Care Home: Euxton Park Care Home

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What the care home does well There is a good system in place to make sure that the individual needs and requirements of each prospective new resident are known prior to admission. This helps to make sure that people are only admitted to the home if their individual strengths and needs can be met by the staff team. Privacy and dignity is well respected. The staff team now work well together and showed a good understanding of the needs of individual residents. The routines of the home are flexible and aim to allow residents their freedom and independence by enabling them to retain as much control over their lives as possible, thus promoting equality and diversity. Visiting arrangements are in place to suit the needs of individual residents. The health care needs of people living at the home are well met meaning that residents have confidence that the staff team would arrange for medical assistance quickly if they were unwell. Residents spoken with felt well cared for and said they were pleased with the level of care and support provided. One resident told us that, “I cannot grumble, I get the help that I need when I need it, I cannot fault it. If I am down a bit they will come in and do all sorts for me, they are very kind”. What has improved since the last inspection? As recommended in the last key inspection report, the way medication is managed at the home has now been improved. This means that people are better protected and ensures that they receive their medication as prescribed. Care plans have been strengthened and are now much more person centred. This makes sure that staff have clear direction so that individual wants and needs can be met in a consistent way. There has been improvement to menu planning and the way of serving meals. In addition to the choice of menu served at each meal time, there is now a ‘lite bite’ menu and a substantial range of option for those people who prefer a vegetarian menu. This has meant that residents have a wide range of food made available at each meal time and also at other times of the day. People Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 spoken with were pleased with the choice of meals served. One person told us, “They look after me very well and the food is lovely”. The range of social activities available has been extended. This helps people living at the home to continue to enjoy previously enjoyed hobbies and pastimes while providing opportunity to try things they may not have done before. What the care home could do better: The staff team at Euxton Park Care Home have worked hard over the last twelve months and have made significant improvement so that the needs and requirements of residents are well met. However there are a number of things that could still be done to strengthen the service further. There is an expectation that at least 50% of the care staff team will achieve at minimum, a nationally recognised National Vocational Qualification (NVQ) Level 2 in care. Although the home is working towards meeting and exceeding this, there is at present, some way to go before this target will be achieved. Although staff training is considered important, refresher training should be routinely provided at the recommended intervals. This would make sure that staff had up to date information in respect of current best practice. Infection control and first aid training should be provided for all care staff. Wherever possible residents should be regularly asked if they are receiving the level of social care and social stimulation in the way they prefer. Staffing levels should be kept under constant review to ensure assessed needs are met in a timely and relaxed manner. Key inspection report CARE HOMES FOR OLDER PEOPLE Euxton Park Care Home Wigan Road Euxton Chorley Lancashire PR7 6DY Lead Inspector Denise Upton Key Unannounced Inspection 25th August 2009 09:15 DS0000025559.V377144.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Euxton Park Care Home Address Wigan Road Euxton Chorley Lancashire PR7 6DY 01257 230022 01257 230385 euxton.park@fshc.co.uk www.fshc.co.uk Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Vacant Care Home 63 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) Category(ies) of Old age, not falling within any other category registration, with number (63), Physical disability (63) of places Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Physical Disability - Code PD. The maximum number of service users who can be accommodated is: 63. 19th August 2008 Date of last inspection Brief Description of the Service: Euxton Park Care Home is situated on the edge of Chorley, in the village of Euxton. The home is within easy reach of the towns of Chorley and Leyland, is located on a bus route and is in close proximity to the local railway and motorway networks. The home is purpose built and caters for a total of sixty-three people of either sex with either nursing or personal care needs. At the time of the site visit, fifty six people were living at the home. Accommodation is over two floors, served by a passenger lift. Each floor has communal lounges, dining room and access to a kitchen. There is a range of single bedroom accommodation. Residents with nursing needs are located on the first floor of the building and the majority of people requiring assistance with personal care are accommodated on the ground floor. The home is set in extensive grounds with seating areas to the front and rear of the home which residents can access as they wish. Visitors are made welcome but have now been asked to restrict visiting to between 9:00am and 9:00pm to enable staff to carry out their duties during the busy times of the day. Visitors can be entertained in the privacy of the residents individual bedroom accommodation or any communal area of the home. The current range of fees and what is included in those fees can be obtained from the manager at the home. Additional charges are also made for such items as hairdressing, private chiropody, personal toiletries and newspapers. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced site visit took place during the course of two mid-week days and in total spanned a period of approximately thirteen hours. The twenty-one core standards, plus an additional standard of the thirty-eight standards identified in the National Minimum Standards-Care Homes for Older People were assessed, along with a re-assessment of the requirements and recommendations identified in the last inspection report. We spoke with the home’s manager, the unit manager/deputy manager, a registered nurse, a senior carer, three care assistants, the cook, the home’s maintenance person and the activities coordinator. In addition, individual discussion took place with three people living at the home and a relative. Several other residents were spoken with collectively in a communal area of the home during the course of the site visits. A number of records were examined and a partial tour of the building took place that included communal areas of the home, kitchen and laundry areas and some bedroom accommodation. The visit was just one part of the inspection. Before the visit took place we (the commission) asked the manager to complete a questionnaire that we call an Annual Quality Assurance Assessment or AQAA for short. It gives us information about how the home is meeting the needs of the people who use the service and includes future plans for further development. Prior to the site visit taking place, thirteen Care Quality Commission (CQC) surveys were completed and returned by people living at the home. Four members of staff also completed a CQC staff survey. This helped to form an opinion as to whether individual needs and requirements were being met to the satisfaction of people living at the home. The last key inspection at Euxton Park took place on 19th August 2008. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 6 What the service does well: There is a good system in place to make sure that the individual needs and requirements of each prospective new resident are known prior to admission. This helps to make sure that people are only admitted to the home if their individual strengths and needs can be met by the staff team. Privacy and dignity is well respected. The staff team now work well together and showed a good understanding of the needs of individual residents. The routines of the home are flexible and aim to allow residents their freedom and independence by enabling them to retain as much control over their lives as possible, thus promoting equality and diversity. Visiting arrangements are in place to suit the needs of individual residents. The health care needs of people living at the home are well met meaning that residents have confidence that the staff team would arrange for medical assistance quickly if they were unwell. Residents spoken with felt well cared for and said they were pleased with the level of care and support provided. One resident told us that, “I cannot grumble, I get the help that I need when I need it, I cannot fault it. If I am down a bit they will come in and do all sorts for me, they are very kind”. What has improved since the last inspection? As recommended in the last key inspection report, the way medication is managed at the home has now been improved. This means that people are better protected and ensures that they receive their medication as prescribed. Care plans have been strengthened and are now much more person centred. This makes sure that staff have clear direction so that individual wants and needs can be met in a consistent way. There has been improvement to menu planning and the way of serving meals. In addition to the choice of menu served at each meal time, there is now a ‘lite bite’ menu and a substantial range of option for those people who prefer a vegetarian menu. This has meant that residents have a wide range of food made available at each meal time and also at other times of the day. People Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 7 spoken with were pleased with the choice of meals served. One person told us, “They look after me very well and the food is lovely”. The range of social activities available has been extended. This helps people living at the home to continue to enjoy previously enjoyed hobbies and pastimes while providing opportunity to try things they may not have done before. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 not assessed, intermediate care service not provided. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before deciding to move into the home, so they know that their needs can be met. EVIDENCE: Since the last inspection, the homes Statement of Purpose and Service User Guide have been reviewed and updated. These two booklets that tell residents, prospective residents and other interested people about the home are now up to date and detailed. An individual copy of the Service User Guide is given to Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 10 each newly admitted resident and the Statement of Purpose is made available for everybody to read. It is understood that the Statement of Purpose and Service User Guide can now be provided on CD, made available in different languages or large print and will soon be available in Braille. This helps to make sure that as many people as possible have access to the information in a way that suits their particular needs. People are only admitted to Euxton Park care home if their health, personal and social care needs could be met. The home’s manager, who is experienced in undertaking pre admission assessments, carries out an assessment of people considering moving into the home. This is completed in order to determine if the level of care and support required could be provided at the home. The prospective resident is visited in their own home or in some cases, in hospital. This provides an opportunity for the prospective resident to find out more about the home and for the manager to undertake a formal assessment of current