Inspection on 24/10/05 for Canwick Court Care Home

This inspection was carried out on 24th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Canwick Court Care Home 27/02/09

Canwick Court Care Home 09/07/08

Canwick Court Care Home 14/11/06

Canwick Court Care Home 10/05/06

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 Kathryn Emmons Unannounced Inspection 24th October 2005 09:15 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.V259821.R01.S.doc Version 5.0 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.V259821.R01.S.doc Version 5.0 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 Guardian Care Homes (UK) Limited Care Home 41 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (41) of places South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:The maximum number of service users in each category is as follows:30 - DE(E) (Nursing) 7 - DE(E) (Personal Care) 4 - DE (Nursing) - 1 aged 53 and over, 1 aged 59 years and over and 1 aged 64 years and over). The service user aged 53 years in the category DE is in respect of the person named in the Notice of Proposal to Register dated 16 December 2003. The Service User aged 64 years in the category of DE is in respect of the person named in the Notice of Proposal dated 6 August 2004. It is a condition of registration that the action plan submitted to Lincoln CSCI area office dated 13 June 2005 from Guardian Health Care Limited is fully complied with. All timescales identified must be met. The CSCI must be informed on a monthly basis what action has been taken to comply, and it is acceptable for this to form part of the Regulation 26 monthly report. 20 April 2005 2. 3. 4. Date of last inspection Brief Description of the Service: South Park Care Home is registered to provide nursing care and personal care for 37 people over the age of 65 with dementia and up to 4 people with dementia under 65 years of age. The home has a 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. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Guardian Health Care became the registered provider for the home in May 2005. This is the first inspection of the home since it has been registered in respect of Guardian Health Care. The home was inspected by 2 inspectors spending 5 hours at the home. The main focus was to assess if the conditions of registration, which had been agreed to, when the home was registered, had been complied with. The home can accommodate up to 41 residents. On the day of the inspection there were 25 residents living at the home. Six staff were spoken to. All of the residents spoken with were unable to give their views on the home due to their mental frailty. There were no visitors attending the home during the inspection. Two service user comment cards were received following the inspection. The main method of inspection used was called “case tracking” which involved selecting clients and tracking the care they receive through checking of their records, discussion with them, the care staff and observation of care practices. What the service does well: What has improved since the last inspection? This is the first inspection of the home in respect of the registered provider being Guardian Health care. Since taking over the home in May 2005 a new sluice has been fitted, which provides better management of infection control. A new training programme and supervision programme is to be implemented and the early stages were in evidence.. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 6 Work had been undertaken to review some of the residents care plans and risk assessments. Which enables staff to be aware of resident’s current care needs and abilities. Relative meetings are being held and the new manager has an open door policy in place, which enables resident’s relatives to raise any issues directly. The front lounge area of the home is now utilised as a dinning area for some of the residents, which enables mealtimes to be more relaxing and calm for the residents. A new hot box has been purchased for the kitchenette on the ground floor, which enables resident’s meals to be kept warm when they are delivered from the kitchen. All portable appliance testing has recently been carried out. 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. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 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.V259821.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Without an up to date service user guide or statement of purpose The admission process does not provide information for residents and their relatives/carers to ensure that residents are given a choice or consulted about living at the home. Residents need to be provided with written confirmation that their assessed needs can be met. EVIDENCE: The administrator confirmed that all residents’ relatives had been sent new copies of the homes terms and conditions following the new provider taking over the home. Resident’s personal records contained signed copies of these documents. There was not an up to date service users guide in place. The manager said this document was being worked on and would be available when a new resident was going to be admitted to the home. It was confirmed by the South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 9 manager and area support manager that the home is still aiming to take admissions and are aware that this document needs to be available. The administrator stated that originally the home had not confirmed in writing that residents needs could be met, however a new procedure in place would mean that residents or their relatives would receive written confirmation that their needs could be met. This will provide residents with confirmation that the home is able to meet their needs. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 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 the following standard(s): 7, 9, 10 Certain care practices do not safeguard residents such as medication administration and the management of some behaviours. The delivery of care does not always reflect the assessment and care plan produced. Observation on the day of the inspection identifies that staff respect residents’ privacy. EVIDENCE: The manager and trained nurse on duty confirmed that in the past few months work has been carried out to update some of the residents care plans. The resident who was case tracked had not had their care plan reviewed since April 2005. It was evidenced from reading the risk assessment and care plan that this resident needed to be observered hourly to establish their whereabouts. The record of their location had not been completed as per the risk assessment and care plan. Another resident had a care plan in place to manage a care need. This care practice observered for this resident was not in line with what the care plan identified should be happening. One resident places themselves on the floor as part of their behaviour. On one occasion this resident was laying on the floor for over 10 minutes before being assisted to their chair. 