Care Home: Home Park Nursing Home

What the care home does well Relatives commented that the personal care provided by the service is good and that staff are friendly and helpful. We observed that people who use the service benefit from well supported and relaxed mealtimes. People who use the service benefit from a well maintained, clean and comfortable home. The home conducts a quality survey for relatives of people who use the service and the manager is arranging regular meetings with the relatives. Comments from two social and health care professionals indicated that the home does well in supporting and managing behaviour that is challenging. Another said the service provides a very caring environment. What has improved since the last inspection? Additional support has meant that the health and personal care needs of people who use the service are being better documented, to ensure that staff are informed of and able to these needs. People who use the service are better protected by the procedures for the recruitment of staff. The AQAA told us how the service has continued with the refurbishment of the home, including the kitchen, laundry equipment, soft furnishings, carpets, flooring and bedroom furniture. What the care home could do better: Care plans must be reviewed and updated to ensure that they are meaningful for those using them. The registered person must take action to make sure that all people who use the service benefit from more frequent mental stimulation and exercise. The registered person must make sure that incidents affecting the welfare or safety of people who use the service are reported to the commission without delay, to ensure that all such incidents are appropriately dealt with. A more comprehensive record should be kept of all concerns and complaints made to the service. Staff induction and training must be better documented, to make sure that all staff have the necessary training, knowledge and skills to meet the needs of people who use the service. The systems used for monitoring the service must be further developed, to make sure these provide an effective audit of the quality of care provided and monthly reports must be maintained by the service provider. All staff must receive regular formal supervision, to make sure that all aspects of practice in the home are monitored and development needs are addressed. Key inspection report Care homes for older people Name: Address: Home Park Nursing Home Knowle Lane Horton Heath Southampton Hampshire SO50 7DZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Laurie Stride     Date: 1 8 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Home Park Nursing Home Knowle Lane Horton Heath Southampton Hampshire SO50 7DZ 02380692058 02380613901 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kendalcourt Limited Name of registered manager (if applicable) Anthony Jozef Pekarik Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 35 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Date of last inspection Brief description of the care home Home Park is a care home providing nursing care for thirty- five people who have dementia who can be admitted under and over the age of 65. The home is privately owned and is situated in a quiet rural location in the village of Horton Heath. People who use the service are accommodated in twenty- three single rooms and six shared rooms. Five of the single bedrooms have en-suite facilities and there are three bathrooms with assisted baths and three separate toilets. There are also three communal lounges and a dining room. Accommodation is provided over two floors with Care Homes for Older People Page 4 of 33 Over 65 0 35 Brief description of the care home a passenger lift allowing access to each level. A variety of aids and adaptations provided around the home enable people who use the service to move more independently. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place over two days, 17th and 18th December 2009, during which we, the commission, looked at how well the home is meeting peoples needs and supporting them to have a good quality of life. We also looked at how the service is meeting the requirements from the last inspection that took place on 21st November 2007. During this visit we looked at samples of records and spoke with the registered manager and the responsible individual. We also spoke with four members of the staff team and observed staff interacting with people who use the service. We used the short observational framework for inspection, which is a methodology we use to understand the quality of experience of people who use services who are unable to provide feedback due to their cognitive or communication impairments. Further information used in this report was obtained from the previous inspection report, the homes annual quality assurance assessment (AQAA) and from notifications the home Care Homes for Older People Page 6 of 33 had sent us between the inspection visits. We also received information from Hampshire Adult Social Services. Prior to our visit we had received ten completed survey questionnaires from relatives of people who live in the home, which gave either comments on behalf of their relative or their own comments. We also received comments from eight staff members and three health and social care professionals. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be reviewed and updated to ensure that they are meaningful for those using them. The registered person must take action to make sure that all people who use the service benefit from more frequent mental stimulation and exercise. The registered person must make sure that incidents affecting the welfare or safety of people who use the service are reported to the commission without delay, to ensure that all such incidents are appropriately dealt with. A more comprehensive record should be kept of all concerns and complaints made to the service. Staff induction and training must be better documented, to make sure that all staff have the necessary training, knowledge and skills to meet the needs of people who use the service. The systems used for monitoring the service must be further developed, to make sure these provide an effective audit of the quality of care provided and monthly reports must be maintained by the service provider. Care Homes for Older People Page 8 of 33 All staff must receive regular formal supervision, to make sure that all aspects of practice in the home are monitored and development needs are addressed. 