strengths and needs. This information, along with any other relevant assessments conducted by other agencies such as health or social services are taken into account. This collated information, along with any further information provided by family or other advocates, provides the basis of the initial plan of care. Wherever possible, people are also actively encouraged to visit the home and meet staff and other residents as part of the assessment and introductory process. The files viewed showed that good pre assessment information is gathered and that relatives are involved in this process where possible. Information includes health, religious and social care needs and highlights any areas of risk. This enables the manager to make an informed decision as to whether the individual needs and requirements of a prospective new resident could be met at the home. Once the assessment process is complete and the manager has made a decision, the prospective resident is provided with written information confirming the outcome of the pre admission assessment. One resident spoken with confirmed that she had been provided with written information about the home and that a full pre admission assessment had being undertaken by the manager. This lady told us that “Staff were marvellous” when she was admitted and that she was feeling much better since she had started living at the home. Euxton Park care home does not provide intermediate care. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care needs are met and people are treated with dignity and respect, promoting a feeling of well being and confidence that any health issue would be dealt with. EVIDENCE: Each person has a written plan of care and five of these were viewed. Significant improvement was noted. These provided clear guidance to staff regarding the individual support required for each resident, and how this was to be achieved. This meant that staff knew exactly what they needed to do to help the person to meet their needs in the way they preferred. The plans Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 12 focused on what people were able to do for themselves, as well as where assistance was required which helped to maintain independence whilst providing the support required in a consistent way. Each person has an individual care and health assessment profile that covers a diverse range of issues for example, health care, personal hygiene, mobility, spirituality and end of life care, activity and engagement and consent and capacity. For all residents this care and health assessment profile is reviewed at least monthly or more frequently dependent on need. The outcome of the personal profile identifies the individual needs and requirements of each individual resident. A care plan is then developed for each area of need identified from the care and health profile. There is now evidence of good person centred planning and person centred care was promoted in the care plans seen. This detail helps to ensure that a consistent service is provided and that the individual residents wants and expectations are met. One resident described the care and support provided as, Excellent. Care plans also included social interests and religious needs and requirements. This is good practice and shows that all needs and requirements are equally considered and strategies put into place to address each area of a residents chosen daily life style. One resident individually spoken with said that she was aware of her plan of care, was regularly asked what she thought about it, was happy with the content and stated that staff supported her in the way she wanted. A variety of risk assessments were also in place specific to the requirements of the individual in order to address any potential risks. These also were detailed and person centred. Specific individual risk assessments are determined by the requirements of each resident but can include issues such as nutrition, ulcer risk, manual handling, oral assessment, pain assessment, continence assessment, bed rails and falls risk assessment. There was clear evidence that care plans and risk assessments are reviewed on at least a monthly basis to make sure that the information provided remains current and accurate. This means that staff always have clear, up to date information in order to provide a high quality, consistent service. Three members of the care staff team individually spoken with confirmed that they felt sufficient written information was provided to ensure a good quality of care that was supplemented by good verbal information sharing. One member of staff told us, “Definitely a lot of improvement in care plans, helps us a lot, got a lot more information to work off”. The health care needs of people living at Euxton Park are well met. Health care needs and requirements are addressed through detailed person centred care plans specific for each area of need including specialist nursing interventions. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 13 Health care risk assessments are in place with significant outcomes incorporated in the individual care plan. Residents told us that they always got the medical care and support that they needed when they needed it. Records seen also confirmed that residents health care needs are being fully met. This included a multi disciplinary team communication record detailing health professional visits, the reason for the visit and the outcome. This ensures that an easily accessible and specific record is kept of all health care visits and clearly identified the frequency of need and outcome/action taken. There is good communication between the home and a wide range of health care professionals including nurse specialists, dieticians, continence advisors and palliative care nurses from the local hospice. The home implements the Liverpool Pathway for the dying and in some cases, where residents are able, the Preferred Priorities of care, which is then cascaded to other health professionals and the rest of the team. This enables residents to determine