Inspection on 14/11/06 for Canwick Court Care Home

This inspection was carried out on 14th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Canwick Court Care Home 27/02/09

Canwick Court Care Home 09/07/08

Canwick Court Care Home 10/05/06

Canwick Court Care Home 24/10/05

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

CARE HOMES FOR OLDER PEOPLE South Park Care Home 78 South Park Lincoln Lincs LN5 8ES Lead Inspector Wendy Taylor Key Unannounced Inspection 14th November 2006 09:20 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 Care Home DS0000064152.V319881.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 Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service South Park Care Home Address 78 South Park Lincoln Lincs LN5 8ES 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) 01522 544595 01522 544230 None Guardian Care Homes (UK) Limited Care Home 31 Category(ies) of Dementia - over 65 years of age (31) registration, with number of places South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories:Dementia - over 65 years of age (DE)(E) - 24 (Nursing) Dementia - over 65 years of age (DE)(E) - 7 (Personal Care) The maximum number of service users to be accommodated is 31. 2. Date of last inspection 10th May 2006 Brief Description of the Service: South Park Care Home is registered to provide nursing care and personal care for 31 people over the age of 65 with dementia and up to 4 people with dementia under 65 years of age. There are currently 30 people living at the home. The home has an acting manager in place who is not registered. The home is situated to the south of Lincoln city and is served by a bus route and is within walking distance of the town centre. The property is a large detached Victorian building laid out over 4 floors. The top floor is for staff and an administration area. The first floor comprises of resident bedrooms and the ground floor has bedrooms and communal areas. The lower ground floor has the main kitchen and the residential care unit, which can accommodate 9 residents. This unit is called Heathlands and has its own entrance. The fees for the home range from £379:00 to £623:81 per week. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place during November 2006 and the visit to the home was carried out over approximately 7 hours on one day. The care received by four residents was followed in detail. Feedback was obtained from residents and their relatives about their experiences of living there. Individual resident’s records and general house records were looked at, as wells as staff records. Staff and the acting manager were spoken to and observation of the care being provided was made. Information already held by the commission was also used as part of the inspection process. Comments made by residents and relatives are reflected in the main body of the report. What the service does well: What has improved since the last inspection? Since the last inspection care plan recording has improved and plans now reflect current needs including tissue viability, and funding levels are also clearly recorded in admission information. Care plans are also signed by the resident or their representatives to show that they have been consulted. The temperature of food that is stored in a hot trolley is now recorded before it is served. There is a clear complaints procedure available, and a quality monitoring process, which includes the views of residents and their representatives. Staff now receive a nationally recognised induction programme. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 7 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 Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive assessment process, which assures residents and their representatives that their needs will be met; and they receive a variety of information about the home, which helps them to make informed choices. EVIDENCE: There is a service user guide and statement of purpose in place, and service user guides were seen in individual bedrooms. Individual contracts are in place and have been signed either by the resident where they are able, or their representatives. There is evidence that a pre admission assessment is carried out and then letters confirming that needs can be met and offering a placement are sent to prospective resident or their representatives. There is also evidence of a local authority needs assessment. Following admission a further assessment of needs is carried out, which includes a night care profile, nutrition, falls, moving South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 9 and handling, continence, tissue viability, general dependency rating, social needs and preferences. Funding levels are recorded on the admission profiles. There are no intermediate care services provided at the home. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are safeguarded by medication procedures and generally comprehensive care plans. Care is provided in a manner that maintains their privacy and dignity although care plans do not reflect this. EVIDENCE: Care plans are available for individual residents, which cross-reference with assessed needs. The plans include areas such as medication, finances, pressure area care, personal hygiene and anxiety. Core care plans are in use for most needs and they contain a section in which to record variances to the core plan, and personal and individual information. Preferred names are recorded in the plans and there are food intake charts where required. Not all of the plans contain explicit information about privacy and dignity. Records show that the plans are reviewed on a monthly basis, and residents where they are able or their representatives sign the care plans and reviews. There is evidence that a care plan audit was carried out in October 2006. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 11 Staff were seen speaking to residents in a respectful and supportive manner, and they were meeting their care needs in private. A relative said that ‘they look after mum very well, they make sure she has her privacy and dignity, they know her little ways’. Medication records and storage arrangements are satisfactory, and there is no one who administers their own medication at present. Records show that there is a medication audit carried out on a monthly basis and any issues arising are managed appropriately. An inspection by the local pharmacist took place on 10/11/06; the report of the visit is not yet available but the acting manager said that no issues were raised. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Regular activity plans are not available, and although highlighted in assessments, there are no care plans relating to social and leisure needs, which has an impact on people’s quality of life. A balanced and varied diet is available but more robust monitoring procedures for the food being served are needed to ensure safety for residents, and to make sure that their expectations are met. EVIDENCE: Menus are available on a four-week rotation. They demonstrate a varied and balanced diet with the availability of choice. Residents made comments such as ‘the food’s good’, ‘I usually like what’s on the menu, but I can choose something else if I don’t like it’, ‘the cook comes and asks what I want the night before’. A relative said ‘the food seems good, mum likes it and always says she gets a choice’. During the lunch time meal, the meat served to one resident appeared to be undercooked, and two relatives said that the meat was too hard for their relative to eat. A relative also said that the vegetables were very often too hard for their relative to eat. The acting manager dealt the situation appropriately and she checked that the meat temperature records South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 13 were appropriately completed and within guideline temperatures. Other meals that had been served were also checked and no other problems were noted. A relative said that they have to feed residents other than there own relatives as there are so few staff (see Standards 27-30). The acting manager said that staff sign to say which residents they have helped with their meals and she checked those records immediately. There was no evidence in the records that relatives help to feed other residents and this was not observed on the day. Staff said that this does not occur. There is no formal activity plan available but there are records to show some sessions have taken place such as 1:1 chats, hand massage and knitting. There was also evidence that there is occasionally a planned outing. Since the last inspection there has been a new activity co-ordinator employed on a part time basis, who is currently working as a member of the care team. A resident said ‘activities happen but I don’t always want to join in’. One relative said that there is ‘not a lot of activity available during the day’, and another relative said that there is ‘plenty to do and mum likes to go on the outings’. There are no care plans relating to social and leisure needs. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by clear policies, procedures and risk assessments. A trained and knowledgeable staff team enhances that protection. EVIDENCE: There is a complaints policy in place, copies of which are displayed in the entrance hallways, and it is contained in the statement of purpose. A resident said ‘I know how to make a complaint and staff will listen to me’, and relatives said ‘we know how to make a complaint’, and ‘there’s information around to tell you what to do’. Records show that there have been no complaints since the last inspection. There are policies in place regarding safeguarding adults and whistle blowing. Records show that there has been no adult protection referrals made since the last inspection. Staff demonstrated a good working knowledge of adult protection issues and what to do if they suspected or witnessed such. Independent advocates are in place for residents who require their support. Risk assessments are available and include specific areas such as pressure area care, use of bedrails and the use of door locks. There is also a general safety risk assessment carried out for each resident. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is well maintained and specialist equipment is available to meet people’s needs, however their quality of life is compromised by the lack of personalisation and stimulation within the environment. EVIDENCE: A tour of the home showed the environment to be clean, tidy and free from obstructions to mobility; and the décor and furnishings were well maintained. Hoists, a specialist bath and specialist mattresses are in place in accordance with care plans. Call bells are in reach of people in all areas of the home. There is no use of recognition aids for people who have a dementia, for example colours, pictures or surface textures; and bedrooms and communal areas contain very few personal items such as photographs or ornaments. Staff said that the decor has improved since the last inspection but bedding is in a very poor condition. During the visit the acting manager received South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 16 confirmation of an order for bed linen to replace all of the existing stock, as well as crockery and cutlery. A relative said that things have improved and some decorating has been done. The acting manager said that there is an ongoing programme of decoration and she described plans to improve the décor in the lower ground floor corridors. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Current recruitment procedures safeguard residents, and at present their needs are met by adequate numbers of staff. Training programmes ensure that staff have the appropriate knowledge to meet needs. EVIDENCE: On the day of the visit an ‘open day’ was being held and a new acting manager commenced work in the home. A relaxed atmosphere was observed and resident’s needs such as continence, bathing, feeding and regular adjustments of clothing to maintain dignity were being met. Staff were seen to have tea breaks. The commission has received one notification since the last inspection in relation to a shortage of staff. The provider was asked to investigate the occurrence and appropriate action was taken. During the visit staff and relatives said that there are not enough staff on duty and they said that they are ‘always on the go’ or ‘rushing around’. Staff said that they can meet physical needs but there are not enough staff to sit and chat to people and there is not enough social and leisure activity, although some staff acknowledged that the increase in hours for an activity co-ordinator should help this (see also Standards 12-15). They also said that staff levels have not increased since the last inspection but needs are now less complex. Staff said that they are not allowed to use