Care Home: Park House

What the care home does well Several residents told the inspector that they were very happy in the home, that they were treated well by a caring staff team. They spoke highly of the food they received in the home. All residents stated that their health care needs were met, and if they were feeling unwell, staff immediately consulted with their Doctors. Park House is a small residential home for 7 residents with mild to moderate dementia type illness. The home is well maintained and furnished, with a pleasant, well maintained back garden. The home is bright and airy and has no offensive odours. Staff are employed in sufficient numbers throughout the day to meet the health, personal and social care needs of the residents. What has improved since the last inspection? Since the last key inspection the staff have received training in understanding risk assessments, diabetes and epilepsy. Improvements have been made in regard to medication in that a controlled drugs cupboard has now been securely fixed to the wall, in accordance with the pharmacy inspector’s advice. The Monthly Administration Records are completed fully and signed appropriately when medication has been administered. Staff responsible for the administration of medication have all received medication management training. The inspector looked at the kitchen and found that the registered provider had purchased many new items of equipment. The kitchen was clean and tidy on the day of this key inspection. There was reference and a requirement in the last report that those residents’ who are vegetarian, should have their menu reviewed. The registered manager spoke with relatives of the residents who are vegetarian, to find out what foods they had preferred prior to coming to live in Park House. The relatives stated that none of the residents were strict vegetarians and would eat meat and fish from time to time, it depended on how they felt on the day. The registered manager said that if the residents chose not to eat a meal that contained meat they would be offered another protein such as cheese, eggs or fish. What the care home could do better: In view of the complaints and a safeguarding vulnerable adult referral to the safeguarding team at East Sussex Social Services department, in regard to medication. The inspector made a requirement for the medication policy and procedure to be updated to clearly explain to staff what actions they would need to take should a prescription be sent to the home when the registered manager had gone off duty, there needs to be clear guidelines within this medication policy and procedures to say who will be responsible for collecting medications from pharmacies or hospitals. The inspector has also asked that the registered manager draws up a policy and procedure on PRN (as required) medication, to clearly guide the staff as to when PRN medication should be offered, and the recording of administration. While many of the care staff in the home have received mandatory training, there are still some gaps in moving and handling, first aid, food hygiene, fire safety, infection control and safeguarding of vulnerable adults. Three training courses have been arranged for November 2008, but further training needs to be organised, to ensure that all staff have completed all mandatory training. Some improvements needs to be made in regard to infection control in the home, by insuring that all communal hand washing facilities have a paper hand towel dispenser in place, and the domestic washing machine needs to be replaced at some point with an industrial washing machine that provides a sluicing facility. A risk assessment needs to be compiled in regard to the portable radiator in the dining room. A lock should be in situ on the kitchen cupboard that contains kitchen cleaning materials. Residents and/or their relatives must be asked to sign up to pre-admission assessments and care plans. Call bells should be accessible to the residents, one bedroom requires a call bell cord, and call bells in communal toilets should be easily accessible should a resident fall. CARE HOMES FOR OLDER PEOPLE Park House 1 Walton Park Bexhill-on-sea East Sussex TN39 3NH Lead Inspector June Davies Unannounced Inspection 21st October 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Address 1 Walton Park Bexhill-on-sea East Sussex TN39 3NH 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) 01424 211258 01424 732404 britheadoffice@hotmail.co.uk Mrs Jacqueline Brittain Vivienne May Tree Care Home 7 Category(ies) of Dementia (7) registration, with number of places Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the maximum number of service users to be accommodated will not exceed seven (7). That service users accommodated will be older people aged sixty five (65) or over on admission. That only service users with a dementia type illness will be accommodated. 13th February 2008 Date of last inspection Brief Description of the Service: Park House is a detached property situated approximately one mile from Bexhill town centre. Accommodation is on two floors with a stair lift fitted to assist service users to have access to the first floor accommodation. The home has a large garden, which is shared with the care home next door that is owned by the same proprietor. The home is registered to accommodate up to seven older people who have a dementia type illness and the registered owner is Mrs J Brittain. The fees for the home as of April 2008 range from £427 to £440 per week. Additional charges are made for hairdressing, chiropody and dry cleaning. The home ensures that copies of the inspection report are made available upon request and there is always a copy available in the home to refer to. Park House DS0000021183.V372938.R02.