Care Home: Parkside

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What the care home does well People living at Parkside have their care and support needs thoroughly assessed before they move to the home. This helps to make sure that the home will be suitable and able to meet their needs and their expectations. We found that these assessments are reviewed and kept up to date in order to meet the changing needs of each resident. We looked at a sample of care plans for some of the people that use this service. They are generally based on the findings of the care needs assessments, but are updated as the resident settles into the home and staff become more aware of individual preferences. Care plans are developed and written in a very person centred way. There is detailed information recorded regarding what people can or cannot do for themselves, clearly identifying individual needs and wishes, whilst supporting people to be as independent as possible. Consideration is given to people`s personal preferences, choices and routines. Care plans contain elements of nutritional assessments and risk assessments. Nutritional assessments are undertaken with residents and the plans for this element of their care and support are also reviewed monthly with them. Where concerns are identified, people are monitored by regularly reviewing their food and fluid intake and close monitoring of any weight gain or loss. Daily notes record that the manager seeks the advice and support from relevant health care professionals when needed. The people taking part in our assessment of the home told us that they `always` get the medical support they need, when they need it. The risk assessments identify where people may have a problem with their mobility and need the support of staff to help them accomplish certain activities safely. Where special equipment such as handling hoists or pressure relieving equipment are needed, their use is documented, together with strategies for staff to follow. This helps to make sure that both safe and the residents they are supporting are safe from harm or injury.Staff have received training in a variety of relevant subjects, including implementing person centred care planning. This helps ensure people are supported to exercise increased choice and control over their lives and the plans made to support them. One of the people we spoke to during our visit told us; `I am very well looked after, staff are very good. I can go outside when I please as I like to sit and watch what is going on. I can have drinks or anything when I want, the staff are very helpful.` We also observed some of the staff working with the residents during our visit. We noted that staff were attentive and friendly towards the people living at Parkside. We saw good interaction between staff and residents and they appeared very comfortable with each other. People were asked about their personal care needs with sensitivity and dignity. Where people needed support from staff this was carried out gently and in the residents own time, there was no rushing or impatience from staff. The manager told us of the work that has been done at the home with regard to helping people who may have dementia. More appropriate colour schemes, new carpets and signage have been introduced. These measures have helped residents to maintain their independence and control over their own lives. Further improvements of this nature are planned and the manager told us that picture menus are to be introduced to help people when choosing their meals. During our visit to the home we carried out a short audit of the way in which people`s medicines are managed at the home. Senior staff are responsible for managing the medication kept at the home, including the maintenance of records for the receipt, disposal and return of medicines, to and from the pharmacy. Staff with the responsibility of administering medicines have undergone training to help them undertake this task safely an additional safety measure is in place and the administration of medication is witnessed by a second member of staff. Other systems in place, that help prevent or reduce the risk of medication errors include colour coded records and medication packs and a photograph of each resident is included on their medication record to help ensure correct identification. Where people have been prescribed medicines that are given `as and when required`, such as headache remedies for example, protocols are in place and included in the medication records. We looked at the way in which the home keeps `controlled` medicines. There is secure and appropriate arrangements in place. We looked at some of the records for this type of medication, the register had been maintained accurately and the `stock count` was correct. There is a complaints, compliments and suggestions procedure in place at the home. The manager told us that she has not received any complaints. Staff working within the home are provided with training to help them understand the complaints procedure. People we spoke to or who returned surveys told us that they know about the complaint process. They also said that staff `always` listen and act upon what is said to them. The manager holds residents meetings and this provides another forum for people to air their views or raise issues they may have. The manager and staff at the home are aware of the Safeguarding of Vulnerable AdultsGuidelines and procedures. There is a clear process in place at the home and the manager has made referrals to social workers where necessary. The manager is aware of other legislation and guidance such as the Deprivation of Liberties process and has applied for assessments for some residents at the home. This helps to ensure that their best interests are protected. What the care home could do better: Although the information recorded in individual care plans is generally up to date and accurate, there were some areas where the manager could make improvements. Food and fluid intake charts, cover only the main meals of the day and mid-morning/mid afternoon drinks. The charts refer to `small amount eaten` or `refused` but give no indication of what a small amount might be or that alternatives were offered or that food and drinks are offered at different times. Where records indicate that people have lost weight unintentionally, there are no clear indications that they are provided with an enriched diet or high calorie snacks. We saw that some people`s individual risk assessments could be more detailed, particularly where people may be at risk of falling. There should be clear strategies for staff to follow when assisting people up from the floor, particularly where challenging or unco-operative behaviour may be displayed. One of the residents at the home has a risk assessment in their care plan relating to their medication. A copy of this should be included in the medication records, to help ensure all staff are fully aware of this potential problem and are able to manage it safely. In one of the care plans we looked at it is recorded that the resident has an ointment prescribed for twice daily use, when required. This medication is not included on the medication administration records, although there are some records in the care plan. The use of this cream is not detailed in the care plan either but there is evidence to suggest that staff administer it. The manager should ensure that the use