 13 Five care plans were inspected from this area. Detailed information was available and staff observed were clearly aware of how to meet individual needs. Healthcare needs are monitored through nutritional assessments and the prevention of pressure sores. Advice from the CPN through the Community Mental Health Team is regularly sought and behaviour management strategies are in place. One service user who was nursed in bed had a risk assessment in place regarding a ‘cocoon’ type bed which was for safety reasons. Carers were observed entering this room, and whilst staff did not consistently knock on bedroom doors prior to entering it was evident that there was some positive recognition between the service user and care staff. This lady had dementia and had a limited quality of life. Staff ensured her bed was clean and tidy and she was kept comfortable. Staff were aware of how to care for service users who were agitated, depressed and those who had dementia. This was evidenced through observation and detailed information discussed in the care plans. Staff were observed treating her with respect and input from the key worker was evident in the care plan which was reviewed on a monthly basis. Details regarding death and dying have been incorporated into the care plans and whilst this is sometimes difficult to discuss, staff are aware that this is necessary information to be obtained. Medication The monitored dosage system is in operation and staff are familiar with this. Medication charts were completed accurately and controlled drugs were administered in line with the medication policy. The medication room was neat and tidy and whilst staff were aware of how to dispose of most medication they were unsure how to deal with Fentanyl patches (controlled drug).Medication audits take place monthly and any inconsistencies are acted upon. South Park DS0000027981.V295027.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): 12,13,14 & 15 Quality in this outcome area is poor. Services users have a varied experience in the home depending on whether they are on Jorvik or Ebor Unit. Autonomy is not consistently encouraged and mealtimes need improving. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Jorvik Unit The home employs an activity organiser who currently works on Jorvik Unit. Relatives and surveys users commented positively on the activities available, these includes basket weaving, playing skittles, board games, trips out in the mini bus and having entertainers in the home. Staff spoken with said they do not have time to offer a one to one session with service users. Family and friends are welcomed and they can visit at anytime, this was confirmed when inspecting the visitors book. Links with the local church are encouraged which include C/E, Methodist and RC religions. Currently there are no service users from ethnic minorities or with other cultural or religious needs. The home could cater for these if required. Visitors can be received either in private or in one of the communal areas. There is a telephone available for service users. However, this is in the main walkway and there is little privacy. Service users are able to bring personal possessions into the home which was evident when inspecting the rooms. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 15 Service users were observed in the large lounge, dining room, conservatory and small lounges. A choice was given regarding where everyone sits, the clothes service users wear and the time they get up and go to bed. This was confirmed when speaking with service users and relatives. However, care staff spoken with said that often on a morning service users are waiting to get up (they vocalise this) but the night staff say ‘nobody wanted to get up’. This is a communication issue between staff which is affecting the autonomy and choice of service users and should be addressed. At lunchtime it was evident that many service users were left in the lounge area with the TV on very loudly, they were not asked if they wanted to sit at the table for lunch and when observing the dining room this was very quiet with many empty seats. All service users should be given a choice as to where they would prefer to dine. The dining room is light and airy with pleasant décor and suitable chairs and tables. One relative spoken with said she has to come in and feed her husband every meal otherwise he would lose weight. She felt the staff were too busy to spend time ensuring his nutritional needs are meet. However, she was concerned that he may spill on the lounge chair. She said she would prefer him to go into the dining room which he agreed with, but the staff did not give him this option. Another man indicated he would prefer to sit at the table and eat his lunch. The atmosphere in the lounge with the television on was not conducive to a pleasant, relaxing experience of eating lunch. It was evident throughout the communal areas that many service users were sat here all morning, during lunch and throughout the afternoon. This should be reviewed. Mealtimes The menus are available and discussed with the service users prior to being served. The regional and deputy manager are aware that the choice of food needs to improve. The peripatetic manager is sampling all the dishes and identifying where the improvements need to take place. At lunchtime mushroom quiche, croquette potatoes and vegetables were served. In the dining room material bibs were used and many service users had plastic beakers. Service users were not treated on an individual basis and it was assumed that most service users needed a plastic cup to drink from. Pureed