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. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 who are interested in using the service have their needs assessed prior to moving in, to ensure that their needs can be met by the service. The home does not provide intermediate care, therefore this standard is not applicable. Evidence: The AQAA states that the service has a detailed admission assessment and they aim to take two staff members along to conduct assessments to ensure a balanced view. We looked at the records for two people who use the service who had recently moved into the service. For one person the records included a completed pre-admission assessment, hospital discharge and transfer notes and a monthly review record up to and including the month they were admitted to the service. The records indicated that a continuing healthcare assessment had been initiated. Care Homes for Older People Page 11 of 33 Evidence: Another person had only very recently moved into the service. There was no care manager assessment but there was a hospital discharge summary including a list of current medication on file. The manager had carried out an assessment, which included a risk assessment for falls. The needs assessment form includes a section on whether a continuing healthcare assessment (CHCA) has been initiated. The manager ticked the No box at the time of us reading the record. The manager said there should be a CHCA completed by the care manager. We asked if he had asked for this and the manager said no. The records included assessments of needs and risks in relation to mental capacity, moving and handling, use of bedrails and nutrition. A dependency profile was not yet completed. Also not fully completed were the sections on social history and mental health needs. Daily records since the time of admission had been kept up to date. The manager confirmed that the assessment process for this person was ongoing. We met and spoke with visiting relatives of one person who uses the service. They told us that they were able to visit the home prior to making a decision and received a copy of the homes service user brochure to help them in this. They said they had been very impressed with the treatment they and their relative had received and told us there is a lovely atmosphere in the home. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Additional support has meant that the health and personal care needs of people who use the service are being better documented but the manager needs to ensure this is completed so there is a robust system of recording and monitoring in place. Evidence: The AQAA told us that the service aims to encourage residents to maintain their dignity and mobility. Each person using the service has a personal care plan which uses nutritional screening tools and monthly weight recording. The care planning has been revised to include sections on deprivation of liberty and mental capacity. As a result of a safeguarding investigation by Hampshire Adult Services, care managers were working with the service to improve the depth and structure of the care planning records within the home. Over the last few months, improvement had been seen with the records and Hampshire were continuing to offer support and arrange training for staff involved in care plans and paperwork. The service had appointed an administrator to help with aspects of the record keeping. Care Homes for Older People Page 13 of 33 Evidence: During our visit we looked at the records for five people who use the service. Care plans included information such as nutritional risk assessments, bed rail assessments and agreements involving relatives. There were records of visits by external health care professionals such as GPs and chiropodist. For the records we looked at, the assessed needs were monitored through the care planning process. For example, one persons record had been updated to reflect changes with their ability to feed themselves and gave staff guidance on meeting these needs. However, another record was in need of some updating. Whilst there were records of such areas as mobility, weight and personal hygiene, these had not been clearly updated since September/October 2009 with no changes often recorded. Another care plan showed that the person can be verbally and physically aggressive if staff interfered with their activities. A monthly monitoring chart had been set up, however, this stated no changes for the last 4 months. We observed staff approach this person for some personal care prior to lunch. The person stated they did not wish to move, however, two staff attempted to lift them. At this point the person became more verbally resistant and the staff then left. We also observed bruising and a dressing which we followed up by viewing the care plan. This showed how the injury had been sustained. We asked the manager if this had been recorded in the accident book but when the manager checked he said it had not. One recommendation from Hampshire Adult Services was for the service to implement and maintain a diary of falls. We saw that the current record lists numbers of falls rather than identify individual falls and enable patterns to be monitored or individual risks. The manager agreed but said that incidents are recorded on accident forms. Hampshire Adult Services have also stated that updated falls assessments need to be included in care plans. We saw that deprivation of liberty and mental capacity assessment forms had been included in each of the files we looked at. Most of these had been completed by the manager. On one persons form the manager had indicated that the individual had been assessed by a healthcare professional as lacking capacity. The assessment did not say who did the assessment or when it was carried out. We asked the manager about this and he stated he was told this by someone in the hospital. We advised the manager to include the name of the person who made the assessment. We spoke with a member of the care staff, who told us they understood what care plans are for but had not yet read any although the seniors advise carers to do this. The carer said that staff generally help you but you get to know residents one by one and their