2 staff walked past the South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 11 resident and assistance was only given when one of the inspectors requested this. It is a concern that there may be some complacency amongst the staff in respect of managing some of the behaviours residents display. Medication records were inspected in the Heathlands unit and the nursing wing of the home. It was evidenced that medication had not always been signed for once administered. There was no protocol in place to decide when to give “When necessary “sedative medication. It is advised that a protocol in implemented to assist with consistency in decision making. Medication administration was not being carried out as per the homes procedure. A care assistant was seen to be assisting a resident to take their medication. This administration of medication needs to be reviewed to ensure that the trained nurse has sufficient time to undertake the medication round as per the homes procedure. Interactions were observed between residents and care staff. Residents were addressed in a sensitive and caring manner and were given time to express themselves. Staff knocked on bedroom and bathroom doors before entering and were noted to not be discussing residents needs in front of other residents. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 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 the following standard(s): 12, 15 Inadequate activities are taking place, which does not enable residents to have their mental, social, and recreational needs met. The need for stimulation and occupation is very important for people who have a dementia condition. The provision of varied meals is met and the timing of these meals meet resident’s needs. A review of the delivery, due to staff deployment needs to take place. EVIDENCE: The home has no activities coordinator and staff stated that they are very busy and have very little time to provide any activities. Residents were not able to communicate their views on the lack of activities. The manager said that an advertisement had been placed in the local press for an activities coordinator. On a previous visit to the home the inspector had observed three residents being engaged in a board game. This was the only activity seen on that occasion and during this inspection no activities were taking place. A television was on in one lounge but the picture was fuzzy and the residents were not watching the television. The television in the other lounge area did not have an adequate picture and could not be heard due to the loud pop South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 13 music, which was playing on the radio. The manager stated that normally older style music was played to enable residents to relax. The manager confirmed that in the warmer months resident had been assisted to sit out in the garden. The manager also stated that they understood the importance of recruiting an activities coordinator as soon as possible. One of the homes cooks and one kitchen assistant have left in the past 2 months. The other cook who has worked at the home since it opened was leaving the following week. The cook said the budget for food had been reduced but the meals provided were satisfactory and there was sufficient budget to provide all the food that residents liked. Meals are served at appropriate times and breakfast now starts at 8am. Currently 17 of the 25 residents need full assistance with taking their meals, which makes mealtimes very busy. Breakfast was observered in both the nursing wing and residential unit. The staff were able to sit with residents and give support in a calm manner in the residential unit. Due to the ratio of staff to residents in the nursing wing the dining room was busy but residents were given the support they needed. The manager is aware of this being a very busy period of the day and is currently reviewing this. A new hot box had been purchased for the kitchenette on the ground floor to keep residents meals warm while assistance is being given to residents. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Systems are in place for issues of concern to be raised with the manager and registered provider. Training has been provided to provide staff with the skills to identify potential abuse. EVIDENCE: Since the registered provider has taken over the home the Commission has received 3 complaints. All of these have been investigated by the home and concluded to the complainant’s satisfaction. One adult protection referral has been made and this has now been concluded. Adult protection training has been delivered to most of the staff and all staff will have received this training by the end of November. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 23, 24, 25, 26 The inadequate maintenance and décor, adverse odours, inadequate cleanliness and repairs required to furniture do not provide residents with safe comfortable surroundings. Resident’s possessions are not protected from other residents. The improvement in the garden area provides residents with an area where they have pleasant surroundings. EVIDENCE: The provider has confirmed that a major refurbishment programme is about to commence with the majority of work to be completed by January 2006. Additional visits will be made to the home to monitor the progress of this work. The décor in the home is of an unsatisfactory standard in the communal areas and redecoration is necessary. Examples are torn wallpaper in the lounge area, badly chipped kickboards around doorframes .The kitchenette microwave was South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 16 very dirty and had not been cleaned for some time. Some chairs in the dining area were soiled with food and drink stains. Some of the bedrooms viewed were of a satisfactory standard while others needed redecoration and repairs to bedroom furniture. Door locks are not fitted which enables residents to wander into other residents’ bedrooms. Bathrooms need to have a review, as the cleanliness was not satisfactory in 2 of the bathrooms. Domestic staff are employed but the home was still not at an acceptable level of cleanliness. An adverse odour was noted throughout the ground floor and the first floor stair well. The acting manager confirmed that all carpets were due to be replaced as part of the refurbishment programme. The layout of the home does not provide residents with much room to walkabout or rest away from the communal areas. As part of the refurbishment programme this should also be reviewed, to provide more comfortable and conducive surroundings for the residents needs. Work has taken place in the garden so that residents have a pleasant view from their bedrooms. Staff confirmed that residents had been supported to sit in the garden during the warmer months. A new sluice has been fitted to assist with infection control arrangements. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 The number and deployment of staff available during the daytime is not sufficient to meet the needs of the residents. The supervision aspect of residents is not satisfactory and this places residents at risk. Care staff are delivering the best level of care they can in a very high dependency environment. Supervision sessions, which have commenced, provide care staff with a support system. EVIDENCE: During the inspection staff were spoken with and it was confirmed that on occasion there was only one care staff working on the residential unit in the home. This is not satisfactory. It was also evidenced from inspecting the duty rotas and deployment diary that on occasion this care staff had also been expected to undertake laundry duties and prepare the evening meal for the entire home. The staff spoken with said they did not feel there were sufficient staff working on the Heathlands unit to meet the residents assessed needs. The assistant regional manager was spoken with during the inspection who confirmed that an additional care staff was going to work in the Heathlands unit and that there would always be at least 2 staff working in the unit. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 18 Supervision sessions have commenced with several of the staff having received at least one supervision session. This activity needs to continue and all staff need to receive supervision sessions. A training programme has been implemented and it was confirmed form speaking with staff that they had started to receive training in areas such as moving and handling and adult protection. Staff were seen to be delivering care in a sensitive manner, and were speaking to residents in an appropriate way. Staff were seen to be caring and willing to give a good service to the residents. The opportunities to do this are very limited due to the lack of staff. Staff confirmed that there was very little spare time to sit and engage with residents as most of the shift was taken up with delivering physical care needs. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 38 The home needs to have a manager in place who understands the care needs of Older People with dementia and is able to bring about change to provide a quality service to the residents living at he home. The acting manager needs to forward an application to the CSCI. Record keeping is robust and evidences resident safety is promoted. EVIDENCE: The home has a new manager in place since the last inspection. An application form has been sent to the acting manager but at the time of the inspection this application had not been completed and returned to the CSCI. The acting manager is a Registered Mental Nurse with experience in the field of caring for older people with Dementia. Care staff spoken with said they found South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 20 the manager approachable and that they were always able to raise any issues with her. The acting manager gave examples of policies and procedures that had been implemented such as supervision sessions and a review of staff deployment at meal times. The manager confirmed that there was still a lot of other care practices that she needed to review in order to provide an improved service for the residents living at the home. Servicing certificates for hoists and portable appliance testing were in place. The fire log record book was up to date. Infection control procedures are in place. The home employs a maintenance person who has the main lead for health and safety issues in the home. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 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 1 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 1 2 2 2 2 2 2 1 STAFFING Standard No Score 27 2 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x 3 x 3 South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5(1) Requirement Timescale for action 31/12/05 2 OP7 15 The registered person must provide an up to date service users’ guide, which is available for resident relatives and visitors to the home. The registered person must 24/12/05 ensure that all resident care plans reflect their current care needs and are reviewed regularly Risk assessments must be up to date and care delivered as identified in the risk assessment. The registered person must ensure that medication is administered in a safe manner. Medication administration records must accurately reflect medication administration. The registered person must provide an activities programme, which meets the needs and abilities of residents. The registered person must undertake the refurbishment work as identified in the conditions of registration. Prioritising those issues, which have an impact on health and DS0000064152.V259821.R01.S.doc 3 OP9 13(2) 10/12/05 4 OP12 15(2)(m) 31/12/05 5 OP19 23(2)(d) 31/03/06 South Park Care Home Version 5.0 Page 23 safety. The cleanliness of the home must be reviewed and improved. The registered person must 30/12/05 ensure that resident’s personal possessions and bedrooms are protected from other residents. The registered person must take 10/12/05 action to eradicate the adverse odours that are present throughout the homes communal areas. The registered person must 24/11/05 ensure sufficient numbers of staff are on duty to meet residents needs at all times. 6 OP24 23(2)(e) 7 OP26 16(2)(k) 8 OP27 18 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 OP36 Good Practice Recommendations It is strongly recommended that staff supervision sessions are given a priority to identify what training and guidance staff require in order to fulfil their job role. South Park Care Home DS0000064152.V259821.R01.S.doc Version 5.0 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: 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. 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