CARE HOMES FOR OLDER PEOPLE
South Park Yorvik Unit Gale Lane Acomb, York YO24 3HX Lead Inspector
Wendy Dixon Unannounced 8 June 2005 10:00
th 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 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 J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service South Park Address Yorvik Unit, Gale Lane, Acomb, York, North Yorkshire, YO24 3HX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01904 784198 01904 785234 Ringdane Limited Wholly owned subsidiary of Four Seasons Health Care Mrs Judith Margaret Clapham Care Home 102 Category(ies) of Dementia (49), Mental disorder, excluding registration, with number learning disability or dementia (49)Old age, not of places falling within any other category (53) South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16/11/05 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 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 Yorvik is for general nursing care. The home also also offers day care for up to 8 sevice users South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection that took place on Wednesday 8th June 2005.The inspection lasted 5.0 hours (10.00am to 3.00pm) and involved 3 inspectors. There were 99 service users resident in the home, all requiring nursing care and 4 receiving a day care service. The inspection focused on a number of key standards and on the areas of concern identified at the last inspection. An inspection of the premises took place, including a number of bedrooms, the homes bathrooms, kitchen and lounges. The care records of ten service users were examined in detail and these service users where possible were spoken with about the care they receive. There were also discussions with members of staff and visitors at the home There were concerns raised about some areas of care provided to service users during the inspection and a numbers of requirements have been made. What the service does well:
Service users spoken to stated they were happy at the home and thought it was a good place to live. They said staff were kind and caring. Visitors confirmed that staff always made them feel welcome and on the whole worked hard to ensure their relatives/friends were well cared for. Complaints were well documented, and the management of the home investigated the issues raised trying to make sure the problems did not happen again and the people who had complained were now happy with the care provided at the home. Staff are properly checked before they are employed at the home to ensure they are trustworthy and have the necessary skills and qualifications to look after the service users. New care staff work with a senior member of staff who show them how best to care for the service users and a member of the management team go through polices and procedures so that staff know how to deal with problems such as service user having an accident or reporting to them that they have been abused.
South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The main complaint on the day of inspection by service users, visitors and some staff was the food provided in the home. Service users stated they felt the food was ‘poor’, ‘there was no variety’ and it didn’t look or taste nice. One vegetarian was being offered a meat dish on the day of inspection. A number of the care plans inspected showed service users were losing significant amounts of weight but there was then not always a plan in place to tackle this problem. Not all documentation was fully completed, especially information about service users past, likes and dislikes and social interests. It is especially important to get this information to complete a full plan of care wherever possible about service users especially those with dementia, as it is often difficult for them to give this information as their illness progresses Staff must ensure that service users are kept safe, sluice doors were left open meaning service users could just wander into them and there was access to very hot water and cleaning chemicals, an accident could have easily happened. The sluice on the ground floor Ebor wing was also dirty. The homes call bell in Yorvik is not working properly and it was noted to be ringing unanswered for long periods of time especially during the run up to lunch. When this was questioned during the inspection staff stated that calls made in certain newer parts of the building did not show up on the display panels so they had to search as to where the call was being made from. This problem needs to addressed quickly to ensure service users who require attention get it as speedily as possible. Some parts of the building need to be adapted/changed to better suit the needs of the service users. The part of the home known as Ebor is where service users with dementia and mental health problems live, the service users
South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 7 bedrooms are set along the corridors, the doors are all the same colour and only have a small label on them with service users names on making it hard for service users to identify them. These should be individualised to make it easier for service users to recognise their rooms and make the home less institutional in appearance. The lounge area in Ebor was dirty, the carpet was stained and the chair arms were grubby. There was a smell of urine on the first floor of the Yorvik unit. Work also needs to be done on the homes gardens as these have a uncared for appearance During the inspection when observing staff work there seemed to be a lack of warmth and respect towards the service users in some areas of the home. Basic care was being carried out, but in a perfunctory way with little regard for the individual. For staff it is a challenge just to ensure everybody is washed, dressed, kept clean and fed and when service users called out care staff would often walk past them without speaking to them, carrying on with the task in hand. The homes management needs to ensure a culture of individualised care centred on service users is nurtured. 