agency if they are short of staff through sickness, but the acting manager and area manager for the parent South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 18 company said that agency use was allowed if all other options had been tried first. Records show that one staff member is about to leave, and there have been no other changes to the staff team since the last inspection. Discussion took place with the acting manager and the area manager about the monitoring and review of staffing levels and communication with staff. Rotas show that there is one qualified nurse and five carers on the morning shift, one qualified nurse and four carers in the afternoon and one qualified nurse and three carers at night. Most staff said that they get good access to mandatory training such as fire safety, first aid and moving and handling. They said that they also have training in dementia needs and infection control. One member of staff said that they do not get a lot of training other than the mandatory courses. Training records show that staff have been trained in fire safety, moving and handling, first aid, health and safety, challenging behaviour, abuse, food hygiene, dementia and infection control. Records also show that a nationally recognised induction package is being used with new staff together with a programme of orientation to the building and the residents. The acting manager said that nine carers have been identified to commence a nationally recognised qualification. Staff files contained all of the information required to demonstrate a safe recruitment process, such as criminal record bureau checks, references, an application form and identification. Files also show that staff are provided with a code of conduct from the General Social Care Council. There is evidence that all criminal records bureau checks that are over three years old are being renewed. Interview records are now being completed and kept in individual files. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed at present and systems are in place to ensure that care is provided in a safe and appropriate manner. EVIDENCE: Since August 2006 a temporary acting manager has been in post, and on the day of the visit a new manager commenced in a permanent capacity. The new manager confirmed that he will be applying for registration with the commission straight away and he is also undertaking the Registered Managers Award. Staff said that communication has been better under the temporary acting manager, and they feel more supported. They said that they are encouraged to say how they feel. They said that they have supervision and records show that South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 20 sessions are held regularly. Records also show that appraisals are due in January 2007. The minutes of staff meetings are available, which show that group supervision is also undertaken. A quality assurance programme has been implemented. Since the last inspection audits have been carried out for laundry management, kitchen management and quality of care; there have also been surveys carried out among staff, relatives, resident and professionals. A quality assurance policy is available. There have been no audits relating to residents and relatives views about the quality of the food provided (see Standard 15). The temporary acting manager said that she holds a monthly coffee morning for relatives, at which they can raise any concerns and air their views. The new acting manager said that this would continue. There is an up to date fire risk assessment, completed in September 2006, and there are risk assessments and information sheets available for substances likely to cause a hazard. Policies are available for issues such as general health and safety, first aid, food hygiene, infection control, confidentiality, record keeping, spiritual care and use of bed rails. Accident reports cross-reference with resident’s individual records. The provider monitors any trends in accidents so that appropriate action can be taken if needed. There is a policy relating to the safekeeping of residents money. Records, receipts and money held in the home cross referenced with each other, and they are held in a lockable safe. Weekly audits are undertaken by the acting manager and recorded in individual ledgers. South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 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 OP31 Regulation 8 Requirement The provider must appoint a manager who must register with the Commission. This requirement was made at the previous inspection on 05/07/06. The time scale for action has not yet elapsed. The responsible person must provide a programme for social and leisure activities that reflects the needs and preferences of the residents, and which must be developed in consultation with the resident and their relatives. The responsible person must ensure that there are robust monitoring processes in place to ensure that food served is properly prepared, to the satisfaction of the residents. Timescale for action 30/12/06 2. OP12 16 (2) (i) 30/12/06 3. OP15 16 (2) (n) 01/12/06 South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 23 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 2 3 Refer to Standard OP10 OP12 OP15 Good Practice Recommendations It is recommended that care plans refer to the way in which privacy and dignity is maintained for the individual. It is recommended that care plans are available for preferred social and leisure activities. It is recommended that a regular audit of residents and relative’s views of the quality of the food served is carried out; and that the advice of the Environmental Health Officer is sought in regard to monitoring food safety. It is recommended that current good practice guidelines for people with dementia are implemented in respect of the environment. It is recommended that resident’s are supported to personalise their rooms so as to promote a more comfortable environment for them. It is recommended that staffing levels and the management of staff shortages be closely monitored so that any issues can be identified and dealt with immediately. It is recommended that individual staff training records be reviewed to ensure all staff are receiving appropriate training. 4 5 6 OP19 OP24 OP27 7 OP30 South Park Care Home DS0000064152.V319881.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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