abilities. The carer added this depends who youre on with. The carer said Care Homes for Older People Page 14 of 33 Evidence: that senior workers advise them about who in the home require assistance with their mobility. Another carer told us about doing 10 minute checks to see if a resident wanted a drink, as the person requires support with this. We asked if this was in the care plan and the carer said they did not know but that senior staff had told them about this. A senior carer said that some staff understand verbal guidance better than a care plan. We observed a senior nurse conduct a medication round. Medications were dispensed from a trolley, to each person individually and the record completed immediately after the person took their medication. A sample of the medication administration records were seen and were up to date. The senior nurse also showed us the controlled drugs storage and recording arrangements and took us through the procedures followed for receiving and returning medication. Medication is stored securely and medication is only administered by the qualified nursing staff in the service. We met and spoke with visiting relatives of one person who uses the service. They told us that the home involves them in planning the care and support their relative receives. They said they felt that their relatives privacy and dignity is respected and that people who live in the home always look clean and well presented. One relative stated in our survey questionnaire that their relative was generally well looked after, clean and tidy. Another commented that the personal care was very good. Further comments from relatives included that their relative was always dressed nicely, clothes and personal care is very good and the home is very friendly and look after everyone. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Consistent improvements in the daily life and social activities of people who use the service have not been sustained, so people with dementia do not benefit from regular mental stimulation and exercise. People who use the service benefit from well supported and relaxed mealtimes. Evidence: The AQAA told us that the service could do better by improving the activity programme which is limited by staffing/financial constraints and lack of volunteers. This has been a repeated comment in the AQAA over the past three years. During our visit we spent time in one of the lounges and dining areas observing the interactions between people who use the service and the staff. We saw the homes activity organiser spending one to one time with the people in the lounge which the recipients responded to positively. We spoke with the activity organiser who told us that she is allocated one day each week to do this; the rest of the week she performs caring duties as well as fitting in activities where time permits. The manager and the activity organiser told us that other staff also support activities during their shifts. We spoke with another member of staff about activities and they told us sometimes Care Homes for Older People Page 16 of 33 Evidence: its about having time for activities and that the responsibility for activities should be everyone not just ... the activities organiser. We saw the current activity plan advertised on the noticeboard. This showed one activity each day such as ball games, hand massage, word games. These activities are intended to be undertaken largely on a one:one basis. In a previous AQAA the manager has commented on the need to focus on one:one activities as group activities are not as suitable. The activities organiser keeps a record of the work she does with the people using the service. The daily records also contained some references to activities undertaken but this is sporadic and not structured. From the current AQAA and discussions with the manager, we were informed that the service was provided with a free service by an external consultant on a proactive model for active living. At our visit we saw that the consultant had issued a report with recommendations for the service to implement. While one or two of the suggestions have been tried in the service, there is no overall development plan for taking the recommendations forward and this was confirmed by the manager. The manager and the activity organiser also stated that they were waiting for some specialist books from another external organisation. A survey received from a person using the service (assisted by a relative) told us that the home sometimes arranges activities that they can take part in if they want. A relative commented that the home could do better by providing stimulation for the residents that are still capable of doing a few things. Another relative commented that the service organises social events (summer party and Christmas party) that anyone can go to. Comments from professionals about the service stated that the home could do better in providing activities based on a persons needs. They are working on this but progress is slow. Another professional also commented that the service could do better with providing regular activities which are tailored toward individual needs. Survey comments received from five staff indicated that more staff on duty would enable them to spend more time with the residents. We met and spoke with visiting relatives of one person who uses the service. They told us that there are no restrictions on visiting times and that they receive a nice welcome from staff. They said that staff always make a point of talking to them when they visit. A daily menu is displayed in the hall and this indicated an alternative main course and dessert at each mealtime. We observed lunch being served in the two dining areas. Meals were served from food trolleys on covered plates so that food stayed warm. All Care Homes for Older People Page 17 of 33 Evidence: the staff on duty joined in to assist those people who required support with eating. This was done in a relaxed and unhurried manner and at the individual residents own pace. One relative commented that since their relative had been in the home they had put on weight and is much happier since being there. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst policies and procedures are in place, shortfalls in documentation and reporting of incidents limit the effective implementation of these. Evidence: The AQAA told us that the home has an open door policy to management so staff are able to express any concerns they may have. It also stated that they have very few written complaints and have received two complaints within the last twelve months. Both these complaints had been received by us and passed on to the service, with one also being passed to Adult Services under the safeguarding procedures. During the visit we saw a basic folder with details of correspondence relating to any complaints received. This log of complaints appears to only relate to complaints received in writing and not to concerns or complaints raised verbally. We saw a procedure for making complaints displayed in the hallway. The relatives of one person who uses the service confirmed that they had received a copy of the complaint procedure in the service user brochure (guide). They also said that the home is accommodating regarding any concerns they might raise. The AQAA told us there had been two safeguarding investigations within the service. The service did not notify us of either incident. The manager stated that for both of the safeguarding issues adult services had said that they would notify us. We advised the manager that it was his responsibility as the registered person to ensure that we Care Homes for Older People Page 19 of 33 Evidence: were notified of any incidents involving the welfare of people who use the service. The home has safeguarding policies and procedures in place for staff to follow. From the training records available to us, seven staff had attended relevant training on safeguarding in July and August. In the last inspection report we noted that the manager was unable to demonstrate that staff had received training in safeguarding. At this visit, whilst there was evidence of some training taking place, the manager was not able to demonstrate that sufficient numbers of staff had received the relevant training. We spoke with 2 members of staff, who both demonstrated their awareness of the reporting and recording procedures for safeguarding people who live in the home against abuse. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 who use the service benefit from a well maintained, clean and comfortable home. Evidence: The AQAA informed us that the service provides a clean and well equipped environment. It also stated that it could do better in relation to more accessible grounds and told us that the layout is less than ideal. The AQAA told us how, in the last 12 months, the service has improved through the refurbishment of the home, including the kitchen, laundry equipment, soft furnishings, carpets, flooring and bedroom furniture. The accommodation in the home is over two floors and includes six double and twenty-three single bedrooms, five of the single room have en-suite facilities. There are two passenger lifts that provide easy access to both floors. There are three bathrooms and three separate lavatories, which have been adapted and equipped to suit the needs of the people who use the service. There are three lounges, two of which are at the front of the home overlooking the garden, and a dining room in each wing. The kitchen and laundry are on the ground floor and are not accessible to the people who use the service. Care Homes for Older People Page 21 of 33 Evidence: We did not view peoples bedrooms during this visit. During our previous visit it was noted that bedrooms are personalised by the occupants and their families with small pieces of furniture, pictures and ornaments. A programme of regular maintenance and renewal is in place and over a period of time hospital-type beds have been replaced with profiling beds. Specialist equipment, which includes hoists and pressure relieving mattresses, is available for people who need them. As noted in the previous inspection report, the gardens are at the rear of the building, away from the main road, but the people who use the service cannot use it unless they are accompanied and even then the access is down a very steep slope. There is a very large lawn at the bottom level and a small concreted patio area with chairs and tables on an upper level of grass but it also is not very easily accessed. There are some areas of lawn at the top of the slope, but they also have a slight slope that could be hazardous to people who use the service. The garden is separated from the home by a car parking area, so the garden is not enclosed and not secure for the people who live in the home to wander in. One survey received by a person using the service (completed with the assistance of their relative) commented that there was poor access to the garden. Policies and procedure are in place regarding infection control and suitable protective equipment is made available to staff, such as aprons and gloves. During our visit staff were seen to be using this equipment. A team of cleaning staff are responsible for maintaining the cleanliness of the home and we saw that this is done to a good standard. We spoke with visiting relatives of one person who uses the service. They told us that the home is spotlessly clean and there are no odours. They said their relative has a pretty little room and was happy. They told us how the maintenance person had put the TV up on the wall so that their relative can see it. One survey received from a relative commented that the home is always clean and fresh. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected by the procedures for the recruitment of staff. The service cannot fully demonstrate that all staff have the necessary training and skills to meet peoples needs. Evidence: The AQAA stated that there is a staff development plan and all recruitment checks are undertaken. It informed us that the service provides a good level of staff training and could do better in relation to having more time for training and supervision but this is limited by time/budgetary restraints. This has been a repeated comment in the AQAA over the past three years. The AQAA also told us that the service has offered staff the opportunity to undertake additional training such as National Vocational Qualification (NVQ) courses and palliative care training. The AQAA told us that the service has a comprehensive induction for care staff, which includes the common induction standards. At this visit we saw the staff rota which showed us that there are