Care Home: Parker House Nursing Home

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What the care home does well The staff spend a considerable time and effort to ensure admissions are properly planned and people`s needs assessed. People have a care plan that describes how staff are to support them in their daily lives and they have been consulted on them wherever possible. Health needs are closely monitored and people are referred at an early stage to external professionals if problems arise in their condition. The staff are trained to move people safely, they have good procedures to control infection in line with the Department of Health`s advice. People told us they are in control of their lives; they can choose what they do and how they spend their time. We saw that people are afforded privacy and their dignity is a priority. What has improved since the last inspection? The Key workers role has been re-defined and care staff have been given more support and guidance to carry out this duty. Staff have been on a Dementia awareness course and updated their knowledge through a course in how to protect vulnerable people from abuse. They have recently met the County Council `s quality rating award and received a quality payment for achieving this. Regular staff supervisions take place to tackle issues on health and personal care. Staff have completed a distance learning course on infection control. They have a new member of staff in the kitchen to offer greater choice at tea times and have a "hot" option available everyday. They have organised more activities and appointed staff to ensure these are carried out. They have formed good links with age concern`s advocate service who are able to support and act in the best interest of people if required. They have updated the infection control policy to ensure people are safe in a well maintained, clean and hygienic home. They have installed a new security system to ensure people`s safety. They now have a gardener who comes every week to maintain the gardens. The manager has now registered with the Commission. CARE HOMES FOR OLDER PEOPLE Parker House Nursing Home 6 Albemarle Road Woodthorpe Nottingham NG5 4FE Lead Inspector Mary O`Loughlin Unannounced Inspection 27th August 2008 09:00 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 Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parker House Nursing Home Address 6 Albemarle Road Woodthorpe Nottingham NG5 4FE 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) 0115 9608862 parker_house@hotmail.com Rodenvine Nottingham Limited Shameem Akhtar Care Home 19 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (19) of places Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users within the following gender: either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 19 19th April 2007 2. Date of last inspection Brief Description of the Service: Parker House is a care home providing nursing and personal care for 19 older people and who may have Dementia. It is located in a residential area of Nottingham, close to local shops, general practitioners surgery and other amenities. A bus route into the city is accessible within walking distance. The home is a converted residential house, which consists of two storeys. The home has one lounge, a conservatory and a dining room. Established gardens lay to the rear of the building with sufficient car parking space. There is a passenger lift and stair lift available to the upper floor and the home is accessible for wheelchair users. There are two bathrooms and one shower room. The current weekly fees range from: £348.00 to £397.00 The provider makes the statement of purpose, service user guide and previous inspection reports, available on initial enquiry and when visiting the home. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. A review of all the information we have received about the home was considered in planning this visit including the Annual Quality Assurance Assessment (AQAA), and this helped decide what areas were looked at. The main method of inspection used was called ‘case tracking’ which involved selecting the care plans of 3 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Members of staff, people who use the service and their relatives were spoken with as part of this visit. A partial tour was undertaken, which included looking at people’s bedrooms and communal areas of the home. The quality rating for this service is 2 star this means that people who use the service experience good quality outcomes. What the service does well: The staff spend a considerable time and effort to ensure admissions are properly planned and people’s needs assessed. People have a care plan that describes how staff are to support them in their daily lives and they have been consulted on them wherever possible. Health needs are closely monitored and people are referred at an early stage to external professionals if problems arise in their condition. The staff are trained to move people safely, they have good procedures to control infection in line with the Department of Health’s advice. People told us they are in control of their lives; they can choose what they do and how they spend their time. We saw that people are afforded privacy and their dignity is a priority. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The management of health and safety practice must improve to ensure that people are assessed for any risks to their safety from hot water, and unsecured exits. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 7 All incidents and accidents that affect the well being of people at the home must be reported to the Commission without delay to safeguard people who are using the service. 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. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-6 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken and people are assured that their needs can be met. Intermediate care is not provided. EVIDENCE: Previous inspections have found that the staff at the home spend a significant amount of time ensuring that admissions to the home are compliant with the National Minimum Standards. Since a major variation to accommodate people who suffer from Dementia in April 2008, staff have received training in Dementia care, this was an introductory training and now they are undertaking a distance learning course Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 10 that is a more in depth study to ensure that they provide good outcomes for these people. The Nurse manager said she was using this training to review how they plan care and train staff. The information provided by the home to prospective residents has been updated to include the types of conditions that they can care for. The information is available in large print and can be translated into certain languages upon request. We examined the way a person was admitted recently and found that the staff continue to meet the standards by visiting people and assessing their needs before they offer them a place at the home. The assessment was comprehensive covering all areas of daily living; they had taken a full life history and recorded this with a signed statement from the relatives, showing that they had fully consulted people and were sure that the home was able to provide the care that they would need. The relatives of a recently admitted person said they were involved in the assessment prior to the admission. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Prospective residents are given the opportunity to spend time in the home. An individual member of staff is allocated to give them information and special attention to help them to feel comfortable in their surroundings and enable them to ask any questions about life in the home. The AQAA tells us that the manager has received training in equality and diversity issues and this has helped her to update the home’s policy and train all members of staff. They have a cultural mix within the care staff team, which helps to promote their understanding of cultural and diversity issues. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8-9-10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care is person centred but the management of safety for those people with deteriorating conditions is not sufficiently robust to fully protect them from harm. EVIDENCE: The last inspection found that the people at the home had care plans in place that showed staff how they were to support the person’s health and personal care. We looked at 3 people’s care records on this occasion and found them to be very clear and person centred. The AQAA told us that staff complete a monthly review of each person’s care Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 12 plan and that all staff are informed of people’s care needs through the plans, daily records, during handovers and during daily briefings carried out by nursing staff and manager. A resident told us, “ You cant go wrong here, there’s always someone at hand, the food is good and you get choices. I can spend my time as I choose.” A relative told us, “the staff are caring and the home is a friendly place. Health needs are monitored and appropriate action and intervention taken except when people are at risk of wandering from the home, we found that the information within the care plan was not sufficiently robust to ensure the person was fully protected. We also found that staff were not routinely closing external doors or utilising the door alarm system, which would alert them to anyone leaving the building that might come to harm as a result. People at the home receive their medicines as they are prescribed and staff are trained and supervised in the practice of medicine administration. Improvements have been made since the last inspection to ensure that staff do not sign for medicines until they have been administered. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-13-14-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been fully involved in the planning of their lifestyle and quality of life wherever possible. EVIDENCE: The last inspection found that people at the home had sufficient activities that suited them. The AQAA told us that staff have tried to encourage people and their families to join in with social activities and special events. They keep people informed through newsletter, coffee mornings and general visits, of all events taking place. These have included birthday parties, boat trips, a strawberry and Christmas fayre. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 14 They have an activity coordinator in post and a social activities programme for staff to follow. They also now have a programme for armchair based exercise. We saw that each person had a social care file that described their life history, the things they like and dislike and choices they wish to make in all areas of their life. The people case tracked had deteriorating mental health and could not participate in all activities on offer, however staff worked closely with them and they were a part of the group as the normal activities of daily life took place. The mealtime was a happy and organised event; the people in the home were informed of what was on the menu and given choices. The AQAA told us that they have a new member of staff in the kitchen to enable them to offer greater choice at tea times and have a “hot” option available everyday One person told us “ I don’t like joining in with the activities, I prefer to occupy myself and staff respect that” Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are robust procedures in place that ensure people are listened to, taken seriously and protected from abuse. EVIDENCE: The Commission has not received any complaints about the service since the last inspection. People who use the service are supplied with a complaints procedure that they can understand. It is displayed in the main hallway and is available on request in a number of formats including other languages. The policies and procedures for safeguarding adults are available and give clear specific guidance to staff using them. The staff have received training in the last year about how to protect people from abuse and they have guidance within their supervision on how to protect people from harm including how to report concerns about colleagues and managers to ‘blow the whistle’ on bad practice. The AQAA tells us that they plan over the next 12 months to ensure all staff Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 16 are aware of the new regulations under the Mental Capacity Act and how to protect people’s right to make decisions. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean environment that meets their individual needs. EVIDENCE: The AQAA told us that staff have completed a distance-learning course on infection control which we verified at this inspection. They are following the guidance tool from the Department of Health on essential steps to clean, safe care; to make sure people are safe from contracting infections in the home. They have a maintenance book, which all staff can use to identify areas of maintenance needed to ensure repairs are undertaken quickly. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 18 They have installed a new security system to further ensure people’s safety, however, as described in standards 7-10, the staff do not always ensure this is alarmed. We found the home to be warm and clean but some areas are cluttered, particularly the treatment room due to a lack of storage space. The dining room tablecloths looked cleanly laundered but had not been ironed. One person said they did not find the home to be clean and tidy to their standards. We saw people in their bedrooms and they had been able to personalise them and make them homely. There are small communal areas that are suitable for people at the home, providing a small homely feel. Some furnishings are in need of re-upholstery such as armchairs. The manager told us they have applied for planning permission to extend the home and enable them to provide more storage space, a safe outdoor area and a quiet room. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-28-29-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are in safe hands at all times. EVIDENCE: We examined 3 staff files and found that staff continue to ensure they follow robust procedures when they recruit new staff, this ensures that they are suitable to work with vulnerable people. From the start of their employment staff receive a comprehensive induction to their role which meets National Standards to ensure people are in safe hands at all times. Senior staff at the home supervise all new staff and introduce them to people’s individual needs by teaching them about care plans and supervising them in the delivery of personal care. The Manager explained how all staff meet at lunchtime to discuss any issues, changes in people’s conditions etc. Notes of these meetings were seen and they included guidance to staff on ensuring the little things such as dentures, Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 20 hearing aids and wheelchairs that are all very important, were properly fitted or maintained. Since the home have been registered to care for people with Dementia the manager has made sure staff are enrolled on a distance learning course that will provide them with the skills they need for this specialist area. 90 of the workforce is presently enrolled on a National Vocational Qualification in care. After staff have received induction they continue to have opportunities to update their skills and we saw how staff had attended training in how to move people safely, manage continence and maintain people’s dignity. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33-35-38 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of people that live there but there are some areas of health and safety that present a risk. EVIDENCE: The manager is registered with the Commission and has an appointed nurse manager for the management of nursing care at the home. The manager had not notified us of events that affect the well-being of people at the home as required. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 22 There are systems in place that ask people about their views of the home and the manager tells us in the AQAA that she is looking at ways to improve on the responses she receives to enable people to have a say in the way the home is run. The Commission sent out surveys to some people at the home but no responses were received. We found that when people’s condition changed and they could no longer manage their financial affairs, staff recognised this and ensured they were referred to external advocates and professionals to make sure they were properly represented. The manager does not act as an appointee for anyone at the home but there are facilities for people to leave a cash float safely in the office, we saw this was managed safely with proper accounting in place to safeguard people from any financial abuse. The management of Health and Safety showed some risks had not been fully addressed. Hot water was not suitably regulated at any outlet as required to maintain people’s safety. The manager said this would be addressed and that safeguards would be put in place to assess any risks to people until the work is completed. The safe storage of chemicals was not robust, as staff had left a key in the lockable chemical storage room door that could be accessed by vulnerable people. The ground floor rear fire exit door was propped open all day and the security alarm system was not activated, which presented a danger to people who could wander from the building and onto the road. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 24 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 OP31 Regulation 37 Requirement You must notify the Commission of any event that affects the well-being of people at the home. You must ensure that people are assessed for any risks to their safety with regard to; Hot Water Open doors Timescale for action 30/09/08 2. OP38 13(4)(a) 30/09/08 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 OP7 Good Practice Recommendations Ensure that care plans contain a clear description of a person’s identity including a recent photograph for use when people are at risk of wandering from the building. DS0000065380.V370626.R01.S.doc Version 5.2 Page 25 Parker House Nursing Home 2. 3. 4. 5. 6. OP9 OP19 OP19 OP19 OP38 Hand written entries on medicine administration records should be signed by two members of staff to show these have been checked as correct. Ensure that the tablecloths are ironed before use. Prioritise the repair or re-upholstering of worn armchairs. Look at improving the storage areas provided in the treatment room. Ensure all staff are reminded to keep the hazardous chemical storage room locked at all times. Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Parker House Nursing Home DS0000065380.V370626.R01.S.doc Version 5.2 Page 27 - 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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