Inspection on 20/06/07 for Weston Park Care Home

This inspection was carried out on 20th June 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

Weston Park Care Home 12/12/07

Weston Park Care Home 23/11/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Weston Park Care Home Weston Park Moss Lane Macclesfield Cheshire SK11 7XE Lead Inspector Helena Dennett Unannounced Inspection 20 June 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Weston Park Care Home DS0000068323.V335034.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. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Weston Park Care Home Address Weston Park Moss Lane Macclesfield Cheshire SK11 7XE 01625 613280 01625 502914 weston.park@fshc.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lunan House Limited vacant post Care Home 90 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (39), of places Physical disability (2) Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 90 service users to include: * Within the total number of 90, 51 service users in the category of DE (E) may be accommodated in Mulberry and Silk Units at any one time. * No more than 39 service users in the category OP (Old age, not falling within any other category) may be accommodated in Weaver Unit. * Within the total number of 39 in the category of OP, no more than 10 service users requiring intermediate care may be accommodated. * Within the total number 10 service users requiring intermediate care, no more than two service users between the ages of 55 years and 65 years in the category of PD may be accommodated in Weaver Unit. 13th March 2007 Date of last inspection Brief Description of the Service: Weston Park Care Home is within easy reach of Macclesfield. The ownership of the home was transferred in July 2006 from Four Seasons Homes No 5 Ltd to Lunan House Limited, also a subsidiary company of Four Seasons Healthcare. Weston Park Care Home is a three-storey building with accommodation for residents on the ground and first floors. The second floor houses the laundry, offices and staff facilities. A two-storey annexe was opened in 1997 and is connected to the main building by an internal corridor. The annexe (Silk Unit) and the ground floor (Mulberry Unit) of the home provide care and support up to 51 older people with dementia. The first floor (Weaver Unit) provides nursing and support for up to 39 older people. Within that number of beds, 10 are used to provide intermediate care for people leaving hospital, under a contract with the local health agencies. There are nine day/quiet rooms, eighty-nine single bedrooms with en suite facilities, one twin bedroom with en-suite facility, ten bathrooms and nine showers. There are enclosed garden areas to the rear of the building. According to information received before the site visit, the scale of fees range from £390.35 to £545.00 per week. Weston Park Care Home DS0000068323.V335034.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 site visit took place over one day. Three inspectors as well as CSCI pharmacist inspector visited the home to do a site visit. CSCI is trying to improve the way we engage with people who use services so we gain a real understanding of their experiences of social care services. As part of this process one of the inspectors spent approx. two hours observing the care being given to a group of people who live in the home in one of the lounge areas. The findings are incorporated into this report. Before the site visit the acting manager of the home was invited to provide information as part of this inspection process. Survey forms were sent to the home and the acting manager was asked to distribute these. The new manager was telephoned approximately three weeks before the site visit, as CSCI had received no response from the survey forms. She agreed to distribute these forms to the people living in the home and their relatives. None had been returned up to the morning of the site visit. The forms were seen to be left in the main area next to the administrator’s office. The deputy manager agreed to distribute these on the morning of the site visit. Two forms have since been returned. During the site visit inspectors spoke with the deputy manager, several staff members, people who live in the home, health care professionals including nurses from the Primary Care Trust (PCT) and a doctor. Discussions also took place with the manager of the nurses from the PCT and with a social worker following the site visit. Six people’s records were examined as part of the inspection process, in respect of the care they receive. Records of medication, care plans, staffing rotas and training were also examined. After the last inspection, the senior manager who was identified as the person responsible in company for the way the home is run (called ‘the responsible individual) was required to send CSCI an improvement plan showing how and by when the organisation intended to meet the large number of requirements made. A random inspection was carried out on 13 March 2007. This was done to check that the requirements made during the November 2006 inspection were met. Some improvements were noted at that time; however some requirements had not been met. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 6 Senior managers and officers from the company that runs the home met with the Commission for Social Care Inspection to discuss in detail the improvements that were required and those requirements that were still outstanding. The company gave assurances of their intention to improve services at Weston Park Care Home. This included a more robust management structure with the appointment of a new manager, the intention to appoint managers for Mulberry and Silk Units and Weaver Unit and provide the deputy manager with five days supernumerary time in order to address the outstanding requirements. What the service does well: What has improved since the last inspection? A new unit manager has been appointed for Mulberry and Silk Unit and started work on the day of the site visit. She is a very experienced registered mental nurse (RMN) so the care provided to people on Mulberry and Silk unit should meet their needs. Records of fluid balances for people who are at risk of dehydration have improved since the last inspection. There is now a clear record made of the amount of fluids some people are taking in one day so the risk of people becoming dehydrated should be reduced. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 7 People living in the home said that staff now respond within a reasonable time when they ring their call bell. This means that they can get attention and support when they require it. The cleanliness of the home and the storage of equipment have improved since the last inspection so the environment is now more pleasant for the people who live there. All of the necessary checks are done and recorded before any member of staff starts working in the home so the manager can be confident the person to be employed is suitable to work in a care environment. What they could do better: Care planning practices needs to improve, as there were some instances where a care plan was not in place when a risk had been identified. Some of the care plans had not been updated when a person’s needs had changed and so there is a risk that the person’s needs will not be met properly. A requirement has been made on previous inspections regarding care-planning practices. This has not been met and is still outstanding. It was difficult to ascertain through the care records whether the health care needs of two people living in the home were being met in full. One person assessed as being at risk of developing pressure sores was nursed on an inappropriate mattress and so the risk of developing pressure sores was increased. The standard of managing the medicines for the frail residents of the home, many of whom are not able to cope themselves, is a cause for concern. Action must be taken to put this right without delay as the health of people living in the home is at risk because of poor medicine management. The manager of the home is trying to recruit another activity organiser but without success to date and the activity organiser has tried hard to improve the quantity and quality of activities provided at the home. However, on the day of the site visit there were no meaningful activities going on in the home for the people who were living there so there is a risk of people not being stimulated. The dignity of people living in the home is not always maintained. For example: members of staff were seen to tell people they are putting a ‘bib’ on them before lunch. Another carer was seen to stand over a person whilst helping them to drink. Staff on Mulberry unit continue to have a handover in the lounge area. This means that confidentiality could be breached. In addition some records about people who live in the home were left unsupervised in the lounge area on Mulberry unit. Both of these problems were raised during the random Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 8 inspection on 13/03/07 and inspectors were given assurances that this would not happen. The health and safety of people living in the home may be at risk through staff practices. For example: two members of staff were seen to lift a person inappropriately, putting themselves and the person at risk. Communication systems need to be improved – in particular communication between the nurses on Weaver Unit and the management of the home. For example, the regional manager and deputy manager were not aware that one person on Weaver Unit had a pressure sore and what action that had been taken by staff to address this. CSCI have not been informed of some serious incidents that have occurred in the home and so were not aware of the risk presented to some people living in the home. 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. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 9 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 Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 10 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&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An assessment of a person’s needs is done before a person moves into Weston Park Care Home to make sure that staff can meet their personal, health and social care needs. EVIDENCE: The records of three people that have moved into the home since the last inspection was examined, (one on Mulberry, one on Silk and one on Weaver). All of them contained an assessment that had been carried out before the person moved into the home by one of the nurses employed at the home. The assessment document contained sections regarding the health and social care needs of the person being assessed, and these were filled in appropriately. Intermediate care is provided at the home. There are designated bedrooms rooms for this purpose; however the communal lounge/dining room is used by Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 11 all of the people living on Weaver unit, including those who are living at the home for intermediate care. This falls short of the National Minimum Standards, which state that there should be designated facilities for people receiving intermediate care. Staff from the Primary Care Trust (PCT) visit the home regularly to monitor the condition of the people who are receiving intermediate care. Two members of PCT staff were spoken with during the site visit. They said they found the staff at the home helpful and approachable. The home now provides dedicated staff to work on the intermediate care unit to ensure continuity of care. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 12 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 & 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are not always set out in an individual care plan and so there is a risk that their needs will not be fully met. EVIDENCE: The records for six people who live at the home were looked at during the site visit. Some contained assessments that had been done before the person came to live in the home which identified their needs. However, one of the records did not have a completed assessment even though the person had complex needs. Some of the care plans that were in place were not written for the individual person so it was difficult to establish whether that person’s needs were being met. Although care plans were in place in the main there were some instances where a care plan had not been developed to address a specific need. For example: in three of the records looked at, the people were identified as at Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 13 risk of developing pressure sores but there was no care plan for skin care in place. This problem was identified during the random inspection which was carried out on the 13/03/07, and a requirement