normally two registered nurses and seven care assistants on duty in the morning. In the afternoon there is one nurse and six carers and the nights are covered by one nurse and four carers. A relative commented that the service could do better by having more contracted staff, not agency, available at weekends and have staggered break times because too often there are not enough staff to supervise the residents in the lounge. Care Homes for Older People Page 23 of 33 Evidence: At our visit, we did not observe all staff taking breaks at the same time. Another relative commented that residents are sometimes left for a long time in the lounge unattended when staff are busy. Four relatives commented on the friendliness of the staff. The previous inspection report identified requirements in relation to staff recruitment checks and the training and development plan. The provider had written to us following the previous inspection telling us of the actions they had taken to ensure all recruitment records were up to date for one particular member of staff. During our visit we looked at the personnel files of three members of staff who had all started work in the home sine the last inspection. These showed that Criminal Records Bureau (CRB) checks had been carried out by the service for each individual before they started working in the home. Completed application forms, two written references and job descriptions were seen on file for each of these staff. Based on this evidence the previous requirement for staff recruitment has been met. The staff training record we saw was not up to date with the details of training staff have attended and it did not indicate what training was planned to take place. This makes it difficult to ascertain if all staff have received the training needed to equip them to work with people who us the service. We spent time with the manager trying to ascertain whether staff had received all the necessary training, which we were unable to do in full. The manager was able to confirm from records that, since July 2009, six staff had completed challenging behaviour training, fourteen staff had received dementia training, seven had received safeguarding training and five had received health and safety training. The manager showed us a note stating that nine members of staff had been interested in undertaking a distance learning course in dementia care and he thought they most of them had done this but there was no available record of completion to demonstrate this. The manager told us that out of twenty one care staff, eight are currently trained to NVQ standard. We looked at an induction workbook for one member of staff who had recently started working at the home. This consisted of checklists for induction into the homes procedures followed by the common induction standards. A number of the first sections had been signed as being completed but there were no further dates or signatures to indicate that the induction had been continued. Another two workbooks were not available and the manager told us that staff members keep the books at their homes. The manager agreed that a record should be kept in the service. We spoke with a senior carer who told us how they try to ensure that inductions are completed. They also told us that mandatory training is allocated on a list with individual staff members names on it Other training has to be asked for or volunteered Care Homes for Older People Page 24 of 33 Evidence: for by staff. The senior carer had completed courses in dementia and palliative care. We were also told that the training in managing challenging behaviour is updated frequently, two/three times a year. From discussions with staff we also established that there is currently only one appointed first aider in the home. This was confirmed by the manager and means that the home cannot provide an appointed first aider for each shift. Another carer told us that the first two weeks of induction had been spent working alongside senior or experienced staff. The carer confirmed that infection control training had been included in the induction and that they had completed training in moving and handling, dementia care, challenging behaviour and safeguarding. Comments received from two professionals said that staff sometimes have the right skills and experience to support peoples social and healthcare needs. Two professionals commented that the home does well in supporting and managing behaviour that is challenging. One staff member commented in our survey that carers are offered training in house as well as outside the home. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Relatives are kept involved in the service but a lack of robust quality monitoring, audit and supervision means the service cannot be assured that it is run in a way that fully meets the diverse needs of people who live in the home. Evidence: The manager of Home Park Nursing Home has been in post for many years and he is a trained nurse with experience in providing nursing care for people with dementia. Until recently he was supported by a deputy manager. The AQAA told us there are plans for the manager to complete the Leadership and Management for Care Services course. A quality survey is carried out for relatives of people who use the service and we saw samples of the most recent of these. Comments from relatives were largely positive, with some issues raised about laundry, food, activities and suggestions for regular meetings. The manager had started meetings in November. The manager told us that a meeting had been held with relatives at which a solicitor had been invited to talk about Lasting Power of Attorney and other legal matters. Care Homes for Older People Page 26 of 33 Evidence: We discussed the recommendations made at the safeguarding strategy meeting in November. These recommendations centred around documentation needed and held within the service such as falls assessments, end of life/best interests/mental capacity assessments, updates to care plans. The Chair of the safeguarding strategy meetings stated in December that the original main concerns were the lack of documentation which had left the home vulnerable if they are offering the level of care they report. This raised concerns that should any issues arise the tools were not in place to support the staff. This is also a concern because it may not be