of all medications and the administration of them are clearly and consistently documented so that people receive their treatment as their doctor intended. Records show that the manager notifies us of most of the serious incidents that occur at the home as required. Where relevant, accident records are completed and other professionals such as social workers and the community mental health team are consulted and the manager told us that the home has a good working relationship with these teams. However, some of the records we looked at indicate that the manager may not always notify us of aggressive events that happen between service users and this is another area that would benefit from review by the manager. The manager is hoping to employ an activities coordinator to help improve the social life for people who live at Parkside. Volunteers and Age Concern currently have an input to interesting social and leisure activities at the home but this is an area where the manager wishes to make further improvements. The manager also told us that she would like the opportunity to `feedback more frequently with service users and families so that residents and relatives feel confident that their comments or concerns will be listened to and acted upon.` Random inspection report Care homes for older people Name: Address: Parkside Netherhall Road Maryport Cumbria CA15 6NT three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Diane Jinks Date: 1 2 0 5 2 0 1 0 Information about the care home Name of care home: Address: Parkside Netherhall Road Maryport Cumbria CA15 6NT 01900812723 01900815067 parkside@cumbriacc.gov.uk www.cumbriacare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Linda Donoghue Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cumbria Care care home 32 Number of places (if applicable): Under 65 Over 65 23 32 dementia old age, not falling within any other category Conditions of registration: 0 0 The home is registered for a maximum of 32 service users to include: up to 32 service users in the category of OP (Older people not falling within any other category) up to 23 service users in the category of DE/E (Dementia over 65 years of age). The home may also from time to time admit persons between the ages of 60 and 65 years of age in this category. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults. Two service users may share a bedroom of at least 16 sqm usable floor space only if Care Homes for Older People Page 2 of 10 they have made a positive choice to do so, and when one of the shared spaces becomes vacant the remaining service user has the opportunity to choose not to share, by moving to a different room if necessary. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. Date of last inspection Brief description of the care home Parkside is a care home owned by Cumbria Care, an internal business unit of Cumbria County Council and registered to provide accommodation for up to 32 older people, 23 of whom may have varying forms of dementia. The home is operated on a day-to day basis my Mrs Linda Donoghue. Parkside is situated in a residential area of Maryport and is close to all local amenities, shops and bus routes. It is purpose built and situated over two floors, the upper floor being serviced by a passenger lift. The home, which is divided into three units, provides lounge and dining faculties in each and a larger communal lounge that can be used for group activities, visiting entertainers or parties. There is a small room on the ground floor for any residents wishing to smoke. Some of the bedrooms are a little small but all have wash hand basins and there are some with en-suite toilet facilities. The toilets and bathrooms are equipped to assist people with disability. There are well kept gardens around the building and car parking facilities are provided. Details regarding the weekly fees and charges for this service are available from the manager at the home. This home does not provide intermediate care. Care Homes for Older People Page 3 of 10 What we found: Prior to this inspection the lead inspector asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was fully completed and returned to us by the date we asked. We also sent surveys to some of the people who live in the home and the staff that work there. Some of their comments are included in this report. Based on the information provided in the AQAA, and the feedback received in our surveys, we judged the home was continuing to provide a safe service. We therefore decided to carry a short random inspection, rather than a full inspection at this time. Diane Jinks made an unannounced visit to the care home on 13th May 2010. We (the Care Quality Commission) looked around the building and spent some time in the dining lounges to see was happening and to talk with people. We also spoke with the manager and some of the staff on duty. We looked at some care records and carried out a short audit of the management of medicines. What the care home does well: People living at Parkside have their care and support needs thoroughly assessed before they move to the home. This helps to make sure that the home will be suitable and able to meet their needs and their expectations. We found that these assessments are reviewed and kept up to date in order to meet the changing needs of each resident. We looked at a sample of care plans for some of the people that use this service. They are generally based on the findings of the care needs assessments, but are updated as the resident settles into the home and staff become more aware of individual preferences. Care plans are developed and written in a very person centred way. There is detailed information recorded regarding what people can or cannot do for themselves, clearly identifying individual needs and wishes, whilst supporting people to be as independent as possible. Consideration is given to peoples personal preferences, choices and routines. Care plans contain elements of nutritional assessments and risk assessments. Nutritional assessments are undertaken with residents and the plans for this element of their care and support are also reviewed monthly with them. Where concerns are identified, people are monitored by regularly reviewing their food and fluid intake and close monitoring of any weight gain or loss. Daily notes record that the manager seeks the advice and support from relevant health care professionals when needed. The people taking part in our assessment of the home told us that they always get the medical support they need, when they need it. The risk assessments identify where people may have a problem with their mobility and need the support of staff to help them accomplish certain activities safely. Where special equipment such as handling hoists or pressure relieving equipment are needed, their use is documented, together with strategies for staff to follow. This helps to make sure that both safe and the residents they are supporting are safe from harm or injury. Care Homes for Older People Page 4 of 10 Staff have received training in a variety of relevant subjects, including implementing person centred care planning. This helps ensure people are supported to exercise increased choice and control over their lives and the plans made to support them. One of the people we spoke to during our visit told us; I am very well looked after, staff are very good. I can go outside when I please as I like to sit