and diabetic diets were catered for but the choice was limited. The pudding was pear crumble, one lady said she enjoyed her lunch another lady asked for ice cream with the pears, the chef obtained this for her. Surveys completed discussed the poor choice of food, the staff said they would not eat the food. One carer said it was appalling. Ebor Unit This unit does not have an activities organiser. However, this position has been advertised. The regional manager is keen to employ an experienced person with the ability to facilitate activities which are suitable for people with dementia and mental health needs. One carer was observed having a sing-aSouth Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 16 long with the service users who clearly enjoyed this. In the afternoon a preacher was due to visit to facilitate a service for anyone who wished to join in. Staff spoken with said they try to find the time to have one to one sessions. The Head of Unit has a good understanding of mental health conditions, staff are encouraged to enable service users to be as autonomous as possible within their mental capacity. An advocacy service is available which relatives are made aware of. Family and friends are encouraged which was evident at the inspection and surveys completed stated that the care on this unit was good. Service users are able to get up and go to bed when they want and this is recorded in the care plans. Rooms are decorated with personal possessions and daily routines are driven by the service user. Mealtimes Staff were observed assisting service users with lunch, soft and pureed diets were evident and whilst plastic cups were currently been used the Head of Unit stated that new crockery has been ordered, this was confirmed by the regional manager. Staff treated service users in a respectful manner and allowed them time to digest their food before moving on to the next mouthful. Finger food is available and autonomy is encouraged. Service users could dine where they wanted to whether this was in the dining/lounge/bedroom area. Mealtimes overall One of the main issues discussed was the poor communication between the chef and the care staff. The chef does not walk around the dining areas and ask service users if they have enjoyed their food or ask their views on improving the food. Staff felt they were often ignored if they asked for anything different i.e. bread and butter. The chef offers home baking, but there are often frozen vegetables on the menu, and lots of crumbles which are not suitable for soft diets. In discussion with the chef he feels the communication in certain areas is better than others. He says he does not have time to do quality assurance as he is understaffed. During the inspection it was evident that care staff had used the kitchen and beverage area, this had been left untidy and in an unclean state. This was discussed with the management as a requirement was made at the last inspection and no improvements have been made in this area. The service users nutritional needs are not been fully met as it is unclear if the chef is aware of those service users who are undernourished and what the views of service users are. This must be addressed as a matter of urgency. South Park DS0000027981.V295027.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 Quality in this outcome area is poor. Service users concerns are listened to but not always acted upon quickly enough. The home’s adult protection procedure is not effective in minimising the risk of abuse to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home have a complaints procedure in place, this is displayed in the entrance area of the home, though it is not available in large print for service users who have visual impairments. The information is clear with an appropriate timescale. The home have recently had a complaint regarding laundry, this was upheld and the home have dealt with it appropriately. Service users spoken with said they could go to the nurse in charge to make a complaint, and they confirmed the deputy speaks to them on a regular basis to discuss any issues. Service users main concerns were regarding the choice of food, clothes going missing when sent to the laundry, staffing levels and the poor environment. Relatives of the service users on the dementia unit are able to speak with the Head of Unit to discuss any concerns. Staff in this area are able to communicate effectively with this group of service users. While adult protection policy in place is detailed and staff confirmed they have received adult protection training recently. There has been two issues where the home have not protected service users from abuse. The previous registered manager failed to implement the correct procedure which clearly put service users at risk. Staff were aware of this but did not inform the senior South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 18 managers. This manager has now resigned, and a peripatetic manager is in place until another manager can be employed. The regional manager is fully aware of the potential risks service users were exposed to and subsequently referrals to social services adult protection team have been made. Action is being taken and the situation is monitored on a daily basis. Service users looked happy in their environment and no issues regarding safety were identified in the surveys returned. Staff spoken with were aware of the whistle blowing policy and the different types of abuse. South Park DS0000027981.V295027.