available to advise the team and support the service user. The manager told us that a meeting had been held with staff to discuss and resolve the ongoing deficiencies in the documentation, but minutes of this had not been taken. He also told us that the deputy manager who had been employed had been working on care plans and audits of training. The manager had informed the safeguarding meetings that, when he had not had an administrator, he had been doing the administration himself and had left the completion of care plans to staff, which they had failed to do. The manager told us that an administrator was now employed but they were on leave. The responsible individual told us that he was looking at ways of sharing good practices across the two services run by the company, which would involve a member of staff, very experienced in completing care plans, visiting Home Park Nursing Home to provide some support. The manager told us the service is looking at implementing a new system of care planning in the new year. We looked at the supervision systems within the service. A requirement had been made at the previous inspection for formal supervision arrangements for nurses. We saw that regular supervision was not happening for nurses so this requirement had not been met and supervision was not happening for care staff. The records we saw of formal supervision for nurses were sporadic and incomplete, though the manager said these do happen. Those we saw had been signed by a deputy manager. We viewed five records. One person had an annual appraisal in March 2008 and no formal supervision, three had received two supervision sessions in September and October 2009 and one had received three supervision sessions in 2009. We looked at the records for three care staff. Two had received one supervision session though they both appear to have been prompted by the carers concerned. The manager looked at the records of another member of staff with us and confirmed there was nothing much recorded there recently. We spoke with a member of staff who told us they had not had formal supervision but the manager and senior staff were supportive. We asked a more senior member of staff if they had supervision and they said not much recently. We also looked at records for team meetings. Minutes were seen for meetings in October, September, July and May 2009 so there were limited opportunities for staff to meet formally to review practice and team working. Care Homes for Older People Page 27 of 33 Evidence: Visits to the service are carried out by the responsible individual. He told us that he generally visits the service at least once a week and compiles a monthly report based on his observations and discussions during these visits. We saw the monthly reports since May though reports were not available for July and August. The report for November gave action points for the nurses to have more office time to update the care plans and for the moving and handling trainer to ensure all updates were completed, starting in December. The reports did not indicate that issues raised by previous inspection requirements had been addressed or were being monitored. The importance of monitoring and auditing the service through quality assurance, responsible individual visits and supervision and development of staff was discussed with the manager and responsible individual. The service looks after the personal allowances of some of the people who use the service. We saw clear systems in place for recording and checking individual accounts and balances. We saw the fire safety log book, which indicated that there had been fire safety training and a practice drill. We received comments from eight members of staff who responded to our survey questionnaire. Three staff commented that the communication in the home could be better, either among management/senior staff or between staff. Four commented on the good level of care provided in the home. One social and health care professional commented that the service works hard in managing any problems and asks for support appropriately. Relatives who sent in survey responses commented on the good level of care and the friendly staff. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 An up to date record of the 10/02/2008 staff training, and a development training programme must be in place, which will ensure that staff fulfil the aims of the home and meet the changing needs of the people living there. 2 36 18 The registered person must ensure that supervision arrangements for the registered nurses are developed and put into practice. 10/02/2008 Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be reviewed 30/04/2010 and updated to detail the health, care and social needs of people using the service. To ensure they are meaningful, working documents, used by the staff. 2 12 16 A clear daily programme of activities must be implemented and recorded. To meet the individual mental and social stimulation needs of people who use the service. 30/04/2010 3 18 37 All incidents affecting the 18/02/2010 welfare or safety of people who use the service must be reported to the commission without delay. To ensure that all such incidents are appropriately dealt with. Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 30 18 Documentation must be improved to clearly show that staff have received a structured induction and the training they have received and is planned. To ensure that all staff have the necessary training, knowledge and skills to meet the needs of people who use the service. 30/04/2010 5 33 26 Reports by the provider must be completed each month. To ensure the conduct of the service is monitored. 18/03/2010 6 33 24 The systems used for monitoring the service must be further developed. To ensure these provide an effective audit of the quality of care provided. 30/04/2010 7 36 18 All staff must receive regular 30/04/2010 formal supervision. To ensure that all aspects of practice in the home are monitored and development needs are addressed. Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 16 Improvement should be made to the complaints log so that a comprehensive record is kept of all concerns and complaints made to the service. Care Homes for Older People Page 32 of 33 Helpline: 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. 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