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 key unannounced inspection took place on the 21st October 2008 over a period of 8 hours. The inspector spoke with the registered provider, the registered manager, residents, staff and a visitor to the home. A tour of the premises was carried out, as well as observation of staff practices, and a medication audit also took place. The inspector looked at documentation in relation to the key standards inspected. Information contained within in the Annual Quality Assurance Assessment (AQAA) was also taken into account. What the service does well: What has improved since the last inspection? Since the last key inspection the staff have received training in understanding risk assessments, diabetes and epilepsy. Improvements have been made in regard to medication in that a controlled drugs cupboard has now been securely fixed to the wall, in accordance with the pharmacy inspector’s advice. The Monthly Administration Records are completed fully and signed appropriately when medication has been administered. Staff responsible for the administration of medication have all received medication management training. The inspector looked at the kitchen and found that the registered provider had purchased many new items of equipment. The kitchen was clean and tidy on Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 6 the day of this key inspection. There was reference and a requirement in the last report that those residents’ who are vegetarian, should have their menu reviewed. The registered manager spoke with relatives of the residents who are vegetarian, to find out what foods they had preferred prior to coming to live in Park House. The relatives stated that none of the residents were strict vegetarians and would eat meat and fish from time to time, it depended on how they felt on the day. The registered manager said that if the residents chose not to eat a meal that contained meat they would be offered another protein such as cheese, eggs or fish. What they could do better: In view of the complaints and a safeguarding vulnerable adult referral to the safeguarding team at East Sussex Social Services department, in regard to medication. The inspector made a requirement for the medication policy and procedure to be updated to clearly explain to staff what actions they would need to take should a prescription be sent to the home when the registered manager had gone off duty, there needs to be clear guidelines within this medication policy and procedures to say who will be responsible for collecting medications from pharmacies or hospitals. The inspector has also asked that the registered manager draws up a policy and procedure on PRN (as required) medication, to clearly guide the staff as to when PRN medication should be offered, and the recording of administration. While many of the care staff in the home have received mandatory training, there are still some gaps in moving and handling, first aid, food hygiene, fire safety, infection control and safeguarding of vulnerable adults. Three training courses have been arranged for November 2008, but further training needs to be organised, to ensure that all staff have completed all mandatory training. Some improvements needs to be made in regard to infection control in the home, by insuring that all communal hand washing facilities have a paper hand towel dispenser in place, and the domestic washing machine needs to be replaced at some point with an industrial washing machine that provides a sluicing facility. A risk assessment needs to be compiled in regard to the portable radiator in the dining room. A lock should be in situ on the kitchen cupboard that contains kitchen cleaning materials. Residents and/or their relatives must be asked to sign up to pre-admission assessments and care plans. Call bells should be accessible to the residents, one bedroom requires a call bell cord, and call bells in communal toilets should be easily accessible should a resident fall. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park House DS0000021183.V372938.R02.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 Park House DS0000021183.V372938.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 People using this service experience good quality outcomes in this area. Residents move into Park House knowing that many of the staff have the skills and knowledge to meet their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three pre-admission assessments were viewed and found to contain detailed information in regard to all the personal, health and social care required by the residents. From the pre-admission assessments the registered manager is able to determine if the staff have the knowledge and skills to meet the needs of the prospective resident. Where a resident is going to be funded by the local authority, the registered manager also obtains a care manager assessments and plan of care prior to the resident moving into the home. It Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 10 was noted that the prospective service users had signed none of the preadmission assessments including those from local authorities. The home does not offer intermediate care. Park House DS0000021183.V372938.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using this service receive good quality outcomes in this area. Resident’s health needs are well met and recorded in their individual care plans and potential risks are managed. Medications is generally well managed but further improvements could be made to ensure that staff are given clear guidelines in relation to prescriptions coming into the home after G.P. visits and to ensure that staff administer PRN (as required) medication in a timely and appropriate way. Personal care is offered in a way that protects the residents’ privacy and dignity and promotes independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were viewed and case tracked against the pre-admission assessments. All three care plans related to the findings on the pre-admission Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 12 assessments, and contained further detailed information in relation to personal, health and social care needs of the residents. It was noted that residents and or their relatives/representatives had not signed up to their care plan or risk assessments. It was also noted that on one care plan viewed, that the resident had their gall bladder removed, and should have been on a low fat diet, but this was not noted. This was pointed out to the registered manager who said that she would rectify this so that staff are informed of the resident’s dietary requirements. Each care plan had a personal hygiene matrix showing what tasks or assistance have been carried out on a daily basis by care staff, this included, bathing, washing, dentures, glasses, shaving etc. There is good information contained within all care plans that tissue viability, continence and mobility needs are met. There was evidence during the inspection of premises that specialised mattresses had been provided for those residents who skin integrity was at risk. Where cot sides had been provided there were disclaimers in care plans signed by the residents relatives, and the risk assessment stated clearly