for these care plans to be developed was made at that time. One record looked at identified that the person displayed some challenging behaviour when at home. A care plan was not in place to identify how staff should manage this behaviour. In another person’s record, members of staff had written on the daily notes that the person had a wound which required nursing treatment. There was no care plan in place to identify what dressings were being used and how often staff should re-dress the wound. In one persons records there was a pain assessment chart in place. This was last completed on 13/6/07. However daily records indicated that the person continued to have pain on 14/06/07 and 16/06/07. This means that the pain assessment chart was inaccurate and could lead to the person’s needs not being met. Some of the care plans were not updated to reflect the changing needs of the person and so there is a risk that the person’s needs may not be met. For example: the daily records for one person identified that nursing staff had decided to encourage them to stay in bed to try and heal a wound. However there was no plan of care in place to reflect this change of care. There was also no mention on how members of staff would ensure that the person would not be at risk of getting a chest infection or a blood clot whilst in bed for long periods of time. The inspector visited the person in their bedroom and noted that a ‘Spenco’ mattress was being used rather than an airflow mattress and so the person could be at risk of developing pressure sores. A similar problem was noted during the random inspection carried out on 13/03/07, although it had been identified at that inspection that a specialised mattress was needed and staff were waiting to obtain one. This issue of using the correct mattress was discussed with staff at the home at that time. The recording of the amount of fluids and food people have in a day has improved since the last inspection. There was evidence that a senior member of staff checks the charts to make sure that some of the people assessed as at risk of dehydration have been given enough fluids throughout the day so that their health can be maintained. The care plan for one of the people observed in the lounge area said that he was easily distracted and that staff members need to initiate conversations about his interests to divert his attention. During the observation this did not happen and the person observed appeared to take up most of the carers’ time as he “wandered”; all they were seen to do was to keep asking him did he want to sit down. The person’s care plan for mobility refers to aggression but Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 14 does not mention a risk of falling; the falls risk assessment identified him as being at high risk. During the hours of observation, staff members were seen to address people in a respectful way and showed care and concern for people by offering reassurances, such as holding hands and explaining what they were doing. Several people who live in the home were spoken with during the course of the site visit. People on Weaver unit said that staff answer their call bells promptly and attend to their needs. One person made the following comment about their health: ‘I have improved 100 since I been in the home. One of the night staff is the most wonderful person I have met, I know she will look after me well, I feel I have been thoroughly washed when she attends to me. I have every confidence in the staff at the home’. On Mulberry unit a nurse was seen giving an update on the peoples’ condition to care staff. This took place in the lounge/dining room where residents were sitting. This was highlighted as bad practice at the last inspection as it does not promote people’s dignity and could compromise confidentiality. The care records checked showed that people were referred to their GP, and other healthcare professionals, e.g. chiropodist, district nurses, were involved in their care. The GP visits the home three days a week and spends one session on each of these days on one of the units. The units are aware of which day the doctor visits them, and are able to contact him outside of these sessions. A CSCI pharmacist inspected the medicines because of concerns that they are not managed properly. The pharmacist visited all three sections of the home, spoke with the nurses on duty and looked at the medicines and the records. Each unit has a locked room for storing medicines safely in cupboards and trolleys. There are company procedures to show staff how to manage medicines but these are not always followed. People’s medicine records did not show clearly whether some of the medicines listed were to be used or were finished. The record did not show the quantity of these items on the premises at the start of a new sheet. This would show that they were current and would support records of their use. Many records of medicines given to residents were not made carefully. Problems found included medicines given but not recorded, medicines not given with no explanation and no record of the dose given when the doctor gives staff a choice of dose according to the resident’s needs. Some records showed that medicines were not given to doctors’ directions and no explanation was included. Failing to follow prescribed directions of medicines may cause harm. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 15 There was no detailed protocol for those people living in the home that were prescribed variable doses of sedatives for agitation to guide staff when and how much to give and sometimes the falls risk assessment did not correctly identify the number of medicines affecting the outcome. A number of medication errors were discussed with the manager. CSCI had only been informed of some of them. One involved incorrect administration of a controlled drug. The CSCI pharmacist found a serious medicine error during the inspection where an incorrect dose had been given for two days. There were a lot of waste medicines in a store cupboard. The waste contractor arrived during the inspection. The medicines had not been put in the containers provided. The nurse was hastily unwrapping medicines to fit in as many as possible. She said that she had made no record of the waste medicines. There were other examples of medicines not being looked after properly including running out of prescribed medicines, a person living in the home having a double supply that was not accounted for, a cream with no identifying label and one dispensed over two years ago, and a controlled drug not being stored in the cupboard provided. End of life pathways (plan of care for someone in the last stages of their illness) were in place. One person’s record was examined. There was nothing documented on how the family wanted to be informed of any change in the person’s condition, or whether the family expressed understanding of the plan, only that they had agreed with the plan. Therefore there is a risk that the person’s wishes may not be upheld during the last stages of life. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 16 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. Although the provision of activities has improved there is still not enough for people to do to keep them active and stimulated. People are not always helped to make choices and keep control over their lives so there is a risk of their needs not being met. EVIDENCE: At the last inspection the manager said that an advertisement had been placed to recruit an additional activities organiser so that the needs of the people in the home would be met. The home has been unsuccessful in appointing anyone to date. However the organiser currently in post has tried to address the activities by providing the people with a schedule so that they know what is going on in the home. The people living in the home said that they were aware of the activities going on. One person said they enjoyed the traditional band that visited. On the day of the site visit crafts were scheduled for the day. However the activity organiser had taken annual leave and so there was nothing going on Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 17 throughout the day. People were seen sitting in their rooms and lounge areas with little to do other than watch television or listen to music. In one of the units one lady was seen to be agitated and calling out – in response, a nurse walked into the lounge and said ‘it will be alright’ and then walked away. The following comment was made on a survey form returned to CSCI after the inspection: “I know the situation is very difficult but wonder if they get enough stimulation”. People living in the home confirmed that their visitors could visit when they wished. There are smaller lounge areas visitors can use if they wish to meet their relatives in private. One of the people also said that they appreciated the fact that a religious service was held at the home regularly so that they could follow their religious beliefs. Some of the staff practices in relation to meal times needs to improve. On Mulberry unit a care assistant was seen walking around with a plate of biscuits when the mid morning drinks were being served. She took a biscuit off the plate and handed this to one of the people who lives in the home. No choice was offered. One carer was seen sitting beside a person helping her with her drink, whilst another carer was standing over a person whilst helping her with a drink. This carer did not talk with the person she was helping, and at one stage left her to fetch a ‘bib’ that she placed around the person. A nurse was heard to say to a person living on Mulberry unit: “I am putting a bib on you as you’ll be having lunch soon”. This language is inappropriate when speaking to older people. The general menu only showed a choice of main courses on one day. An alternative menu is in place that lists the range of standard alternatives available. Staff spoken with said that they knew what each person’s preference was and would order an alternative if they felt the person wished it. The dining room on Weaver unit did not appear homely or attractive for people to eat in. Four tables were placed in the dining part of the dining/lounge area. Two of the tables had tablecloths on them but no cutlery or crockery. One of the tables was used for staff to store napkins and cutlery. Two people who live in the home were seated at the other table. This had no tablecloth on it. In the lounge area staff had set up bedside tables for three people. They were offered their meals in the lounge area. Members of staff were seen offering people a cup of tea before the main meal was served. The people in the dining area were offered a cup without a saucer. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 18 The time spent observing people’s daily life and social activities provided evidence that staff members were patient. The carers on duty generally took time to listen to people and asked them questions rather than deciding for them. During the lunchtime meal, nobody was asked what they wanted for their lunch; both the main course and the dessert were simply placed in front of people. In addition there seemed to be some confusion because a couple of people had a soft diet and the staff seemed unsure whom these meals were for. The experience for one resident in particular denied her from having a relaxed meal. The carer who was helping her left the table on a number of occasions without explanation and went to do another task. He then returned and continued helping her with her meal, saying, “I am here again”, no other conversation with the person was taking place during the time he was sitting with her. It took over 30 minutes for her to eat her meal. It was also noted that another carer who was helping one person with his lunch kept getting up from his table and whilst walking between tables put a fork/spoon into the mouths of two other residents; she did not speak to the residents whilst doing this. She then returned to her seat. The agency carer was asked by another staff member “are you feeding ******”; this was done across the tables with no apparent thought about preserving the resident’s privacy or dignity. The mealtime for this person did however appear relaxed as the carer sat with her throughout the entire meal and spoke quietly to her as she placed the food into her mouth. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 19 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. Complaints are addressed quickly so residents can be confident that they are listened to and their concerns acted on. EVIDENCE: People living in the home said they knew who to complain to if they had a problem. A log of complaints received by staff at the home is kept. This records the detail of the complaint and the action staff have taken to address any concerns. There is an adult protection procedure in place at the home. The deputy manager confirmed that he has provided training to all staff so that they are aware of what to do should an allegation of abuse or neglect arise. Staff spoken with said that they had received updated training on the protection of vulnerable adults. They knew where to get the policies and procedures for this and confirmed that they knew about the company’s whistle blowing policy, saying that this was included in the staff handbook. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 20 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, 23 & 26 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 maintained so people live in comfortable and clean surroundings. EVIDENCE: Maintenance staff are employed at the home for the general maintenance of the building and grounds. When walking around the units it was noted that there were airflow mattresses and cushions in place in some of the bedrooms and hoists for use with people who cannot walk unaided. The bedrooms visited were comfortably furnished and had in many cases been personalised by the person occupying them or by members of their family. The standard of cleanliness on Silk much improved. No odours were evident after cleaner had gone round. The general standard of cleanliness on Mulberry Unit and Weaver unit was satisfactory. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 21 People spoken with said they were happy with the laundry service. They said their clothes were well looked after and they had no concerns. The following comment was made on a Survey form returned to CSCI after the inspection: ‘I find my relative is clean and their clothes changed most days. I often go in their room and I have always found it very clean and tidy’. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the home are put at risk by poor staff practices. EVIDENCE: There were two trained nurses and four care staff working on Mulberry unit on the morning of the site visit. The inspector noted that for long periods of time one carer was left on their own in the second lounge/dining room. This carer was provided by an agency and may not have been aware of everyone’s needs. There appeared to be enough staff working on Silk Unit and Weaver unit on the morning of the site visit. Staff spoken with said that they have had recent training on protecting adults from abuse, pressure area care, care of the dying, dementia and medicines. The files for the three most recently appointed members of staff seen contained all of the required information and a good recruitment procedure was in place for the protection of residents. Prospective staff members are checked against the POVA (protection of vulnerable adults) list before they start working at the home and CRB disclosures are obtained to ensure that they are suitable to work in a care home. New staff members are given training through the home’s induction procedure to ensure that they are suitably trained when they start work. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 23 Some problems identified under standard 8 relate to staff practice and competency. A number of errors pertaining to the administration of medicines have occurred since the last inspection. Members of staff have been offered additional training on the management of medicines; however there was no evidence provided to suggest that their competency in administering the medicines has been checked and so people could be at risk. The following problems relating to staff practices were seen during the observational period in the lounge area. One of the carers came into the lounge/dining room and stood there for a time with her hands behind her back without speaking to anyone or interacting in any way. She then proceeded to tidy the chairs around the dining table. When a person living in the home approached her she started to talk to him. Another carer came into the room saying they were warm; they then opened all of the windows and did not ask anyone if this was all right to do so. At one point during the observation a carer brought some files into the room which were passed on to another carer, sitting with the resident, who then made some notes in them. During the observation of care practice in the lounge it was noted that there were some shortfalls in safe working practices. Two staff members helped a resident from an armchair into a wheelchair using an inappropriate lift. They lifted the person by putting their arms through his from the front to the back rather than the other way around. The unit manager who was also in the room told them this was incorrect. This person was obviously uncomfortable being lifted in this way and it has since been confirmed that any transfers for this person should be done by the use of a hoist. It was also seen that the transfer was carried out without applying the brakes of the wheelchair. These shortfalls potentially place the person’s health and safety at risk. The unit manager confirmed that she would be following these issues up. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of people living in the home is not always promoted and protected and so people may be at risk of injury and harm. EVIDENCE: A new manager has been appointed since the last inspection. She was not at the home on the day of the site visit. The deputy manager was on duty and the regional manager from the company that owns the home came to the home on the morning of the site visit. At a recent meeting with CSCI, the provider agreed that the deputy manager would be full time supernumerary (ie: not working as one of the nurses on the rota) to support the manager and to supervise staff whilst unit managers were Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 25 being recruited. The rotas showed that he has not been allocated all of these supernumerary hours and has continued to work as one of the nurses on duty. The manager of the home has not informed CSCI of some incidents that have occurred at the home as required under the Care Homes Regulations. There is a quality assurance system in place. A representative of the company that runs the home has written to CSCI in 2006 agreeing to carry out monthly audits of medicines as part of its quality assurance system. This action has also been included in the plan that CSCI required to show how and when requirements would be met and improvements made at the home. The deputy