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 Quality in this outcome area is poor. Service users live in an inadequate environment. Areas of the home smell unpleasant, and infection control procedures are not adhered. Service users are not consistently safe due to high water temperatures in sinks and baths where they have access to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: South Park is located in Acomb and has a secure garden area for service users on the dementia unit and there is a large car park for relatives and staff to use. The home has plans to refurbish parts of the environment. Mostly on Jorvik Unit with some changes to Ebor. This will make the environment much more pleasant for service users to live in. Currently the entrance area is pleasantly decorated and odour free. The general nursing area (Jorvik) is operated on three floors which is difficult for staff to manage. The dementia unit (Ebor) has two floors which has pleasant areas, however there is a lack of communal space. Service users are not consistently safe in their environment due to the lack of monitoring of water temperatures (See Standard 38).This is discussed in more detail. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 20 Jorvik Service users and relatives commented on the poor environment, there are two shower rooms which cannot be used as in one the head of the shower is missing and in the shower room there are dressings, continence products, and linen skips surrounding the shower. Though there are four bathrooms which are frequently used. There are continence products in boxes on the upstairs floor which are left in the corridor areas or on chairs (these are not in packets or labelled). Many areas in the communal part have chipped paint, tired décor and insufficient storage area for wheelchairs and hoists. The communal areas have an unpleasant odour, the conservatory smells of stale milk and relatives spoken with commented on this. There is very little fresh air circulating on the ground floor and service users often spend long periods of time in one area. Bedrooms on the 1st and 2nd floor were inspected, generally the size of the room was adequate and some commodes had been replaced with new ones. However, it was evident that rooms needed a thorough clean. Surfaces were dirty and skirting boards, beds, televisions and cupboards all had dust on them. The home have an infection control policy in place which needs to be adhered to. Staff have received training in this area but there does not appear to be enough domestic staff to maintain this area effectively. The sluice room was inspected, this was not very clean and the disinfector had only recently been repaired. This will be altered when the refurbishment is completed. Ebor Unit A tour of this area took place. Service users rooms were clean and tidy and beds were well made with clean sheets. No unpleasant odours were observed in these rooms. The communal areas were used to store equipment including wheelchairs and hoists. Two sluice rooms were examined the upstairs area was clean and tidy and staff spoken with were aware of handwashing techniques and universal precautions. However, the sluice room downstairs was extremely dirty. An immediate requirement was issued for the following reasons: The sink was full of the mop and bucket contents, a yellow sack full of used continence pads were on the floor open instead of been placed in the sanitiser. This was overflowing because no-one had emptied it. The floor covering had brown stains and did not fit properly. The sluicing machine and surrounding commode pots were dirty and the door was left open on two occasions for long periods of time. It was suggested that a key pad could be fitted to the door. Service users who are disorientated could easily enter this room and put themselves at risk due to the unhygienic state of the room. This was a requirement from the previous inspection in December 2005 and must be addressed as a priority. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 21 Laundry The laundry area is on Jorvik Unit and in discussion with two staff it was evident that they were aware of the procedures for washing service users clothes. Soiled clothes, bedding and general washing is kept in different skips. There are sufficient washing machines and tumble driers to meet the needs of service users. The floor covering is appropriate and areas were kept clean and tidy. Linen cupboards were checked and there were sufficient sheets, pillows and towels available. Surveys completed identified that service users clothes often go missing, this was evident when speaking with service users, relatives and staff. Staff discussed a scheme which was available last year where clothes could be ‘tagged’ and they would automatically be returned to the right person. A fee was involved and from discussions and comments clearly service users were not happy with this scheme. However, the regional manager stated that this was a pilot scheme which was never implemented. Service users terms and conditions were checked and they state that laundry is included in the fee. This appears to be miscommunication by the home as people are still concerned about this. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. Service users are cared for by competent and suitably trained staff. However, this could be enhanced through improved communication systems in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall service users are cared for by a sufficient number of staff. The manager is supernumerary and the deputy has two days a week supernumerary. Jorvik Unit During the day there are two registered nurses and nine carers for a maximum of fifty three service users, this is over three floors. Overnight there are two registered nurses and four care staff. Surveys completed suggested that the home was short staffed. However observations did not confirm this, some staff had their breaks together and relatives commented that after lunch everyone seems to disappear. The format that staff work to needs to be reviewed and if communication is improved between Head of Unit, Registered Nurses and Care staff this would increase efficiency. One relative said that she had been asked the same question regarding laundry in a space of ten minutes by two different care staff, they had not communicated with each other. Four relatives who were visiting all said that they never know how things are progressing with their relative, and they always have to ask to find out what is happening. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 23 On Jorvik the Head Of Unit, registered Nurses and all the care staff were spoken with. The home employs staff from Britain, Poland, New Zealand, and the Phillpines. No concerns were raised regarding the treatment of the overseas staff, they felt quite happy working in the home and said they had been given somewhere to live when they initially moved here. All staff felt that communication could be improved, they said they did not have time for one to one sessions with service users and during the morning they have to get people out of bed on their own when there should be two people. This was discussed with the senior carers who said this is not a problem. Staff said they do not have enough hoists, however one has been faulty but has been repaired. There are four useable hoists for staff to use. Staff confirmed that they have received induction training when they first started this job this was confirmed in the training records. Currently the home do not have 50 of care with an NVQ Level 2 qualification, there is a high turnover of staff, however the home are keen to develop this area. Ebor Unit There is a new Head of Unit who is a qualified RMN with many years experience. During the day for forty nine service users there are two registered nurses and seven care staff over two floors. This is adequate to meet service users needs. Overnight there are two registered nurses and three carers. The off duty shows that the Head of Unit is the only RMN on the unit when he is not working there are five other general nurses who are from overseas. The home need to ensure that the overseas staff can communicate effectively and discuss mental health needs appropriately with service users and their relatives. The Head of Unit felt further specialised training is needed for the registered nurses. The regional manager confirmed that challenging behaviour training has previously been completed. Recruitment The home have a robust recruitment policy in place, they are aware of equal opportunities and are keen to promote diversity in the workplace through employment of overseas staff. Four staff records were examined they all had two written references, enhanced CRBs (including POVA checks), induction and supervision records and details of training and development. No issues were raised regarding recruitment. In discussions with the regional and deputy manager it was evident they were aware of the advertising process, job applications, interviews and offer of employment procedure. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality outcome in this area is poor. The home could be run more efficiently through improved quality assurance and health and safety, which service users would benefit from. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home currently employ a peripatetic manager, this is until a permanent manager is in place. As discussed earlier, the previous manager did not run the home in the best interest of the service users, this was evident as the adult protection procedure was not effectively implemented which left the service users of risk of harm. The position of a new manager is currently been advertised. The peripatetic manager is aware that her role is temporary, but has started having discussions with staff regarding care practices. Her background is in working and managing care homes. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 25 The deputy manager and regional manager are aware of the improvements that need to be made to the home and are keen to work with the CSCI to progress the service. Currently the quality assurance system is been developed. The home have previously sent out questionnaires to service users and relatives, however when the new system is in place this will include an annual development plan and action will be taken in respect of the findings of the information obtained. Whilst some meetings take place it is evident that regular staff and service user/relatives meetings need to occur to ensure their views are sought and acted upon. The deputy manager speaks to service users on an informal basis every day, this was confirmed by relatives and service users. Staff felt more meetings would be useful as communication was poor between staff and managers. The home currently undertake care plan and medication audits these were evident and improvements have been made in both these areas. Service users finances were examined a policy is in place regarding money, valuables and financial affairs. The terms and conditions state what the fee covers and the extras to be paid for. Service users are encouraged to have their own accounts. Pocket money is kept on behalf of service users and they are invoiced when extra charges are made. Health and safety in the home was observed and discussed. The home are currently waiting for a visit