and watch what is going on. I can have drinks or anything when I want, the staff are very helpful. We also observed some of the staff working with the residents during our visit. We noted that staff were attentive and friendly towards the people living at Parkside. We saw good interaction between staff and residents and they appeared very comfortable with each other. People were asked about their personal care needs with sensitivity and dignity. Where people needed support from staff this was carried out gently and in the residents own time, there was no rushing or impatience from staff. The manager told us of the work that has been done at the home with regard to helping people who may have dementia. More appropriate colour schemes, new carpets and signage have been introduced. These measures have helped residents to maintain their independence and control over their own lives. Further improvements of this nature are planned and the manager told us that picture menus are to be introduced to help people when choosing their meals. During our visit to the home we carried out a short audit of the way in which peoples medicines are managed at the home. Senior staff are responsible for managing the medication kept at the home, including the maintenance of records for the receipt, disposal and return of medicines, to and from the pharmacy. Staff with the responsibility of administering medicines have undergone training to help them undertake this task safely an additional safety measure is in place and the administration of medication is witnessed by a second member of staff. Other systems in place, that help prevent or reduce the risk of medication errors include colour coded records and medication packs and a photograph of each resident is included on their medication record to help ensure correct identification. Where people have been prescribed medicines that are given as and when required, such as headache remedies for example, protocols are in place and included in the medication records. We looked at the way in which the home keeps controlled medicines. There is secure and appropriate arrangements in place. We looked at some of the records for this type of medication, the register had been maintained accurately and the stock count was correct. There is a complaints, compliments and suggestions procedure in place at the home. The manager told us that she has not received any complaints. Staff working within the home are provided with training to help them understand the complaints procedure. People we spoke to or who returned surveys told us that they know about the complaint process. They also said that staff always listen and act upon what is said to them. The manager holds residents meetings and this provides another forum for people to air their views or raise issues they may have. The manager and staff at the home are aware of the Safeguarding of Vulnerable Adults Care Homes for Older People Page 5 of 10 Guidelines and procedures. There is a clear process in place at the home and the manager has made referrals to social workers where necessary. The manager is aware of other legislation and guidance such as the Deprivation of Liberties process and has applied for assessments for some residents at the home. This helps to ensure that their best interests are protected. What they could do better: Although the information recorded in individual care plans is generally up to date and accurate, there were some areas where the manager could make improvements. Food and fluid intake charts, cover only the main meals of the day and mid-morning/mid afternoon drinks. The charts refer to small amount eaten or refused but give no indication of what a small amount might be or that alternatives were offered or that food and drinks are offered at different times. Where records indicate that people have lost weight unintentionally, there are no clear indications that they are provided with an enriched diet or high calorie snacks. We saw that some peoples individual risk assessments could be more detailed, particularly where people may be at risk of falling. There should be clear strategies for staff to follow when assisting people up from the floor, particularly where challenging or unco-operative behaviour may be displayed. One of the residents at the home has a risk assessment in their care plan relating to their medication. A copy of this should be included in the medication records, to help ensure all staff are fully aware of this potential problem and are able to manage it safely. In one of the care plans we looked at it is recorded that the resident has an ointment prescribed for twice daily use, when required. This medication is not included on the medication administration records, although there are some records in the care plan. The use of this cream is not detailed in the care plan either but there is evidence to suggest that staff administer it. The manager should ensure that the use of all medications and the administration of them are clearly and consistently documented so that people receive their treatment as their doctor intended. Records show that the manager notifies us of most of the serious incidents that occur at the home as required. Where relevant, accident records are completed and other professionals such as social workers and the community mental health team are consulted and the manager told us that the home has a good working relationship with these teams. However, some of the records we looked at indicate that the manager may not always notify us of aggressive events that happen between service users and this is another area that would benefit from review by the manager. The manager is hoping to employ an activities coordinator to help improve the social life for people who live at Parkside. Volunteers and Age Concern currently have an input to interesting social and leisure activities at the home but this is an area where the manager wishes to make further improvements. The manager also told us that she would like the opportunity to feedback more frequently with service users and families so that residents and relatives feel confident that their comments or concerns will be listened to and acted upon. Care Homes for Older People Page 6 of 10 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 set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, 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 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 8 The way in which food and fluid intake monitoring records are completed would benefit from a review. This would help ensure that accurate records are maintained and help demonstrate that the home does support peoples nutritional needs and requirements adequately. The manager should ensure that the use of all medications, including creams and ointments, and the administration of them are clearly and consistently documented so that people receive their treatment as their doctor intended. Any event that adversely affects the well being or safety of people using this service should be reported to the relevant authorities as required. Individual risk assessments should be more detailed with clear strategies for staff to follow, particularly when assisting people up from the floor and where challenging or unco-operative behaviour may be displayed. 2 9 3 38 4 38 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. 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