Inspection on 20/03/07 for The Paddocks

This inspection was carried out on 20th March 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Paddocks 11/03/09

The Paddocks 22/08/07

The Paddocks 26/09/06

The Paddocks 29/11/05

The Paddocks 03/05/05

The Paddocks 01/11/04

The Paddocks 15/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Paddocks 45 Cley Road Swaffham Norfolk PE37 7NP Lead Inspector Kim Patience Key Unannounced 20th March 2007 08:45 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 The Paddocks DS0000027321.V334792.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. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Paddocks Address 45 Cley Road Swaffham Norfolk PE37 7NP 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) 01760 723416 01760 722420 lincolncare1@aol.com Lincoln Care Homes Limited Mrs Elizabeth Keys Care Home 74 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (23), Old age, not falling within any other of places category (50) The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The unit known as Sandpiper to accommodate 23 (DE(E) and 1 DE. The unit known as Kingfisher to accommodate 29 (OP). The unit known as Nightingale to accommodate 21 (OP). 26th September 2006 Date of last inspection Brief Description of the Service: The Paddocks is a residential home providing care for 74 elderly people. It is situated on Cley Road, and is within walking distance of the town centre of Swaffham. There are three parts to the home, the original building which has a new extension and an adjacent new wing. In addition to the main building there is a separate building which houses the administrative offices and laundry. The home is set in mature and attractive grounds. There is car parking at the rear of the home. Medical and nursing services are provided via the local G.P. service. The home has now been extended to provide care to 24 residents with dementia type illness. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and the second key inspection in the last 7 months and completed by the lead regulation inspector, a regulation manager and the pharmacist inspector. In order to assess the standards, a tour of all three units was completed. Records relating to residents, staff and the management of the home were inspected. In addition, residents, visitors and staff were spoken with and nine resident/relative surveys were returned to the Commission. The results of the survey and feedback from direct consultation has been incorporated in the report. The manager was present during the inspection and available for feedback at the close. Since the last inspection the home has shown a commitment to improving the service provided and have actively sought the advice of the Commission in doing so. What the service does well: What has improved since the last inspection? • • • • • Care planning for people with dementia. Nutritional needs assessments. Risk reduction plans. The appointment of an activities coordinator. Person-centred activity for people with dementia. DS0000027321.V334792.R01.S.doc Version 5.2 Page 6 The Paddocks • • • • • • • • The dining rooms in Sandpiper and Kingfisher have been improved. The environment in Sandpiper has been improved to make it more suitable for the needs of people with cognitive impairments Sandpiper now has a quiet lounge, providing more choice. The work in Kingfisher is near completion providing an improved standard of accommodation and facilities. The new lounge is now open. Staff files now meet the required standards. The home has a recognisable quality assurance system that includes stakeholder involvement and has produced a QA report. Regulation 26 visits are being completed. There is a plan of staff supervision and all staff are being supervised. 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. The Paddocks DS0000027321.V334792.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 The Paddocks DS0000027321.V334792.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): 3 and 6 Quality in this outcome area is good as the home can demonstrate that new residents are only admitted to the home once an assessment has been completed to determine that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure on new admissions to the home. All prospective residents have their needs assessed prior to coming to live at the home and are given information about the services provided so they can make an informed decision as to whether the home is suitable. Prospective residents and their relatives are invited to view the accommodation as part of the decision making process. Service user surveys indicate that residents are provided with a contract and adequate information about the service prior to moving into the home. However, the Statement of Purpose urgently needs updating to reflect the individual purposes of the three units within the home. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 9 People coming to the home for short-term respite also have their needs assessed in the same way. The management of the home indicated that they have currently stopped new admissions to the home as there will be a major move around of residents once the current building work is completed. This is good practice as it will avoid an upheaval for newly admitted residents many of whom have some cognitive impairment. The Paddocks DS0000027321.V334792.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 poor, as the home cannot demonstrate that people’s needs are met in full due to the lack of individual care plans and adequate risk assessments. Medication arrangements also raise concerns for the safety and welfare of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents care plans in Nightingale and Sandpiper were inspected. A number of concerns relating to care plans and associated records were raised at the last inspection. Since then the home has made several improvements and progress can be seen, particularly in Sandpiper, which accommodates people with dementia. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 11 Care plans in Nightingale were found to contain some good information about peoples preferred daily routines and personal history, which helps care staff to provide a service that is consistent with the individual’s previous life experience. However, the care plans inspected were still disorganised and contained too much information that was not needed on a daily basis. Having the records structured in this way makes it difficult for staff to access the relevant information. In addition, the care plans identify the need, but still do not provide staff with clear guidance as to how the needs should be met in a way that considers people’s strengths and abilities, promotes independence, preferences and choices. This includes social care plans. Care plans in Sandpiper had been improved significantly and now contained good information relating to peoples assessed needs and how they should be met. Care plans inspected showed that relatives had been involved in the development and review of the care plans and this is good practice. Social care plans have been developed and provide good information about the individual’s physical and cognitive impairments, interests, hobbies and life history. The home has now introduced a nutritional assessment tool and there is a risk reduction plan in place. Despite the improvements to care plans for people with dementia, the home must continue to develop care plans in order to ensure that the needs of all residents are assessed and provide staff with a clear plan as to how they should be met, taking into account strengths and abilities, preferences and choices. See requirements. All three Unit Managers are expected to work two days as management time and the remaining hours worked are as a member of staff. It is not surprising therefore that the care plans have not been more uniformly developed as all three Unit Managers reported that they did not have enough time to attend to the management tasks. (see Staffing and Management and Administration). The medication arrangements were inspected by the pharmacist inspector and the findings have been produced in a separate report, which is available on request. However, there are ongoing concerns about the medication arrangements and the rating for this standard remains poor. On the day of the inspection two of the Unit Managers were responsible for serving lunches as they were acting as members of care staff and as the senior on duty they were also responsible for administering medication at lunchtime for residents. This was of concern, as it increases the probability that residents’ needs will not be met at a busy time. (See also staffing and management and administration) See requirements. The Paddocks DS0000027321.V334792.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 - 15 Quality in this outcome area is adequate, as the home still cannot fully demonstrate that all resident’s social and emotional needs are being met. However, improvements have been made for those people with dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has appointed an activities coordinator who is providing some group activities and some one-to-one where possible in all three units. She works Monday to Friday from 10 to 4, making a total of 30 hours a week. This is an improvement. Seven resident surveys were returned to the Commission and the question in relation to the provision of activities showed that people indicated activities were usually or always available. As mentioned in standard 7, social care plans still need to be improved in order for the home to show that people are supported to pursue their own interests and hobbies. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 13 During observations in Sandpiper, which accommodates people with dementia, evidence of person-centred activities could be seen. One resident had a newspaper, another a book and when spoken with she said she liked reading and had lots of books available to her. Some concerns were expressed about the suitability of a placement of another resident in the Sandpiper Unit as she had very little choice of meaningful association with other residents and she chose to sit by herself in the quiet lounge as she found the main lounge too distressing and noisy. Other residents were seen helping to set the tables for lunch and generally engaged in daily routines. This is positive and residents clearly enjoyed being involved. Observations were made during the mealtime in both the Sandpiper and Nightingale Units. Some concerns arose about staff practice and the support given to people at this time. Meals in both Units were served ready plated and no choices were given. Drinks were already prepared and on the table, again indicating that people were not offered choice. Staff time was at an absolute premium and in the Nightingale Unit there was no real opportunity for staff to sit and talk with the residents while they had their meal. Many of the residents in this Unit preferred to eat in their rooms and the whole process of serving the food was very task orientated and the room itself did not create any sense of ambience. Several people in Sandpiper needed some assistance to dine and although staff were well meaning they intervened when it was not necessary, some evidence of out-pacing was seen here (a pace determined by staff as opposed to the resident). This may be due to the need to finish lunch before some staff end their shift. The home must ensure staff do not outpace residents and promote their independence and well being at all times. See requirements. In addition, where people needed more assistance with dining care staff were