from the Health and Safety department. Generally health and safety is maintained. Fire equipment was last checked in March 2006, fire alarms are tested weekly which was confirmed by staff. The central heating system was checked in April 2006, an electrical wiring certificate issued in June 2005 and the call bell system checked in September 2005. Qualified first aiders are always on duty and the maintenance person has a weekly plan where issues are addressed. Staff receive training in fire safety, moving and handling. COSHH, adult protection, food hygiene and infection control. Records confirmed this along with the staff and management of the home. Water temperatures were checked throughout the home, these varied on Jorvick and Ebor Unit. Currently the maintenance staff carry out monthly checks on random sinks, baths and shower areas. However, over a period of three months not all the communal areas are checked. Temperatures in one of the bathroom areas on Ebor showed the hot water was 53 degrees centigrade. The hot water temperatures were high in three areas all on Ebor Unit. These are areas where service users have dementia and freely wander in and out of the communal areas. Therefore the risk of burns and scalds is greater. The previous manager had been alerted to some of the high temperatures and the water maintenance company had visited the home to adjust the setting. South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 26 However, no follow up action was taken by the home’s maintenance staff to check if the temperature was adjusted accordingly. In discussion with the maintenance staff they did not feel they needed to follow this up and re-check the temperatures. A formal letter detailing the issue of ‘serious concern’ was issued to the home, and the regional manager was made aware of the quality assurance issues regarding auditing the health and safety procedures of the home. This is extremely poor practice as at the previous inspection six months ago the same issue was highlighted and the management have clearly failed to implement a robust system to ensure the safety of service users in the home. South Park DS0000027981.V295027.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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 x x x x x x 1 STAFFING Standard No Score 27 3 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 x x 1 South Park DS0000027981.V295027.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 OP9 Regulation 13 Timescale for action Jorvik Unit-the medication trolley 25/05/06 must not be left unattended whilst open. Jorvik Unit-Eye drops/ointment must only be administered within the allocated specified time. Once they has expired they must be disposed of. Jorvik Unit-service users must be 26/05/06 offered a choice at mealtimes as to which area of the home they would prefer to eat i.e. lounge/dining room/conservatory/own room. A robust communication system between the catering staff and care staff must be implemented to ensure service users nutritional needs are met at mealtimes. (previous timescale 04/12/05 not met) Ebor Unit-the home must ensure there is adequate and suitable lounge space for all service users (previous timescale 01/03/06) 06/06/06 Requirement 2. OP14 12 3. OP15 16 4. OP19 23 (2) 25/08/06 South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 29 5. OP26 13(3) Jorvik Unit-the strong smell of 26/05/06 urine/stale milk must be eradicated from the conservatory area. Continence pads must be stored correctly (currently upstairs in corridors/on chairs, and not in packets) Immediate req. issued. Ebor Wing sluice-all areas must be thoroughly cleaned. This includes the floor, commode pots, urinals, skirting areas and walls.(previous timescale 04/12/05 not met). Yellow bags must be disposed of correctly. A mechanism for keeping the door locked shut must be put in place.(i.e. keypad) The floor covering must be replaced if the stains cannot be removed. 6. 7. 8. OP27 OP31 OP33 18 9 24 9. OP38 23 A review of the communication system in the home must take place. A permanent manager must be employed who is can be registered through the CSCI A robust quality assurance system needs to be implemented. Views of service users and relatives must be sought regarding the effectiveness of the laundry system (i.e. do clothes often go missing) Immediate req.issued Ebor Unit-Water temperaturesmust be maintained within the expected parameters(approximately 43 degrees centigrade).Action must be taken when temperatures exceed normal. (previous timescale 04/12/05 not met) DS0000027981.V295027.R01.S.doc 08/06/06 25/08/06 08/06/06 26/05/06 South Park Version 5.2 Page 30 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 OP11 Good Practice Recommendations The policy relating to death and dying should be reviewed. This needs to include the action staff take when the home is advised to call an ambulance which may be against the wishes of the service user and/or relative. All staff must be clear on the action to take in this situation. Ebor Unit-a range of suitable activities should be made available to service users on this unit. The management of the home should continue to ensure they are aware of how to implement the complaints and adult protection procedure. Care staff should have achieved an NVQ Level 2 or equivalent be December 31st 2005 2. 3. 4. OP12 OP16 OP18 OP28 South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. Extracts may not be used or reproduced without the express permission of CSCI South Park DS0000027981.V295027.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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