Care Home: Parkside Care Home

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• Chirnside House
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• Parkside
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What the care home does well Parkside Care Home presented as a warm, comfortable and caring environment. The manager and her staff team were observed to engage with residents in a positive and friendly manner and were seen to treat residents with respect. Residents reported that they were happy living in Parkside and confirmed the standard of care provided was good. Comments included: "You couldn`t wish for a better place to live"; "It`s nice living here. The staff are lovely" and "I am treated well and have no grumbles". Examination of records and discussion with residents confirmed people had been appropriately admitted to Parkside Care Home and systems had been established to ensure the needs of residents were assessed prior to admission. Care plans had also been completed to provide guidance to staff on how to meet the individual needs of the people using the service and copies of assessments and care plans from social workers had also been obtained whenever practicable. Health care records viewed confirmed residents had access to a range of medical practitioners subject to need. Health care professionals were observed to visit residents throughout the day of the inspection and one practitioner reported; "I have no concerns regarding health care whatsoever." Residents were observed to receive visits from family members and friends during the day and residents spoken with reported they were able to follow their preferred routines and confirmed Parkside was a relaxed and pleasant home in which to live. The menu provided evidence that residents received a satisfactory diet and additional refreshments were served throughout the day. Feedback received from residents confirmed they were satisfied with the standard of catering and meals provided. Comments included; "It`s like a 5 star hotel. You are well looked after and the food is nice" and "The food is absolutely beautiful." A monthly programme of activities had been produced which identified a daily activity for residents to participate in and feedback received from residents and their representatives via surveys and discussion confirmed the people living in Parkside were generally happy with the range and frequency of activities provided. Comments included: "I`m happy with the activities we have"; "It`s hard to please everyone but there is a good selection to choose from" and "It`s been nice to be able to sit out in the garden now the weather has improved." Examination of the staff training matrix and feedback received from staff confirmed staff had access to induction, safe working practice, safeguarding adults, equality and diversity and other training and development opportunities relevant to their roles and responsibilities. Comments received from two staff included: "With training and learning NVQ and gaining experience working within the home I feel we`re able to meet the service user`s needs" and "The induction covers every aspect of being a member of staff at Parkside." Policies and procedures had been established to ensure an appropriate response to complaints and suspicion or evidence of abuse. Internal and external quality assurance systems had also been established to ensure the standard of service was monitored and run in the best interest of the people using the service. What has improved since the last inspection? Since the last visit in July 2007, the manager has made arrangements to ensure that staff do not commence employment at Parkside Care Home until two satisfactory references have been received. This helps to protect the welfare of the people using the service. A welcome pack has been created for new residents in order to provide information on Parkside and the services provided using pictures, signs and symbols. A questionnaire has been developed to ensure equality and diversity issues are identified and taken into consideration when planning and responding to individual needs. An assessment tool has been produced to enable the manager to review the competency, knowledge and skills of staff designated with responsibility for administering medication. The Registered Manager has completed a level 4 National Vocational Qualification for both the Registered Manager Award and Health and Social Care since the last visit to ensure she has the necessary qualifications for her role. Systems have been established to ensure staff receive supervision and appraisal sessions. The environment had continued to receive ongoing maintenance and investment and this provided residents with an attractive and homely place in which to live. What the care home could do better: The Statement of Purpose and Service User Guide should be updated with the name and contact details of the Care Quality Commission and the details of the registered manager and her qualifications. This will ensure that people have up-to-date information on the service. Medication Administration Records must account for medication administered or refused. A system also needs to be established to ensure medication does not run out of stock. This will help to provide a clear audit trail and provide evidence that the health care needs of residents are being met at all times. Handwritten Medication Administration Records should be signed by another suitably trained member of staff to confirm the prescribed instructions are correct. All care plans should describe in detail the action required by care staff to meet individual needs. Furthermore, care plan review processes should be closely monitored, to ensure residents or their representatives are more involved. This will assist in the development of person-centred care planning processes.Arrangements should be made to ensure the method of fixing the controlled drugs cabinet to the wall is compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. The tea-time menu plan should be updated to reflect the full range of meal choices available to residents. The complaints procedure should be updated to include the name and contact details of the Care Quality Commission so that people understand who they can contact for help outside of Parkside. The manager should ensure that all staff are familiar with the role that outside agencies play in accepting referrals and coordinating a response to adult