seen to stand or kneel by residents and move from one person to another, this is poor practice. Staff must always provide assistance one to one, in a discrete, sensitive manner and should be seated properly. See requirements. In Sandpiper the menu was displayed on a white board but it was not advertised elsewhere in the other Units. The home needs to develop ways of displaying the menu in a way that is more meaningful to people with cognitive impairments, such as using pictures. See recommendations The menu offers only one main meal option and this does not promote choice, the home needs to consider ways of offering all residents a choice of two main meal options. See recommendations. It is accepted that all of the residents knew that if they did not like the main meal option an alternative would be available, but this is not a meaningful choice and in a home of this size it ought to be possible to offer a realistic choice each day. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 14 On the whole meals looked appetising and residents appeared to enjoy the food. The chef was seen to offer extra helpings and this is good. Softened or liquidised food was presented well in separate portions, retaining the taste and texture of the various foods. Nine resident surveys were returned to the Commission and in response to the question relating to whether people like the meals, 4 indicated ‘always’ 2 indicated ‘usually’ and 1 indicated ‘sometimes’. Since the last inspection the home has made some changes to the lounge/dining area in Sandpiper. There is now a distinct dining room and this will help to aid memory and recall. In Kingfisher, the dining room has been refurbished and decorated to create a pleasant area to dine. The room is very small and will only seat 7 residents, however, more tables are now available in the new lounge/dining room. There also appears to be a problem with the heating in this room as at the start of the day, the radiator was cold and the room was very uninviting as a consequence. Later it was revisited and it was warm, but at the end of the day it was, once again, cold. In Nightingale, the home is in the process of building an extension which links to the lounge/dining room. However, it must be said that the building works will take some time and the management of the home need to consider very carefully how they can offer a pleasant place for people to sit and have their meals. There is a lounge upstairs, which staff have taken over as a storage area and thought needs to be given about how to furnish the two rooms so as to encourage people to socialise with one another or at least feel that they have a suitable place to do so. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good, as the home can demonstrate that complaints are handled appropriately and that systems are in place to protect vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is well publicised. Complaints are handled effectively and all of the nine resident surveys indicated that people know who to speak to if they wish to raise concerns and complaints. The home also has policies and procedures in place for the protection of vulnerable people and all staff are provided with adult protection training. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good, as the home provides good accommodation and facilities with an ongoing plan of improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has made lots of improvements to the environment in Sandpiper and in Kingfisher. There is ongoing work in Nightingale to add some more bedrooms and this will be assessed once the work is completed. The Provider is commended for the extensive investment he has made in the building. However, care needs to be taken to ensure that the impact of the building works on the residents is minimised and that they are offered reasonable accommodation while the work is underway. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 17 Work has been completed in Sandpiper to make the environment more suitable for people with cognitive impairments, such as individualising rooms and painting bedroom doors in colours that are preferred by the resident. Some signage has been introduced to aid orientation and the home should consider adopting the same approach in the other units. Homely touches had been added in Sandpiper such as flowers on the tables, friezes in the corridors and old fashioned pictures on the walls. All exterior doors had a key pad and it is still the case that residents cannot independently access the first floor. This will be addressed when this unit moves to the Nightingale unit, once the building works are complete. In Sandpiper, the lounge/dining room has been improved and now looks more homely and there are plans to make further improvements here which need to happen to reduce the noise levels and create smaller areas within the big room to create a feeling of belonging. Carpeting is also essential to reduce the noise impact. Residents now have a quiet lounge, which provides people with more choice. The Unit Manager in Sandpiper had also introduced some rummage baskets for the residents and these small touches were welcomed. The communal areas are overlooked by the office and it was disappointing to note that the blind in the office was half drawn, allowing staff to observe residents without being physically present in the room. This is a continuation of poor practice which has been observed and commented on previously. (This was also the case in Nightingale and Kingfisher Units.) The work in Kingfisher has been completed and residents have a new lounge and dining room but the dining room was alternately very cold and then hot on the day of the inspection, so this needs monitoring. The lounge area seemed very under used and the residents spoken with in this area commented that nothing