manager informed inspectors that medicine audits have not been done monthly; however since the last serious medicine error, audits have recommenced. A record of the number of people with pressure sores in the home is kept and this is sent to the regional manager to ensure that the best treatment is provided to meet the people’s needs. The inspector examined the records of one person living on Weaver Unit who had a pressure sore. This person was not identified on the audit as having a pressure sore so this audit is not accurate. There is a system for the management of money held at the home on behalf of the people who live there. All such money is pooled in one bank account. Information about individual balances is held on computer so people who live at the home or their representatives can be given a balance statement that shows a record of all transactions. Receipts are given for all money paid in, and receipts are kept of all purchases made on behalf of a resident. There is a policy and procedure in place to ensure that members of staff have supervision regularly. Following a serious medication error, nursing staff attended an update on the administration of medicines and had to pass an exam. However staff have not been supervised in their practice of giving out medicines and so there is a risk that correct procedures may not be carried out and people may remain at risk of not getting their medicines as prescribed. Records were seen of up to date servicing of the passenger lift, hoists and portable electrical appliances. The maintenance person tests the fire alarm and emergency lighting systems weekly and keeps a record of these tests. A new control panel has been fitted to the emergency call system, and the call points have been modified in a way that bars calls being turned off in the corridor. Staff now have to enter the room from which the call has been made to turn the buzzers off. Given the number of accident records relating to falls/being found on the floor it was advised that a risk assessment be carried out on the environment in each of the units to monitor trends and reduce risks. Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 26 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 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 2 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 3 X X 3 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 2 Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 (1)(2) Requirement Timescale for action 20/07/07 2 OP8 12 (3) 3 OP9 13 (2) When a specific risk to a person living in the home is identified, a care plan must be developed to show the needs of the person will be met. The care plan must be evaluated and changed as necessary when a person’s needs change to ensure that their needs will be met. (Previous timescale 13/04/07 not met) Where a person living in the 30/06/07 home has been assessed at high risk of developing pressure sores or has developed pressure sores, an appropriate mattress must be provided to ensure that the risk of developing pressure sores is reduced and that the most appropriate nursing care is given. All medicine records including 22/06/07 changes to the record sheet, receipt, administration or omitting doses of medicines and medicine waste disposal must be made clearly and accurately. This is so that residents’ medicines are secure and that there is evidence that these DS0000068323.V335034.R01.S.doc Version 5.2 Weston Park Care Home Page 28 tasks have been carried out properly, safeguarding residents’ health. 4 OP9 13 (2) Residents’ medicines must be checked at least once a month to be sure that they are fit to use, that residents do not run out of medicines and that any medicines not required are promptly removed as waste. This is to make sure that residents always have a supply of good quality medicines. There must be a system to closely monitor the administration and recording of medicines at least once a day to ensure that medicines are given properly to the correct directions and that when errors are found these are correctly documented and staff making errors are identified and given appropriate supervision. This is to make sure that residents are protected from having their medicines incorrectly that may cause significant harm to their health. Information pertaining to specific people living in the home must not discussed in a public area as this breaches confidentiality and any records containing personal information must be kept secure and confidential. The registered person must ensure that suitable activities are provided for residents to take part in on all units so that residents are kept stimulated and active. (Previous timescale 03/04/07 has not been met) Members of staff assisting people to eat and drink must ensure that they are helped on a one to one basis in a way that preserves their dignity and DS0000068323.V335034.R01.S.doc 22/06/07 5 OP9 13 (2) 22/06/07 6 OP11 12(4) (a) 20/07/07 7 OP12 16(2)(n) 30/07/07 8 OP15 12(4)(a) 20/07/07 Weston Park Care Home Version 5.2 Page 29 9 OP28 18 (2) 10 OP31 37(1)(2) enables them to have a relaxed meal so promoting their health and well being. Staff practices must be checked 30/06/07 regularly to ensure that staff are carrying out their duties in a safe manner that does not compromise the health and safety of the people living in the home. CSCI must be notified of any 27/06/07 incidents that could compromise the health and safety of the people in the home and of any allegation of misconduct of a person working in the home. These incidents must be reported as soon as possible after the event and appropriate action take. 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 OP6 OP15 OP33 Good Practice Recommendations Dedicated accommodation, including lounge and dining space, should be provided for people who are staying at the home for intermediate care. Steps should be taken to make sure that people living in the home eat in pleasant surroundings. The manager should ensure that she has the correct information about the number of people in the home who have pressure sores so that she can be confident that her audits are accurate and reflect what is happening in the home and that the correct action is being taken by staff in relation to the treatment of the pressure sore Weston Park Care Home DS0000068323.V335034.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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