their chosen pathway. The home is also part of the Gold Standard framework programme for the End of Life project. As part of the visit, we checked how medicines were being handled. We checked a sample of medicines stocks, medicines records and care plans. Overall we found substantial improvement in the handling of medicines that help protect the health and wellbeing of people who live in the home. There is now a good system in place to make sure that medication is administered safely and as prescribed. All staff with responsibility for the administration and recording of medication have received appropriate training. The medication administration records of five people were viewed. These had been completed correctly and had a photograph of the person attached, this is good practice and helps prevent mistakes being made. Following a risk assessment, people are able to look after their own medication either totally or in part if this is deemed to be safe. Medicines stock was seen to be well organised, records were clearly presented and spare stock was stored securely. Records of medicines received into the home, given to people and disposed of were signed and up to date. We were informed that regular recorded checks are carried out daily and weekly to make sure staff were giving and recording medicines correctly. When any mistakes were found action was taken immediately to help prevent them happening again. Hand written entries on the drug administration record were seen to be signed, dated and countersigned by a second person. This is good practice so as to ensure that the hand written entry is correct for the protection of residents. There was a record for individual ‘when required’ medication and specific instruction of when it was appropriate to administer this to a specific resident. This ensures consistency of use. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 14 Residents spoken with felt that their privacy and dignity was respected and that staff were sensitive and mindful of resident’s feelings, with one resident saying that privacy and dignity was, respected and that she felt ‘comfortable’ when she needed assistance with personal care. A carer also gave a good account of how she respected residents privacy and dignity when assistance with personal care was required. Residents are asked on admission what they would like to be called and whether they would prefer a male or female carer to assist with personal care tasks. This was confirmed by a resident spoken with. As seen, the outcome is recorded in care planning documents and always respected. All staff receive training in respect of maintaining privacy and dignity during induction training and National Vocational Qualification (NVQ) training, and supervision arrangements. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in activities that suit their lifestyle and maintain their interests. EVIDENCE: People living at Euxton Park care home are now offered a wider choice of activities that is suited to their wishes and lifestyle. Prior to admission and also following admission, staff try to obtain as much information as possible about the social, cultural and leisure needs of people living at the home. This includes completing a social assessment that asks a lot of relevant questions. If the resident is unable to complete the social assessment, relatives are asked to assist. One of the social assessments observed, had been completed by the wife of a resident and was clear and detailed. This helped the activities coordinator and care staff to provide a programme of activity that suited the abilities and requirements of this specific person. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 16 Peoples spiritual needs are also recorded so they can be given opportunity and any help they need to continue to follow their faith. Discussion with the activity coordinator confirmed that mornings are reserved for one to one activity with residents, especially those that are bed bound or those that are unable or unwilling to participate in group activities. This often included just sitting and chatting with the resident although some enjoy other activities such as board games. Afternoons are, in the main, spent in group activities. Each resident has a social activity care plan that can include one to one activities such as nails and hand massage and chatting and family visits as well as such things as crafts, games, film afternoon, quizzes and music. Activities undertaken are recorded. Personal social preferences are documented providing evidence of whether the chosen activity was taking place. The activity coordinator explained that she reads the social care plan and makes herself aware of each newly admitted person’s preferred activities before introducing herself to a new resident. The preferred activities were then discussed and explored to make sure that expectations could be met. Birthdays and religious festivals are celebrated and outside entertainers periodically visit the home to entertain residents. We were told that some residents also enjoyed walking round the grounds or a sing song in the garden during periods of good weather. Some gardening is planned for the autumn, especially planting bulbs and a one off flower arranging activity is planned. A summer fair has taken place and we were told that although trips out were enjoyed by some residents last year, this year nobody was interested in this activity preferring instead to watch television or enjoy one to one sessions with staff. Reminiscence activity is also enjoyed by many residents that is generally geared towards a specific theme. The activity coordinator explained that this always ended up “in a really good chat”. A reminiscence room is in the process of being developed that will incorporate furniture and equipment of an earlier era. It is hoped that this will provide further opportunity for residents to participate in discussion and stimulate increased social interaction. However on a Care Quality Commission (CQC) survey in answer to the question ‘What could the home do better’ a relative had written “Stimulation of resident when family not visiting if confined to bed. (Quality of life)” The same person did however go on to say, “Overall no issues. A well run home”. Another relative said on a CQC survey “In mum’s case, lack of regular stimulation – she is not an activities person, but someone to sit and chat over a coffee”. It would appear from these comments that although improvement has been made to the range of activities offered, some people still feel that further improvements could be made especially when one to one interaction is Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 17 required. This should be kept under regular review and residents regularly asked if they feel their social care needs are being met to their satisfaction. People are encouraged to maintain contact with family, so that they can continue to be part of family life. Visiting arrangements are in place to suit the needs of individual residents. Visitors are made welcome but have now been asked, except in specific instances, to restrict visiting to between 9:00am and 9:00pm to enable staff to carry out their duties during the busy times of the day. Residents can entertain their guests in a communal area of the home or in the privacy of their individual bedroom accommodation. During the course of the site visit there were numerous visitors, the relationship between the staff team and relatives was see to be open, cordial and supportive. One relative told us in a Care Quality Commission (CQC) survey, “I feel that my mum is being well looked after and the staff are very caring”. As far as possible, people are encouraged and supported to make decisions about their day-to day lives, such as when to go to bed, when to get up and how to spend their time. Advocacy information is available. Some people are able to manage their own financial affairs and for others a relative or other advocate takes on this responsibility. Individuals are supported to look after all or certain elements of their medication if deemed safe to do so. People are able to bring their own important possessions into the home and so personalise their individual bedrooms. The people spoken with said that they were happy with the meals provided. One person told us that the meals were, “Excellent, I get a cup of tea early in the morning and the chef visited me when I first came in. The chef came and talked to me again when I said that I was not keen on something. He said that if I didn’t like anything I was just to say”. A carer spoken with said that residents usually ate what ever they fancied. “One resident really enjoys scampi and this is often provided for her whether or not it is on the menu”. Since the last inspection, improvements have been made to the range of foods served and menu options. As well as the daily choice menu, there is now a ‘lite bite’ menu offering a wider range of snack type foods both at meal times and at other times of the day and a vegetarian menu is now available offering a substantial choice of vegetarian options for residents to enjoy. The chef explained that it was not only people who chose to eat a vegetarian diet that enjoyed these foods but other people also enjoyed vegetarian meals and incorporated these into their normal diet. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 18 Another resident described the meals served as Excellent and confirmed that a wide choice of foods were offered. Each day every resident is asked what their menu choice is for each meal for the following day. The chef explained that there was very little waste, there was always a meat, fish and vegetarian option at each main meal and 90 of the foods served were home made from scratch, from fresh ingredients including all soups, cheesecakes, pizza and bread. Fresh fruit smoothes are made for residents that are resistant to eating that seem to be enjoyed and the chef explained that residents are encouraged to say what they would like to eat, “One resident at lunchtime wanted egg and chips – no problem”. However one comment was made on a CQC survey about a resident who ate her meals while in bed. A relative of the resident told us, “Main meal, desert and drink (hot) all given at the same time – so any hot desert/pudding is cold. (Mum will not say anything). It is important that residents enjoy their food that is served at a temperature of their choice. Staff should be mindful to allow a resident time to finish one hot course before serving a second course that is also hot. There appeared to be good systems in place in the kitchen and good relationships with dieticians to make sure that residents were provided with a diet suited to their specific requirements. The chef also confirmed that a sufficient budget is made available to ensure a varied and nutritious diet is always provided. Euxton Park Care Home DS0000025559.V377144.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the complaints and safeguarding procedures, which were understood by the staff team. EVIDENCE: Euxton Park has the corporate complaint policy and procedures in place, which includes details that any complaint would be responded to within a maximum of 28 days. From observation, it was noted that a record of complaints is kept that includes details of any action/investigation taken. A copy of the home’s complaint procedure is incorporated in the Service User Guide, a copy of which is provided to each resident in their bedroom accommodation. It is understood that the home’s complaint procedure can be provided in a variety of formats and languages upon request. The AQAA states that since the last key inspection, fourteen complaints had been received by the home. However only five of these were actually about the Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 20 service provided by staff at Euxton Park, the remainder were about other matters. Never the less, all complaints made to the home had been recorded. These complaints had been thoroughly investigated with the complainant receiving a