protection incidents. This will help to raise awareness of the role of the local authority and police. A designated member of staff should be allocated laundry duties to minimise the risk of cross infection. A certificate should be obtained, to provide evidence that the emergency call bell system has been serviced and is operating effectively. Key inspection report Care homes for older people Name: Address: Parkside Care Home Parkside Care Home 280 Prescot Road St Helens Merseyside WA10 3AB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Daniel Hamilton     Date: 1 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Parkside Care Home Parkside Care Home 280 Prescot Road St Helens Merseyside WA10 3AB 0174422821 01619294148 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Parkside (St Helens) Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only -Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Parkside is a large detached Victorian House that has been converted into a Care Home and is registered to provide personal care and support for up to 30 older people. The home is located in St. Helens, Merseyside and is situated on a main road location in a residential area close to local amenities and has good links to public transport and shops. The property enjoys a pleasant view of the park and Grange Park Golf Course to the rear. 0 Over 65 30 Care Homes for Older People Page 4 of 31 Brief description of the care home The home offers three lounges with televisions, a sitting room, small library and a dining room. The premises has 22 single bedrooms of which 17 are en-suite and four companion (double rooms) of which one has an en-suite. Toilet and bathing facilities are located throughout. The first floor rooms are accessible via a passenger or stair lift and a call bell system is in place. There are two large, well-maintained and accessible gardens to the rear of the building and car parking is available to the front and side of the premises. Care Home Fees range from £371.00 to £415.00 per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use the service experience good quality outcomes. This unannounced inspection took place over one day and lasted approximately 9 hours. A partial tour of the premises took place and observations were made. Three care files and a selection of staff and service records were also examined and the owner/ manager, three care staff, the cook, four visitors and fourteen residents were spoken with during the visit. Reference was also made to an Annual Quality Assurance Assessment (AQAA) which was completed by the manager. This document enables a person to undertake a selfassessment on the service prior to an inspection and contains information on how the people living in Parkside are supported, together with numerical information on the service. Care Homes for Older People Page 6 of 31 Care Homes for Older People Page 7 of 31 What the care home does well: Parkside Care Home presented as a warm, comfortable and caring environment. The manager and her staff team were observed to engage with residents in a positive and friendly manner and were seen to treat residents with respect. Residents reported that they were happy living in Parkside and confirmed the standard of care provided was good. Comments included: You couldnt wish for a better place to live; Its nice living here. The staff are lovely and I am treated well and have no grumbles. Examination of records and discussion with residents confirmed people had been appropriately admitted to Parkside Care Home and systems had been established to ensure the needs of residents were assessed prior to admission. Care plans had also been completed to provide guidance to staff on how to meet the individual needs of the people using the service and copies of assessments and care plans from social workers had also been obtained whenever practicable. Health care records viewed confirmed residents had access to a range of medical practitioners subject to need. Health care professionals were observed to visit residents throughout the day of the inspection and one practitioner reported; I have no concerns regarding health care whatsoever. Residents were observed to receive visits from family members and friends during the day and residents spoken with reported they were able to follow their preferred routines and confirmed Parkside was a relaxed and pleasant home in which to live. The menu provided evidence that residents received a satisfactory diet and additional refreshments were served throughout the day. Feedback received from residents confirmed they were satisfied with the standard of catering and meals provided. Comments included; Its like a 5 star hotel. You are well looked after and the food is nice and The food is absolutely beautiful. A monthly programme of activities had been produced which identified a daily activity for residents to participate in and feedback received from residents and their representatives via surveys and discussion confirmed the people living in Parkside were generally happy with the range and frequency of activities provided. Comments included: Im happy with the activities we have; Its hard to please everyone but there is a good selection to choose from and Its been nice to be able to sit out in the garden now the weather has improved. Examination of the staff training matrix and feedback received from staff confirmed staff had access to induction, safe working practice, safeguarding adults, equality and diversity and other training and development opportunities relevant to their roles and responsibilities. Comments received from two staff included: With training and learning NVQ and gaining experience working within the home I feel were able to meet the service users needs and The induction covers every aspect of being a member of staff at Parkside. Policies and procedures had been established to ensure an appropriate response to Care Homes for Older People Page 8 of 31 complaints and suspicion or evidence of abuse. Internal and external quality assurance systems had also been established to ensure the standard of service was monitored and run in the best interest of the people using the service. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide should be updated with the name and contact details of the Care Quality Commission and the details of the registered manager and her qualifications. This will ensure that people have up-to-date information on the service. Medication Administration Records must account for medication administered or refused. A system also needs to be established to ensure medication does not run out of stock. This will help to provide a clear audit trail and provide evidence that the health care needs of residents are being met at all times. Handwritten Medication Administration Records should be signed by another suitably trained member of staff to confirm the prescribed instructions are correct. All care plans should describe in detail the action required by care staff to meet individual needs. Furthermore, care plan review processes should be closely monitored, to ensure residents or their representatives are more involved. This will assist in the development of person-centred care planning processes. Care Homes for Older People Page 9 of 31 Arrangements should be made to ensure the method of fixing the controlled drugs cabinet to the wall is compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. The tea-time menu plan should be updated to reflect the full range of meal choices available to residents. The complaints procedure should be updated to include the name and contact details of the Care Quality Commission so that people understand who they can contact for help outside of Parkside. The manager should ensure that all staff are familiar with the role that outside agencies play in accepting referrals and coordinating a response to adult protection incidents. This will help to raise awareness of the role of the local authority and police. A designated member of staff should be allocated laundry duties to minimise the risk of cross infection. A certificate should be obtained, to provide evidence that the emergency call bell system has been serviced and is operating effectively. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before deciding to move into Parkside Care Home, so that they know their care needs can be met. Evidence: Parkside Care Home had a range of information in place for prospective and current residents and their representatives to view. The documents were available in the reception area of the home and included; a copy of the Statement of Purpose, Service User Guide, previous inspection reports, annual satisfaction survey findings and information on comments, compliments and complaints. A Welcome pack had also been developed in large print using pictures, signs and symbols. The manager reported that there had been no changes to the Statement of Purpose and Service User Guide since the last visit. The documents needed to be updated with the name and contact details of the Care Quality Commission and the details of the registered manager and her qualifications. Care Homes for Older People Page 12 of 31 Evidence: The Annual Quality Assurance Assessment (AQAA) confirmed policies and procedures for referral and admission were in place as noted at the last visit. Three files were selected to view during the visit for people who had moved into the home since the last visit. Each file contained a Daily Living and Needs Assessment, which had been completed by a senior member of staff prior to the admission of each resident. The assessment documentation was well constructed and contained key information on the health, personal and social care needs of residents. Since the last visit the manager had also produced a form to obtain equality and diversity information. This form was available on only one of the three files viewed. Discussion with residents and examination of the AQAA confirmed prospective residents are encouraged to visit and spend time in the home prior to deciding whether to move in. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people using the service are met by staff who understand how to provide care in a manner that protects peoples privacy and dignity. Evidence: The Annual Quality Assurance Assessment (AQAA) for Parkside Care Home confirmed a policy had been developed for Individual Planning and Review and the Control, Storage, Disposal, Recording and Administration of Medicines as previously noted. The files of three permanent residents who had been admitted in the last 12 months were inspected during the visit. Each file viewed contained a care plan that outlined assessed needs, desired outcomes and how to meet needs and manage risks. Care plans had generally been completed to a satisfactory standard although the information and detail recorded in plans was not consistent in standard and information on some routine health care needs had not been recorded. Examples were discussed with the manager during the visit. Care Homes for Older People Page 14 of 31 Evidence: Systems had been established to ensure care plans were reviewed on a monthly basis however a number of residents spoken with reported that they were not directly involved in care plan review processes. Only one file viewed contained a signed care plan agreement form. This issue should be kept under review to ensure the people using the service are involved in person-centred care planning processes. Files also contained a range of supporting documentation including; daily report sheets, risk assessments and weight and personal care records. Some information on files was duplicated as noted at the last visit and it is recommended that files are cleansed to ensure staff are clear as to which forms should be completed. Feedback received from residents via Care Home Survey forms and discussion confirmed the people living in the home had access to medical support subject to individual needs. A visiting health care professional was spoken with during the visit and reported I have no concerns regarding health care whatsoever. Records viewed showed that residents had received visits from general practitioners, opticians, physiotherapists, district nurses, chiropodists and dietitians. Medication systems and records were checked during the visit with a senior member of staff. Staff designated with responsibility for administering medication confirmed they had completed in-house and external medication training. A self-assessment competency assessment had also been completed by the manager to monitor staff knowledge, skills and understanding. At the time of the visit only one resident was self-administering medication. A selfadministration checklist together with a consent to self-medicate form had been completed. Medication storage was checked during the visit. Medication was found to be appropriately stored and