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. South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 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 standard(s) 3 Pre admission assessments contain good information about the health and personal care needs of service users EVIDENCE: The pre admission assessments inspected contained detailed information about service users care needs and been carried out wherever possible by a qualified nurse from the home. Though this was not always being translated into the main care plan. Information had also been sought from service users relatives and other professionals such as care managers and doctors. If the admission was at very short notice and a member of staff could not meet/visit the service user an assessment was sought from other health professionals before a decision to admit them to the home was made. South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 10 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 standard(s) 7,8,9, Service users health and basic care needs are being met but some aspects of care delivery are impersonal and institutionalised. EVIDENCE: 10 service users care plans were inspected. These contained basic information about service users health and personal care needs and in most cases what staff needed to do to meet them. There were examples of good practise where medical intervention had been sought speedily to ensure service users got the care they needed. Medication records were accurate and completed as per the homes policy and procedure meaning fewer mistakes will be made when giving out medicines. However some care plans had not been up fully updated. One service user had had a nutritional assessment that indicated that they were at risk of continued and detrimental weight loss. A care plan had not been completed as how to try and prevent this. The service user continued to lose weight. South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 11 Another service user had been identified as being at risk from getting a pressure sore but again there was not a care plan put in place telling staff what actions to take to minimise the risk of this happening. Also some of the background information about service users had not been fully completed, about their past, likes /dislikes and previous social activities. This is particularly important for service users with dementia, as it is often difficult for them to give this information as their illness progresses. Staff need to ensure that documentation about service users is comprehensive and up to date to ensure all health and personal care needs of the service users are fully met. Between 10-15 service users were spoken to as part of the inspection process, one said she thought the care was good and ‘they ask me what I do and don’t want’, however it was apparent to the inspector that she was laid in a wet bed, when asked about this she confirmed she had been like it for sometime but did not want to bother the staff as they were sometimes short staffed. Another service user said that there were not enough staff and he would bang on the table rather than use the bell as the staff tended to come quicker, both these service users understood the staff were very busy and were not complaining as such but really seemed to have low expectations of the standard of care they should be provided with. South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 12 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 standard(s) 12 ,13 and 15 Some of the care delivered is task orientated and not individualised. The meals provided are of poor quality and lack variety. EVIDENCE: There were a number of visitors in the home during the inspection. The visitors spoken to said staff were kind hearted and worked very hard and they were always made to feel welcome. Service users are able to spend the day in their rooms and a number on Yorvik were doing so or if they wish or go to one of the homes lounges. However the service users doors were locked on ground floor of Ebor unit. This was discussed with the homes management who stated this was to stop other service users wandering in to the wrong rooms and interfering with other service users property. It was noted that all the doors are the same colour with only small labels on them to identify them, some thought should be given into making these more individual perhaps different colours with photographs or mementoes on them to make it easier for service users to recognise as their own rooms.
South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 13 Also in that area of the home the lounge is small for the number of service users (28) accommodated there. Not all the service users could have a seat if they wanted. This makes the unit feel busy and not particularly restful. The home has two activities organisers who were very valued by service users and staff. They were out on a trip with several service users at the time of the inspection and service users were looking forward to a trip to the races arranged for the following week. During the inspection when observing staff work there seemed to be a lack warmth towards the service users in some areas of the home, basic care was being carried out but in a perfunctory way with little regard for the individual. For staff it is a challenge just to ensure everybody is washed, dressed, kept clean and fed and when service users called out care staff would often walk past them without speaking to them, carrying on with the task in hand. Between 10-15 service users were spoken to as part of the inspection process, one said she thought the care was good and ‘they ask me what I do and don’t want’, however it was apparent to the inspector that she was laid in a wet bed, when asked about this she confirmed she had been like it for sometime but did not want to bother the staff as they were sometimes short staffed. Another service user said that there were not enough staff and he would bang on the table rather than use the bell as the staff tended to come quicker, both these service users understood the staff were very busy and were not complaining as such but really seemed to have low expectations of the standards of care they should be provided with. Service users stated they felt the food was ‘poor’, ‘there was no variety’ and it didn’t look or taste nice. One service user stated that he went out, as he did not like the food. The meal served during the inspection was lunch. This was chicken pie, mashed potato, green beans and swede followed by apple crumble and custard. Some service users were unable to eat the pastry as it was too hard and the custard was thin and runny. There was no choice available to service users, a service users who was vegetarian was given chicken pie, when they stated they could not eat it they were given just a plate of vegetables. In a home of this size over 100 it is unacceptable that all the service users are expected to eat the same thing and special diets are not catered for. On discussions with staff it was found that service users who required a soft or pureed diet (over 30) were on a number of occasions a week receiving the same meal for lunch and then again for tea as the meal provided was for instance Cornish pasty or sausage roll and could not be pureed. This lack of variety is unacceptable. Also the main meal was pureed but not enough of the sweet so care staff had to try mash up the pudding with the custard, this not only looks unappealing but if not done enough service users are at risk from choking.