detailed response. This shows that complaints are taken seriously and acted upon to improve the service. Information in the AQAA confirmed that there existed a culture within the home that all complaints/comments were viewed as a way to improve the service. Residents spoken with were very clear that if they did have any concerns they would speak with the manager or another member of staff. Residents spoken with also told us that if they did have a complaint they felt that their concerns would be taken very seriously and acted upon. A member of staff spoken with was also clear about what she should do if a complaint was made to her including making sure that the management team were quickly made aware of the concern. Euxton Park care home continues to have a variety of policies and procedures in place for the protection of residents. This includes the corporate adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff except for newly appointed staff have received training regarding protection and abuse. However some staff require refresher training regarding this topic and very new starters require this initial training. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). Opportunity is also provided for this topic to be discussion during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Since the last key inspection, two safeguarding referrals have been investigated. One was unsubstantiated and the other, that was not regarding staff at the home, was not proven. The management team at the home fully co-operated in these matters. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 assessed. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment in this home is excellent and provides residents with an attractive, homely and well-maintained place to live. EVIDENCE: Euxton Park care home is a large purpose built property set in its own extensive grounds. Resident accommodation is arranged over two floors and Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 22 has been designed to accommodate people with a variety of needs and requirements. The home is welcoming, comfortable, well maintained and provides excellent accommodation. Bedroom accommodation is provided on both the ground and first floor of the building, the majority of which have a profile bed with controls that the resident can use for comfort. A number of bedrooms are provided with an en-suite facility and all are comfortably furnished and personalised to reflect the needs and wishes of the occupant. Pictures and ornaments give a homely touch and there are photographs displayed of residents and staff enjoying social events. Communal areas of the home are spacious, well decorated and furnished and consist of a dining room on each floor and a variety of comfortable lounges. This means that residents have a choice of place to sit quietly, meet with family and friends or be actively engaged with other residents. There are also seating arrangements in the large entrance/reception area of the home where residents enjoy sitting and watch the world go by. A reminiscence room is planned. The fixtures and fittings are of a high quality, well maintained and well adapted to meet the wishes of the current residents. There are two passenger lifts for ease of access throughout the building. To ensure safety, radiators are guarded and there are thermostatic devices on all hot water outlets in resident accommodation to prevent the risk of accidental scalding. A lockable facility is provided for the safe storage of personal items and following a risk assessment, a number of bedroom doors have been fitted with a lock to ensure privacy for the occupant. Aids to independent living, including grab rails, hoists and assisted baths are provided to meet the needs of residents accommodated. There is a rolling programme of redecoration and refurbishment in place in order to maintain the high environmental standards, for the benefit of people living at the home. The grounds are accessible, safe, well maintained and provided with seating areas for residents and their visitors to enjoy. Residents spoken with were again all pleased with their bedroom accommodation and the communal space provided. One person told us in answer to the question, ‘What does the home do well’ said, “Care, activities and cleanliness and safety”. Another person said, “Employ good caring staff. Very clean and efficiently run”. As at previous inspections, Euxton Park care home remains clean, hygienic and very well maintained with a variety of policies and procedures to advise staff in the control of infection. Laundry facilities are in a designated area of the home and situated away from resident accommodation and food preparation areas. The laundry is well equipped to meet the needs of the home. Information in the AQAA confirmed that although the majority of the care staff team have received infection control training, there still remains a number that do not. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 23 This important training should be provided to all relevant staff to ensure that people working at the home are aware of good infection control measures in order to protect residents. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training ensure that people are cared for and supported safely. EVIDENCE: Since the last key inspection, the home has recruited a number of new members of staff. This has resulted in less dependency on the use of agency staff in order to address the assessed needs of people accommodated. The manager explained that with the exception of a full time registered nurse vacancy, the home is now fully staffed. It is anticipated that somebody will be recruited to fill this vacant post in the near future. However a carer working in the downstairs unit said that when the unit was full, there was a definite need for an additional member of staff in the morning. Another member of staff working in the same unit told us that when the unit was full, “We could do with an extra person we are stretched then, especially Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 25 at meal times”. One of the carers also pointed out that when staff are stretched, staff morale goes down and people get stressed. This in turn makes residents more stressed. A relative commented on a CQC survey that “The staff do the best they can with the amount of carers on duty at any one time. Often a member of staff will ring in sick – the home has no back up hence the residents lose out and their routine is broken”. Another relative said, “None essential tasks tend to get left when there is a shortage of staff. It is possible that on extra pair of hands would solve this problem”. This was discussed with the manager who acknowledged that at times, the downstairs unit when fully occupied would benefit from an additional member of staff over the busy periods. This should be monitored. Staffing levels should always be kept under constant review to ensure that the assessed needs and requirements of each resident be met in a calm and relaxed manner and within an acceptable time scale. Members of staff spoken with without exception said that the staff group had improved considerably and that they were all working well as a team. One person told us, “Generally morale right up, good staff team – it’s changed a lot”. Another carer said “A lot of improvement, staff not stressing so much, residents less stressed. Good staff team now and more stable, we help each other out”. A member of the management team commented, “Now a stable staff group – a good loyal staff team”. Residents spoken with and the vast majority of those that completed a CQC survey made very positive comments about the staff team. A relative told us, “The nursing and care staff are very caring and considerate towards the residents at all times”. A resident told us on a CQC survey that the home “Looks after us well, they keep the place clean and the food is good”. Residents spoken with described the staff team as, “Excellent”, “Very helpful and kind” and “marvellous”. In addition to permanent members of staff, the home also has a group of bank staff that cover for periods of sickness and annual holidays. These people have received some training, are familiar with the home and the systems in place so as to enable continuity of care for residents. Although National Vocational Qualification (NVQ) training is promoted, currently there are only 15 members of the care staff team that have actually achieved Level 2 of this award. We were informed that four further members of staff are currently undertaking this training and the remaining members of the care staff team are waiting for an opportunity to commence this course of study. In addition, three members of staff have achieved the more advanced NVQ Level 3 qualification with one member of staff currently undertaking this award and a further two people waiting to commence. NVQ training is a nationally recognised qualification for care staff and shows that some staff at Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 26 the home have had their skills, knowledge and understanding assessed in order to provide a good standard of care. There is a recommendation that at least 50 of the care staff team be qualified to at least NVQ Level 2. Whilst the home is working towards meeting and exceeding this target there is still some way to go before this will be achieved. If the majority of care staff succeeded in gaining this qualification, this would mean that residents could be confident that they were supported by a skilled staff team. There was clear evidence that newly appointed care staff are provided with induction training that is compliant with the nationally recognised ‘Skills for Care’ induction training standards for care workers. This can take up to twelve weeks to complete. The new member of staff remains on probation during this period and wears a badge explaining that they are a trainee carer. This training helps to make sure that newly appointed care staff have the basic skills and understanding to ensure that they are competent to provide an appropriate level of care and support. Good additional training including health and safety training is also provided that is valued by staff. Further training in specialised areas such as tissue viability, is provided specific to the individual needs of the people living at the home and to develop the skills and knowledge of the individual member of staff. This helps to ensure that a good, individualised service is promoted by a well trained staff team. Euxton Park care home has a structured, corporate recruitment policy and procedure in place for the employment of new staff. The staff files of five members of staff were viewed, two of which were of staff that had been recently appointed. Records included an application form, two references including one from the previous employer, a criminal records bureau disclosure and a check against the nationally held list of people that have been deemed unsuitable to work with vulnerable people. This robust system helps to ensure that only suitable people are employed that have the personal qualities to work with vulnerable people. The management team recognises the importance of recruiting staff that have the qualities that people like such as being friendly, good communicators and caring. A member of staff spoken with explained that he had not been allowed to take up his employment at the home until all the required references and clearances had been obtained and deemed to be satisfactory. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 & 28 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Euxton Park Care Home is managed with systems, policies and procedures in place to ensure the health and safety of staff and people living there are promoted and protected. EVIDENCE: The manager at Euxton Park care home is a registered nurse and has substantial experience of managing a care home for older people. In the time Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 28 that the manager has been at Euxton Park, significant improvement has been noted. Staff spoken with told us that the manager was encouraging and supportive. One person told us she felt, “Well supported by the manager, good staff team, changed a lot”. Another person had written on a survey, “Support in place from higher up”. The manager has recently successfully completed the Registered Managers Award. This is a nationally recognised advanced qualification that all managers of care homes are expected to achieve. The manager is also currently in the process of submitting an application to be registered with the Care Quality Commission. In order to achieve this, the home’s manager will have to demonstrate that she has the skills, experience and qualifications to run the care home in the best interests of the people who live there. There are clear lines of accountability within the home and external management. An area manager from the organisation visits the home on at least a monthly basis to audit records and to speak with residents and staff. This helps the area manager to make a judgement as to whether the home is well managed and whether the care and support provided by staff is meeting the needs of the people that live there. Ways to gain information regarding quality assurance about the home and whether the support offered is meeting resident’s needs is considered important. Various quality assurance systems are in place including, questionnaires for residents and their family that are provided annually, regular resident and relative meetings where residents and relatives are encouraged to have their say and influence change and also through informal day to day conversation with residents and relatives when they visit. Residents admitted for a period of respite care or short term care are also provided with a questionnaire when they return home in order to capture their thought and experience of staying at the home for a short period of time. Returned questionnaires are evaluated by head office and a meeting is then arranged with residents and relatives to discuss the outcomes and ask for suggestions for improvement. In addition, separate staff meetings take place, this being daily for the heads of department, and each unit manager organises a staff meeting at least quarterly for members of staff working in that unit. All meetings are minuted and staff are encouraged to offer ideas and suggestions so that improvements can be made for the benefit of the residents. The home has also achieved a RDB four star rating. This means that the home has also been externally assessed as providing a good standard of care. People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. However where the home does retain monies for some people, a robust system is in place to protect the interests of residents. This includes clear and accurate signed and Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 29 countersigned records of any financial transactions undertaken and secure facilities to store monies held. Resident’s monies held in safe keeping are further protected by random, external, financial audits that generally take place twice a year. There was clear evidence that formal one to one staff supervision is taking place. This was confirmed by the supervision notes seen and through discussion with the two members of staff individually spoken with. This means that staff have opportunity to meet privately with their supervisor in order to discuss work practices and training needs as well as any other issues relating to working at the home. The manager stated that at present, this was not the recommended six times a year for all members of staff. However the home is working towards achieving this target. All staff do receive daily informal supervision as part of the management role. Records relating to health and safety were seen. Records showed that equipment such as manual handling equipment and fire equipment are regularly serviced and that electrical installation and electrical equipment are also checked. Staff should also receive mandatory health and safety training including, fire safety training, manual handling training, food hygiene training and infection control training. Euxton Park now has two manual handling ‘in house’ trainers and it is anticipated that all staff will have been provided with either initial or refresher manual handling training by October 2009. Although health and safety training is mandatory, not all staff have completed all elements of the recommended health and safety training. This includes first aid training and infection control training for care staff. We were told that although a minority of the care staff team have received first aid training it is not normally company policy to provide this training as trained nurses are always on duty. Never the less, first aid training along with infection control training is recommended for all care staff and should be provided as a matter of course. Appropriate health and safety training makes sure that staff are aware of the importance of maintaining the health and safety of residents and their responsibility in this matter. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 30 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP12 OP15 OP16 OP27 OP28 OP38 Good Practice Recommendations The range and frequency of social activity should be kept under consistent review so that resident’s receive regular social stimulation in a way they prefer. Care should be taken to ensure that all residents are enabled to eat a hot food item when it is still hot. Adult abuse refresher training should be provided when required. Staffing levels should always be kept under review to ensure assessed needs are met in a relaxed and timely manner At least 50 of the care staff team should have achieved at minimum a NVQ Level 2 in care. Mandatory infection control and first aid training for all care staff should be provided. Euxton Park Care Home DS0000025559.V377144.R01.S.doc Version 5.2 Page 32 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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