much happened on a daily basis. There were lists of activities up in the office, but these need to be displayed where residents can see what is on offer. The new bedrooms have been furnished and carpeted to a high standard, but some remain very dark and difficult to furnish due to the shape. There was no risk assessment of this Unit, although risk assessments have been completed on individual areas. As it is the intention to accommodate the residents from Nightingale in this unit and some have significant physical impairment it is required that a risk assessment of the unit is undertaken with a view to minimising the impact of the changes of level and assisting people with finding their way around. It would also be worthwhile to review the overall lighting scheme, which is currently a mixture of strip lighting and more domestic fittings and lacks an overall domestic appeal. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 18 The bathrooms are also very clinical and in Kingfisher in the assisted bathroom on the first floor the wc is in the wrong position to be helpful to the residents and staff. There were no issues with cleanliness and hygiene. On the day of inspection the home looked clean and tidy and all nine of the resident/relative surveys returned indicated that the home is always clean and tidy. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 19 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 and 29 Quality in this outcome area is poor, as the home cannot demonstrate that staffing levels are adequate at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the last inspection a requirement was made in respect of staffing levels in the home, as there was evidence to suggest that they were inadequate and people’s needs were not being met. The home has not increased the staffing levels as required and there is still evidence to suggest that people’s needs are not being met. In Sandpiper, there were four staff on duty in the morning until 1pm and three staff on duty from 2 pm until 10 pm. Between 1 and 2 pm the Activities Coordinator joins the 2 care staff to assist with the lunches. At the time of the inspection there were 23 residents accommodated in this Unit. The Commission works on the basis of one member of care staff for every 6 residents when caring for people with dementia. On this basis there needs to be an additional member of staff on duty in the mornings and two on for the rest of the day. It would also be wise to look at the timing of the shifts so staff were not looking to go off duty while they were assisting people with their meals. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 20 The workload at the time of the inspection in Sandpiper was quite heavy, in that 3 people liked to walk around the home most of the day and needed more assistance as a consequence, 4 people needed two members of staff to assist with toileting, 3 needed assistance with feeding and most needed prompting to eat their meals. All of the residents were dependent on staff inputs to help generate meaningful activity. In Nightingale there were three members of staff on duty for the morning up until 11.30 and then 2 until 1 pm. At 1pm there was an extra member of staff but this reduced to 2 at 2pm until 10pm and this was for 20 residents. Again, the workload was very heavy, with 11 residents needing 2 members of staff to assist with all personal care and only one of the residents being independent. One resident needed assistance with feeding. The lunchtime practice was observed in this Unit and was very rushed for the staff. Some poor practice was observed in that two staff assisted a resident with a transfer from chair to hoist and they maintained a dialogue with one another rather than with the resident that they were helping. In Kingfisher there was a similar picture. There were three members of staff up until 11am and then 2 for the rest of the day. This was for 17 residents. Again the workload was heavy with 5 residents needing two members of staff to assist them with personal care, 5 needing one member of care staff and many others needing prompting. Following this site visit, the management has given the Commission an assurance that staffing levels will be increased and this is welcomed, however, the requirement will be carried forward for a second time and evidence of the increase will be gathered at the next inspection. See requirements. Staff files were inspected and found to be in order. The requirement, in relation to pre-employment checks, made following the last inspection is now met. Staff training was not looked at at this inspection, but the issue of staff working in dedicated wings was explored. All of those personnel interviewed thought that it would be preferable to be in a dedicated team. This was contrary to the results of a survey that the management had conducted. The outcome of which was that staff did not wish to be assigned to an particular unit. It is possible that many staff are reluctant to work in the Sandpiper Unit as this can be very challenging work. The management need to ensure that continuity of care and approach is not compromised by staff working odd shifts in a unit with which they are not familiar and with a range of needs they do not feel they are able to meet. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 21 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 and 36 Quality in this outcome area is adequate, however the home cannot demonstrate that the management structure is effective. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a registered manager who has been in post since last November who is supported by one head of care in each of the three units and senior care workers. At the last inspection there was some concern that the head of care in each unit was not given sufficient time to fulfil their duties. This area was assessed more fully during this inspection and the concerns still remain. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 22 Each Unit manager is given two days management time each week. The rest of the time they are expected to work as a member of care staff. Each Unit manager was interviewed and they all stated that there was not enough time to complete all of the management tasks they were allocated. In addition, the expectations on each manager were slightly different. It should be expected that each Unit manager should be responsible for the staff roster, staff recruitment, training and supervision for their unit as well as the admissions made to the unit. This would ensure that the overall site manager was able to monitor the work in a meaningful way as one person was accountable for the care offered in each unit. The home must consider a review of the management structure and an increase in the management hours in each unit, so that the health and welfare of residents and staff is promoted. At the last inspection a requirement was made in relation to quality assurance and consultation with major stakeholders. This is now met and the home has made significant progress here. A report on the quality of the service has been produced and this includes stakeholder surveys. Improvement plans have been written based on what stakeholders want and what the Commission has required the home to do. Regulation 26 visits are now being completed and the home has an internal system for monitoring the standard of the service. However, areas have been identified in this report, such as care plans and medication that cast some doubt on the effectiveness of those systems. Therefore the home must continue to develop its own quality monitoring and identify areas in need of improvement. At the last inspection, a requirement was made in relation to staff supervision. This requirement is now met and the home can demonstrate that staff are being adequately supervised. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 23 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 X X The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 24 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(2), 13(4), Requirement The registered person must review medicine administration procedures followed ensuring safe practices are adhered to by members of staff at all times Unresolved since the inspections of 29/11/05 and 26/09/06. The registered person must ensure lorazepam prescribed for an identified resident is administered only when required. The registered person must ensure full and accurate records are completed for the administration of medicines at all times - Unresolved since the inspections of 25/11/05 and 26/09/06. The registered person must ensure full and accurate medicine dose directions are written against which prescribed medicines may be safely administered. Timescale for action 20/04/07 2. OP9 13(2), 13(4), 20/04/07 3. OP9 13(2), 13(4),17( 1), (sched 3) 20/04/07 4. OP9 13(2), 13(4),17( 1) (sched 3) 20/04/07 The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 25 5. OP9 13(2), 13(4), 17(1), (sched 3) 6. OP7 15(a) 7. OP10 12(4)(a) 12(1)(b) 12(2) 18(a) 8. 9. OP14 OP27 The registered person must ensure medicines are administered in line with prescribed instructions at all times and that this can be demonstrated by record-keeping practice -Unresolved since the inspections of 25/11/05 and 26/09/06. The registered persons must ensure that each resident has a written plan of how needs in respect of health and welfare should be met. This includes the regular review of those assessments and the further development of social care plans. The registered person must ensure that privacy and dignity is promoted at all times. This relates to assistance with dining. The registered person must ensure that the home promotes independence and choice. The registered person must increase the staffing levels to ensure that staff are in sufficient numbers to meet peoples holistic needs. 20/04/07 20/05/07 20/05/07 20/05/07 20/05/07 The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 26 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. 4. 5. 6. 7. 8. 9. 10. Refer to Standard OP9 OP9 OP9 OP9 OP9 OP9 OP9 OP15 OP15 OP22 Good Practice Recommendations It is recommended that the controlled drug cabinet is rigidly fixed to the wall to provide additional security measures. It is recommended that the names of residents alongside photograph cards are clarified to assist in safe medicines administration. It is recommended that medicine reminder cards are made available for all MDS blister racks and white (PRN) cards are removed from colour-coded racks and held separately. It is recommended that arrangements are made for the use of PRN lorazepam for a named resident to be reviewed by the prescriber. It is recommended that arrangements are made to review authorisation previously granted for the covert administration of medicines for a named resident. It is recommended that arrangements are made for annual refresher training on medication to be provided. It is recommended that the home regularly assesses the competence of members of staff administering medicines including insulin administration. It is recommended that the home find a way of displaying menus in a format that will meet the needs of service users with a range of impairments. It is recommended that a meaningful choice is offered for every meal. It is recommended that a risk assessment is carried out of each Unit with the intended range of needs in mind to ensure that the appropriate adaptations are made and risks minimised. The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI The Paddocks DS0000027321.V334792.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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