a metal cabinet was available to store controlled drugs. Advice was given regarding the security of the controlled drugs cabinet as the method of fixing was not compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. A resident identification system and specimen signatures for staff authorised to administer medication were available for reference as previously recorded. Records of medication returned to the pharmacist and fridge and room temperature had also been maintained. Copies of Patient Information Leaflets had been retained for staff to reference. This is considered good practice. A sample of Medication Administration Records (MAR) were viewed during the visit. Care Homes for Older People Page 15 of 31 Evidence: Overall, records had been maintained to a satisfactory standard. Some issues were noted. For example, medication had run out of stock for one resident and some unexplained gaps in recording were noted. A handwritten medication chart for four different medications had also not been countersigned to verify the information recorded was correct. Staff spoken with during the visit demonstrated an awareness of the value base of social care and were observed to treat residents with respect and dignity. Residents reported that they were happy living in Parkside and confirmed the standard of care provided was good. Comments included: You couldnt wish for a better place to live; Its nice living here. The staff are lovely and I am treated well and have no grumbles. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily life, social activities and meals are flexible and varied to meet the expectations and preferences of the people using the service. Evidence: A monthly list of activities had been produced which identified a daily activity for residents to participate in. A newsletter had also been developed which provided information on forthcoming events, birthdays and new staff etc. On the day of the visit residents and staff were observed to be enjoying a game of bingo together in the lounge. A copy of the activity programme was displayed on the homes notice board and records of activities provided and participants were recorded in a diary as noted at the last visit. Activities for the month of June included; hairdressing, walking in the park, arm-chair aerobics, sing-a-long sessions, bingo, beetle drive, current affairs, art in nature, table top games, pamper afternoons, quiz, chocolate cookery and crafts. Outside entertainers and ministers of religion also visited the home periodically, to meet with residents subject to their individual religious beliefs. Feedback received from residents and their representatives via surveys and discussion Care Homes for Older People Page 17 of 31 Evidence: confirmed the people living in Parkside were generally happy with the range and frequency of activities provided. Comments included: Im happy with the activities we have; Its hard to please everyone but there is a good selection to choose from and Its been nice to be able to sit out in the garden now the weather has improved. One resident reported that he would like to play dominoes and this request should be considered. The homes Statement of Purpose and Service User Guide indicated that visitors were welcome at any reasonable time and relatives and health care professionals were observed to visit residents throughout the day. Residents spoken with confirmed they were able to follow their preferred routines and confirmed Parkside was a relaxed and pleasant home in which to live. The cook was spoken with during the visit and the menus were examined. A four week rolling menu had been developed which offered a choice of nutritious and wholesome meals. The cook was advised to update the menu as some of the tea-time meals recorded did not include all the options on offer to residents. Meals were served in the homes dining room, which was pleasantly furnished. Tables were attractively set with tablecloths, condiments and table mats. Although meals were served at set times, arrangements were flexible to suit individual needs. On the day of the visit the lunch time meal choice was salmon or steamed fish cooked in milk or battered fish, mash or chips and mushy peas and broccoli. A copy of the daily menu was displayed in the dining room and alternative choices were recorded on a form. It was noted that some breakfast and tea-time choices had not always been recorded and the cook agreed to address this matter. Feedback received from residents confirmed they were satisfied with the standard of catering and meals provided. Comments included; Its like a 5 star hotel. You are well looked after and the food is nice and The food is absolutely beautiful. Discussion with the cook confirmed the service was able to cater for different health, religious and cultural dietary requirements, subject to individual need. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Parkside and their relatives understand how to complain and appropriate action is taken to respond to any concerns raised. Evidence: Parkside Care Home had developed a complaints procedure, a copy of which was displayed in the reception area of the home and the passenger lift. Notices were also displayed around the home to inform visitors and residents of the location of the policy and the contact details of the Care Quality Commission. Information on how to contact the Care Quality Commission had also been recorded in the homes Welcome pack. At the time of the visit the complaints procedures needed to be updated to include the name and contact details of the Care Quality Commission to ensure people understand who they can contact externally if they have any concerns about Parkside. The Annual Quality Assurance Assessment (AQAA) detailed that one complaint had been received in the last 12 months and this was confirmed by examining the complaints record for Parkside. The complaint was initially referred to the Commission and forwarded to the manager for investigation. The nature of the concern concerned the temperature in a residents bedroom. Appropriate action was taken by the manager in response to the issue raised. Care Homes for Older People Page 19 of 31 Evidence: No concerns or complaints were raised during the unannounced inspection by the people using the service or their representatives. Residents spoken with confirmed they were confident that any concerns would be listened to and acted upon by the manager or senior staff. Examination of the AQAA confirmed policies and procedures were in place to protect vulnerable adults from abuse. Discussion with staff and examination of training records confirmed the majority of staff had completed safeguarding adults training via the local authority and records detailed that all staff received awareness training in this key subject as part of their induction training. The manager demonstrated a sound awareness of how to recognise and respond to suspicion or evidence of abuse. Staff spoken with were able to provide examples of the different types of abuse but some lacked knowledge on which agency was responsible for coordinating a response to safeguarding referrals. Records detailed that one safeguarding referral had been made by the manager in the past 12 months. No action was taken by the local authority safeguarding unit due to the nature of the incident. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment with Parkside Care Home is generally well maintained providing residents with an attractive and homely place to live. Evidence: The home did not have a handy person as the owner completed minor maintenance tasks and contractors were hired to maintain the home and grounds when required. Systems were in place to record work in need of attention and to monitor the condition of the environment, fire alarm system and other health and safety issues. Examination of the Annual Quality Assurance Assessment (AQAA) and a tour of the home confirmed the premises had continued to receive ongoing investment, maintenance and refurbishment since the last visit. In the last 12 months, new chairs have been bought for the library and the grange lounge, new carpets and curtains have been fitted in some bedrooms, new garden furniture had been purchased and a number of areas had been redecorated. Some exterior maintenance and weather proofing had also been completed and a new hoist and rota stand had been obtained to enable staff to assist people with poor mobility to transfer safely. Domestic staff were observed to be on duty and areas viewed during the visit appeared well maintained, clean and hygienic. Residents who were visited in their Care Homes for Older People Page 21 of 31 Evidence: bedrooms had personalised their rooms with personal possessions, pictures and other memorabilia which reflected their individual lifestyles and preferences. Those people spoken with confirmed their privacy and dignity was respected. The home provided a choice of communal space and this provided residents with opportunities to meet relatives and friends in private. Please refer to the Brief Description of the Service section for more information on the premises and facilities. The AQAA for the service confirmed that a Communicable Diseases and Infection Control and Control of Substances Hazardous to Health (COSHH) policies and procedures were in place as previously noted. Training records viewed revealed that all of the staff had received training in the prevention and control of infection. The laundry was appropriately equipped to meet the needs of the people living in the home. Care staff continued to have flexible duties as some care staff were also observed to be undertaking laundry duties during the day. It is recommended that one person per shift is allocated this duty to reduce any cross infection risk. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training and development opportunities ensure that people are cared for and supported safely. Evidence: On the day of the visit 24 people were being supported in Parkside Care Home. Four care staff and the manager were observed to be on duty in addition to other ancillary staff who were employed for working in the kitchen and cleaning duties. Examination of rotas, direct observation and discussion with residents and staff confirmed the manager maintained appropriate staffing levels during the day and night, to ensure the residents received the necessary care and support they required. Feedback received from residents included The staff are very attentive and Staff are always available to help when needed. The Annual Quality Assurance Assessment (AQAA) for Parkside confirmed that policies and procedures were in place for Recruitment and Equal Opportunities, Diversity and Anti-Oppressive Practice as noted at the last inspection. The manager reported that nine new care staff had commenced employment at Parkside Care Home since the last visit. Three personnel files were checked for new staff and all were found to contain the necessary records required under the Care Care Homes for Older People Page 23 of 31 Evidence: Home Regulations 2001. This confirmed that staff had been correctly recruited and the welfare of the people using the service was safeguarded. The AQAA detailed that 9 (50 ) of the 18 care staff had completed a National Vocational Qualification (NVQ) at level 2 or above in Care. The manager reported that the outstanding 9 staff were also working towards a National Vocational Qualification in Care to ensure the entire staff team attain the award. Examination of the staff training matrix provided evidence that staff had access to induction, safe working practice, safeguarding adults, equality and diversity and other training and development opportunities relevant to their roles and responsibilities. Training was provided via a range of sources including the St Helens training consortium and Parkside Care Home continued to maintain Investor in People accreditation. Staff spoken with demonstrated a sound awareness of the needs of the people they cared for and confirmed they had access to ongoing training. Comments included: With training and learning NVQ and gaining experience working within the home I feel were able to meet the service users needs and The induction covers every aspect of being a member of staff at Parkside. The training matrix highlighted gaps in training for some staff. The manager was able to provide evidence that she continually monitored the outstanding training needs of staff and was nominating staff for training throughout the year. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Parkside Care Home is run in the best interest of the people using the service so that their welfare is promoted and protected. Evidence: Parkside Care Home is managed and owned by Mrs Glenda Gould who is registered with the Care Quality Commission. Documentary evidence viewed confirmed the Registered Manager had completed a level 4 National Vocational Qualification for both the Registered Manager Award and Health and Social Care since the last visit. Mrs Goulds training and development record was also viewed which highlighted that she had continued to undertake periodic training relevant to her role and responsibilities. Feedback from staff, residents and their representatives confirmed the manager provided clear direction and leadership and was approachable and supportive. Comments received from two residents included: The manager and her staff are very Care Homes for Older People Page 25 of 31 Evidence: efficient and work hard and I think the home is run well. Prior to the inspection the manager completed an annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us numerical information about the service. Overall, the AQAA was detailed and provided a diverse range of evidence to illustrate what the service does well, how it has improved in the last year and plans for improvement in the next 12 months. Examination of records confirmed the manager continued to operate an internal quality assurance system, which involved circulating questionnaires on different themes to residents and their relatives each year. Regulation 26 reports had also been completed, despite the owner being in day-to-day charge of the home. Information on the outcome of the the most recent quality assurance assessment was available in the reception area of the home and a suggestion box was available in reception to enable people to express their views anonymously. A number of residents spoken with during the visit confirmed they had been asked to complete a survey and were confident that their views were listened to and acted upon. Records highlighted that an external consultant had also been commissioned to undertake a quality assurance assessment of the service as previously noted however the certificate on display had recently expired. The manager reported that the consultant was due to re-visit Parkside during July 2009 in order to undertake another audit of the home. Staff spoken with reported that they had access to regular supervision and appraisals and attended regular team meetings. Minutes viewed provided evidence that staff meetings were used to good effect and covered a diverse range of topics. At the time of the visit the manager did not act as an appointee for any of the residents. The homes accountant remained responsible for the management of fees and invoicing and a standing order system had been established for this purpose. The majority of residents continued to receive assistance from family members or personal representatives to manage their personal finances. Safe storage for small amounts of residents monies was also available and receipts and records of expenditure were maintained. The AQAA for the service detailed that health and safety policies and procedures were Care Homes for Older People Page 26 of 31 Evidence: in place and that equipment in Parkside Care Home had been routinely serviced and maintained. It was noted that the last service / test certificate for the emergency call system was dated July 2007 and the owner reported that he had recently asked an electrical engineer to address this matter. This issue was also noted at the previous inspection. Fire records were viewed during the visit. The records showed that the fire alarm system and automatic doors had been tested on a weekly basis and monthly visual inspections of the fire extinguisher and emergency lights had been undertaken. Records also confirmed that staff had received periodic training in fire evacuation procedures. Personal emergency evacuation plans had been developed for each resident and an updated fire risk assessment was available to reference. Checklists had also been established to ensure the condition of the environment including personal rooms were monitored. Training records viewed revealed that the majority of staff had completed training in safe working practice topics however some minor gaps were noted. (Please refer to Standard 30). Care Homes for Older People Page 27 of 31 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication Administration Records must account for medication administered or refused This will help to provide a clear audit trail and provide evidence that the health care needs of residents are being met. 17/07/2009 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 3 The Statement of Purpose and Service User Guide should be updated with the name and contact details of the Care Quality Commission and the details of the registered manager and her qualifications. This will ensure that people have up-to-date information on the service. Care plan review processes should be closely monitored, to ensure residents or their representatives are involved. This will assist in the development of person-centred care planning processes. All care plans should describe in detail the action required by care staff to meet individual needs. Page 29 of 31 2 7 3 7 Care Homes for Older People 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 4 5 9 9 A system needs to be established to ensure medication does not run out of stock. Arrangements should be made to ensure the method of fixing the controlled drugs cabinet to the wall is compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. Handwritten Medication Administration Records should be signed by another suitably trained member of staff to confirm the prescribed instructions are correct. The tea-time menu plan should be updated to reflect the full range of meal choices available to residents. The complaints procedure should be updated to include the name and contact details of the Care Quality Commission so that people understand who they can contact for help outside of Parkside. The manager should ensure that all staff are familiar with the role that outside agencies play in accepting referrals and coordinating a response to adult protection incidents. This will help to raise awareness of the role of the local authority and police. A designated member of staff should be allocated laundry duties to minimise the risk of cross infection. A certificate should be obtained, to provide evidence that the emergency call bell system has been serviced and is operating effectively. 6 9 7 8 15 16 9 18 10 11 26 38 Care Homes for Older People Page 30 of 31 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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