that staff must ensure that cot sides are used in conjunction with the bumper pads. Risk assessments have been reviewed and up to date information is available and also included the number of staff required for bathing, personal care, toileting and mobility. There are clear guidelines in risk assessments in regard to those residents who display aggression and restlessness from time to time. Care plans detailed visits from health care professionals, including the General practitioner, district nurses, optician, dentist, chiropodist and community psychiatric nurse. An audit was carried out of medication, and this was looked at in depth in view of two complaints and one adult protection issue that had occurred recently. The medication policy and procedure must be updated to ensure that further mistakes do not occur in relation to ordering of medication and where a prescription is delivered mid cycle from the General practitioner. The inspector saw that there was a list of trained staff kept at the front of the Monthly Administration Record file, and this included staff signatures and initials. The registered manager has also compiled a list of medication and what it is used for, and the side effects that might be expected. The inspector did note that there is not a policy and procedure in place for PRN (as required) medication. Monthly administration records were seen to be completed correctly when medication is brought into the home, and when it is administered. The inspector did note that in the case of one medication prescribed for osteoporosis and osteoarthritis that needs to be administered prior to any food being taken this was not noted on the monthly administration record. All liquid medication, eye drops and ointments are dated on the bottle/tube on the day of opening. The home does not have any residents at the present time who are required to take controlled drugs. The inspector noted that the controlled drugs cupboard had been secured to wall in line with the pharmacy inspector’s directions. The home does have a controlled drugs register. All medication was seen to be administered appropriately and monthly administration records agreed with the amount of medication on the bubble packs. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 13 Throughout this key inspection the inspector observed that staff speak to residents in a kindly manner, spend one to one time talking to residents, and at all times were seen to respect the dignity and privacy of the residents’. Doors were kept shut while personal hygiene needs were being carried out. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People using this service experience good quality outcomes in this area. The residents living in this home are able to make choices in regard to their everyday lives, and are able to participate in activities if they wish to. The meals in this home are good offering both choice and variety and catering for specialised diets as required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This small residential care home provides residents with the choices and activities they require. At this key inspection the inspector noted that residents are able to get up in the morning as and when they want to. Two residents came into the communal living room just after 9:30 in the morning, having had their breakfast in their bedrooms. Staff were observed throughout the day giving one to one time with the residents. During the afternoon a member of staff was seen to be carrying out activities with the residents in the Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 15 communal lounge and later in the afternoon, a family arrived for one resident’s birthday party. When the weather is nice staff take residents out for a walk. Families also take their residents out for a drive in the car or to lunch. Care plans viewed showed that residents’ lifetime hobbies and interests are recorded. While none of the residents have their own private phone in their bedrooms the manager stated that should residents wish to make a telephone call, they are able to do this in the privacy of the office. None of the residents in the home are able to manage their own finances and have made arrangements for relatives/representatives to manage finances on their behalf. From a tour of the premises the inspector was able to observe that resident’s are able to move into the home with some of their own personal possessions, such a small items of furniture, televisions, radios, photographs, ornaments, and pictures. Should they wish to do so, residents are able to view their own personal records. The inspector observed a lunchtime meal being enjoyed by the residents. It was observed that residents were given choice of food. It was noted in the previous inspection report that two residents required a vegetarian diet, but this has changed and the home does not purchase frozen vegetarian meals or ‘Quorn’. Families had confirmed that these residents were not strict vegetarians, and only from time to time declined to eat meat. Drinks are offered to residents freely throughout the day. The inspector observed that one resident needed assistance with feeding and a member of staff was doing that this discreetly. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using this service experience good quality outcomes in this area. Residents and relatives know their complaints will be listened to and acted on. Arrangements for protecting residents are good and do not place them at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an up to date complaints policy and procedure. Residents on the day of the inspection said that they would know how to complain should they need to. A relative spoken to also said that she would know how to complain. Two complaints have been received by the home since the last key inspection. From viewing the complaints file, the inspector found that both complaints had been recorded, properly investigated with timely replies to the complainants. The home has up to date policies and procedures for Safeguarding Vulnerable Adults. There have been two Safeguarding Vulnerable Adults investigations since the last key inspection. One of which has been resolved and another, which is ongoing in regard to a resident not receiving there, prescribed medication. The registered provider and registered manager have carried out Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 17 investigations into this, which have now been passed to the Safeguarding Vulnerable Adults team at East Sussex Social Services department. The registered manager ensures that all staff have a POVA first check and Criminal Records Bureau check prior to taking up employment in the home. The home has a policy and procedure in place, which advises staff that they are not permitted to receive present or handle residents’ financial affairs or personal allowances. At the present time the registered manager does not deal with any of the resident personal allowances. Should resident need money for personal shopping the registered manager telephones the resident’s relative who then bring in money for the resident. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 People using this service experience good quality outcomes in this area. In general residents’ live in a safe and well maintained home, some further work needs to be done to ensure that residents are not placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Park House is a small residential home, which presents as well decorated with good maintenance of equipment. Residents living in this home live in a bright. clean and homely atmosphere. The inspector carried out a tour of the building, and found it to be well maintained and furnished. During the tour the inspector pointed out that some call bell cords in toilets had been shortened and would not be able to be reached by a resident if they should fall, and in Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 19 bedroom 6, while there was a fixed call bell facility on the wall, the resident would not be able to operate this quickly, and should have access to a bell cord which can be operated quickly, should the need arise. This was also fed back to the registered provided at the end of the inspection, and she stated that she would ensure these issues were put right. In the dining room there was a portable electric radiator, which is used to supply further heat to this room at the request of the residents. This radiator should be risk assessed to ensure that residents are not placed at risk. The kitchen area of the home is well maintained and many new appliances had been purchased, a new cooker, microwave, refrigerator and freezer. The kitchen was clean and well ordered. It was noted that a small cupboard, which contained cleaning materials for the kitchen was not locked and therefore needs a lock fitting to ensure that residents’ do not have access to this cupboard. The home is free throughout of offensive odours. The laundry room was clean and tidy with good water impermeable flooring. The inspector did note that the domestic style washing machine did not offer a sluicing facility, and this needs to be replaced at some point with an industrial washing machine that does offer a sluicing facility. It was noted that while all communal hand washing facilities had liquid soap, there was a need for paper hand towels dispensers to be fixed to the wall in these facilities. Staff are provided with protective clothing, disposable gloves and plastic aprons, to be used for personal hygiene tasks and mopping up spillages. Only two staff in the home have completed infection control training, and further training needs to be provided to ensure that all staff working in the home has completed this mandatory training. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using this service experience good quality outcomes in this area. Staff morale is good resulting in an enthusiastic workforce that works positively with the residents. The vetting and recruitment practices for new staff is good, ensuring that residents are not placed at risk. Some more work needs to be done to ensure that all staff have received their mandatory training, to ensure that residents are not placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rotas were viewed and showed that the home employs sufficient care staff to meet the residents’ needs. Where there is staff sickness or annual leave it is generally the case that the registered manager is able to cover these shifts with staff employed at the home or from other homes within the group. From time to time the registered manager also covers care staff shifts. There are always three care staff on the daytime shifts, and two staff at night, one waking and one sleeping. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 21 Five staff have achieved their NVQ qualification in Social Care while a further two staff are starting their NVQ qualification this month. Well over 50 of staff at present have this qualification. The inspector viewed three staff personnel files and found that generally the registered manager and homes’ administrator operate stringent recruitment practices. All prospective employees are required to provide an application form with full employment history. No one is allowed to start work in the home without a Protection of Vulnerable Adults register check and Criminal Records Bureau check. All files have at least two forms of identification one of which was a recent photograph. Two references are sort for each prospective employee, the inspector did note that a reference in one file was addressed ‘To whom it may concern,’ while the administrator confirmed that she had also checked this out by telephone, this had not been recorded. From the staff training matrix the inspector found that five staff had completed moving and handling, first aid and Safeguarding vulnerable adults training. Four staff had completed food hygiene and fire training. Two staff have completed infection control training. Further training courses in Safeguarding Vulnerable Adults, moving and handling, and medication are booked for November 2008 and two newly recruited staff will be undertaking this training. The registered manager is aware that further training needs to be booked for first aid, food hygiene, fire awareness, and infection control to ensure that all staff have received the mandatory training. The inspector also evidenced that staff had also received training in work related issues, such as understanding risk assessment and introduction to risk assessment, care planning, tissue viability, bereavement, epilepsy, diabetes, learning and development, challenging behaviour, and health and safety. From staff personnel files the inspector found that all new staff undergo an initial induction, two of the most recently employed staff have ‘Skills for Care’ induction. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 People who use this service experience good quality outcomes in this area. The manager is supported well by the staff in providing leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. The quality assurance system in the home is good ensuring that residents receive a good quality of care. Staff receive regular formal supervision to ensure that they have the skills and the knowledge to meet the residents assessed needs. Health and safety in the home is well managed to ensure that residents live and staff work in a healthy and safe environment. This judgement has been made using available evidence including a visit to this service. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager has completed her NVQ in Social Care levels 3 and 4 and Registered Managers Award. She has several years experience at management level. On the day of this inspection she had requested a demotion from the Registered Provider, who is now in the process of moving staff around in other homes in the group to fill the management position at Park House on a temporary basis. Staff said that they get along well with the present manager, and that she is always willing to cover shifts on the floor when necessary. Residents reported that the manager is kind and very helpful. The home has a good system of quality assurance in place; with a few improvements the checking of quality in the home could be excellent. Residents and relatives views are sought on the care the home provides. The registered manager has still to seek the views of professionals who visit the home on a regular basis, this would include, General Practitioners, district nurses, community psychiatric nurses, chiropodists, dentists, opticians, hairdresser, entertainers etc. The registered manager monitors regularly, care plans, reviews, risk assessments, medication, activities, menus, and personnel files. She also observes the competency of staff after they have received training, the cleanliness of the home, but does not record these observations. A six monthly fire risk assessment is carried out of the home and health and safety checks are carried out monthly for all rooms in the home. The inspector was able to view an improvement plan for 2007/2008 A consultant employed by the registered provider carries out regular regulation 26 visits. These regulation 26 reports are detailed and clearly describe all areas of good work carried out in the home together of areas where improvement is needed. There is also a summarised report published each year with the outcome of the residents and relatives questionnaires, further improvement to this summary would include a summary of the monitoring by the registered manager of systems used in the home. At the present time the home does not deal with any of the residents personal allowances. Where purchases are made on the residents behalf, receipts are kept and residents relatives/representatives are billed monthly. The registered manager said that where residents have expressed a wish to purchase something, she then rings the relative and asks them to bring money in for the resident. From staff personnel files the inspector was able to see that staff receive regular formal supervisions, and appraisals. A member of staff, who said that she received regular supervision, also verified this evidence. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 24 As mentioned under staffing in this report, while the majority of staff have undertaken their mandatory training, there were still a few gaps on the training matrix. It is important that all staff receive mandatory training to ensure that the safety of residents is not placed in jeopardy. The inspector was able to view the fire log book and found that fire points, magnetic door closures and emergency lighting are checked weekly, fire equipment is checked monthly. Fire drills are held six monthly the last fire drill being carried out in September 2008. All hot water outlets are checked on a regular basis to ensure that water is being delivered at 43ºC. All windows in the home are fitted with opening restrictors. The premises are secure with a number lock at the front door. All resident’s accidents are reported by staff in the accident book and the manager regularly looks at this accident book. Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 25 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 26 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. 1. Standard OP9 Regulation 13 Timescale for action The registered person shall make 10/12/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The medication policy and procedure should be updated to ensure that staff know what to do, when a prescription arrives out of hours. That the registered manager ensures that she solely is responsible for arranging collection of medications from a hospital or pharmacy. That staff have a policy and procedure in place to ensure that PRN (as required) medication is properly administered in the home. The medication policy and procedure should always be accessible to the staff. 2. OP30 18 The registered person shall, having regard to the size of the care home, the statement of purpose and number and needs DS0000021183.V372938.R02.S.doc Requirement 10/01/09 Park House Version 5.2 Page 27 of the service user – (c) ensure that the persons employed by the registered person to work at the care home receive – (i) training appropriate to the work they are to perform. All staff must receive mandatory training in Moving and Handling, Fire Safety, Food hygiene, First Aid, Infection Control, Safeguarding Vulnerable Adults and Medication. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations When drawing up pre-admission assessments residents and or their relative/representative should sign these to ensure they agree that the assessment appropriately describes their needs. Call bells should be accessible to residents at all times. The cupboard containing cleaning materials in the kitchen should have a lock fitted to ensure that residents are not able to obtain access. The portable radiator in the dining room to provide supplementary heating, should be risk assessed. All communal hand-washing facilities are fitted with paper hand towels, which are contained within a proper dispenser. The domestic washing machine when in need of replacement should be replaced with an industrial washing machine, which offers a sluicing facility. 2. 3. 4. 5. 6. OP22 OP19 OP25 OP26 OP26 Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Park House DS0000021183.V372938.R02.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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