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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 standard(s) 16 Service users concerns properly dealt with. EVIDENCE: Complaints were well documented, and the management of the home investigated the issues raised trying to make sure the problems did not happen again and the people who had complained were now happy with the care provided at the home. South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 15 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 standard(s) 19,22 and 26 The home is generally well maintained but changes need to be made to the environment to make service users more comfortable. EVIDENCE: There were a number of requirements made about making repairs to the building at the last inspection all these have been completed. A number of service users rooms were inspected and these were comfortable and personalised with photographs and mementoes helping the service users feel it was their home. The following areas of the home were in need of cleaning to stop the spread of infection and make these areas a pleasant place for service users to live and staff to work: • The sluice on ground floor Ebor wing • The carpets and chairs in downstairs lounge Ebor unit. • There was a smell of urine on the upstairs of Yorvik unit. Also some thought needs to be given to the layout/size of the homes lounges. The ground floor lounge on Ebor is not large enough to comfortably seat all the
South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 16 service users. Also 2 of the service users on the unit smoke and use part of this lounge, as this is the only lounge space available in this area. An extractor fan has been fitted to try and reduce the smoke in the lounge but it still remains a concern for some service users and their families. The lounge space in Yorvik is also cramped and some parts of it have a very poor outlook, several service users sit in the corridor area outside. These areas are not particularly restful or pleasant. During the inspection the chiropodist was treating service users in the home. Service users were receiving treatment in one of the homes bathroom, this is an infection control risk and an alternative treatment area needs to be located in the home. The following are in need of some maintenance: • • The wallpaper in the corridor outside the dining room is in need of repair/replacement. The homes gardens are rather untidy and overgrown South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29and 30 There are periods especially around mealtimes where there is a shortage of staff though the home meets basic staffing levels set by the registering authority. EVIDENCE: There has recently been a review of the staff required in the home and the number of care assistants on duty has been increased. Staff stated they felt that this had improved some of the workload problems they had been experiencing. However service users commented that they had to wait long periods of time especially at mealtimes to gain staff attention. Also when observing lunch being served some service users have to wait for over half an hour to get the staff attention they required to eat their lunch. Extra staff need to be deployed at busy times to ensure service users receive the care they require. Four staff employment and training files were inspected. All staff had had the necessary checks and references sent for before they were employed. These help to ensure service users are protected from abuse and staff had the necessary skills and experience to care for service users. South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 38 Improvement in communication between management, service users, staff and relatives would improve the care delivered to service users. EVIDENCE: South Park is a large home and there are a number of layers of management. The deputy manager who was in charge during the inspection was unaware or not fully up to date with of some problems/care practices affecting service users. The management team must ensure they are aware and taking action about problems that affect the health and welfare of the service users. This together with the observations of staff interaction with service users detailed earlier in the report suggest that there is a need for positive leadership with modelling and encouragement by managers of more service user focused practice within the home.
South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 19 On Ebor unit the sluice doors were found to be unlocked, staff stated on the unit this was normal practise and not just an oversight. The hot water in these areas is not within safe limits and service users could be scalded also chemicals were not locked up and could have been ingested by a confused service user. These areas must be kept locked at all times. The homes call bell in Yorvik is not working properly and it was noted to be ringing unanswered for long periods of time especially during the run up to lunch. When this was questioned during the inspection staff stated that calls made in certain newer parts of the building did not show up on the display panels so they had to search as to where the call was being made from. This problem needs to be addressed quickly to ensure service users who require attention get it as speedily as possible. South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 1
COMPLAINTS AND PROTECTION 1 x x 1 x x x 1 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 1 x x x x x 1 South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? 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 OP7and OP8 Regulation 12 2 a Requirement Where it has been identified service users are at risk of weight loss and or developing pressure sores a careplan about how these are to be managed must be written The registered provider must develop a plan to address the following problems with the accommadation available to service users. Ensure there is adequate and suitable lounge space for all service users. Service users doors on Ebor unit adapted to make them more recognisable to service users. Ensure all parts of the building are serviced by a call bell system Stop the use of the homes bathroom as a treatment room. Tidy and clear the homes garden. Replace/repair the wall paper in Yorkvik corridor. The registered must provide service users with a varied and properly prepared diet. The following areas of the home Timescale for action On Reciept of this report and maintaned thereafter 11/07/05 2. OP12, OP19, and OP22 23 2 a e 3. OP15 16 2 i 4. OP26 16 2 jk On reciept of this report and maintained thereafter On reciept
Page 22 South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 5. OP32 12 5 b 6. OP38 13 4 a are in need of cleaning. The carpets and chairs in the ground floor lounge Ebor unit. The sluice on the ground floor Ebor unit. First floor Yorvik unit to eliminate the smell of urine The management of the home must develop stratergies to ensure they are aware of the issues affecting service users and staff The sluice doors on Ebor Unit must be kept locked at all times of this report and maintained thereafter On reciept of this report and maintained thereafter On reciept of this report and maintained thereafter 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 OP27 Good Practice Recommendations Suffient numbers of staff should be deployed at busy times to reduce the amount of time service users have to wait to go to the toilet or eat their meals. South Park J53_J04_S27981_South Park_V225181_080605_Stage 4.doc Version 1.30 Page 23 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
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