Care Home: Parkside Residential Home

What the care home does well The management and administration of the home was based on openess and respect, which had a positive affect on the quality of the service people received. Quality assurance systems were in place to promote the health, safety and welfare of people and staff. This was supported by representatives` of people and staff alike in their comments that included, "(I`m) proud to work at Parkside and for my manager, Mrs Hall who deserves a medal", "I enjoy working at Parkside", "my manager Mrs Hall is very supportive at all times. She is a very approachable manager, who is there day or night for staff backing. A pleasure to work for" and "Janet`s marvellous". The admission process was managed well, as people were assessed prior to their admission to the service. This was highlighted by a relative comment, "(we`ve) visited lots of places, but here, the manager knew her job inside out, she`s brilliant". From the admission assessment a well documented plan of care was established and reviewed, which meant the health and personal care needs of people were identified, that told staff what support people needed. Overall, people were treated with respect, dignity and privacy. Illustrating this were some of the comments made by people`s representatives, which were, "there`s a personal touch", "mum`s immaculate and they`re on the ball" and "they`re treated lovely". On the whole, people were assisted to make choices and decisions about their daily life and there was some provision for people to take part in social/leisure activities to enjoy a fulfilling quality of life. There was an open visiting policy, which helped in maintaining good relationships between people, their representatives and the service. The meals served were good quality and offered choice. A complaints procedure was in place that enabled people and their representatives to feel confident that any concerns they had would be listened to. Staff had an understanding of the procedures to be followed to safeguard people. Staff said they would, " refer to manager and appropriate bodies if need be, following company policy and procedure". On the whole, the living environment provided a well maintained, clean, tidy and comfortable environment for people to live and enjoy. Staff were in sufficient numbers to fully meet peoples` needs at all times and there was low staff turnover. Staff felt they were well trained and told us that in the main their induction told them everything they needed to know to do the job when they started and they were given training relevant to their role, helped them understand and meet the needs of people they cared for and kept them up to date with new ways of working. They commented, "Mimosa provides very good training and regular. Just completed my level 3 in care. Many staff are level 2 & 3 qualified. Several more in progress with level 3" and "if I didn`t feel I had the right experience, support or knowledge, I wouldn`t take on the job role. Parkside has always had high standards which myself and colleagues maintain". What has improved since the last inspection? People were assisted to the dining table as the meal was ready to be served, so that they were not left staring at each other with no stimulation. In the last 12 months environmental improvements had included a new carpet in both ground and first floor lounges, new flooring to a bathroom and a wet room installed on the first floor, two new chairs had been donated by relatives and the service had purchased 2 new flat screen TV`s. Nearly 71% of staff held NVQ Level 2 in Care, with a further 21% working towards it, which meant they met the required 50% ratio. Interest paid for the `pooled` account that holds peoples` money was being apportioned out to each person. What the care home could do better: Make the social/leisure activities more person centred and identify this in an individualised social care plan, to enable the service in planning individualised social/leisure activities to provide people with the opportunity to exercise choice. Store all medicines safely and improve the audit trail by making it easier to identify remaining stock through the medication administration records identifying the actual amount of medication that has been administered and carrying forward medication remaining from the previous month to the current month. Staff should explain what they are going to do and ask people permission before they provide or assist people with care, so that people know why they need to intervene and assist them. So that people who need liquidised meals have a well presented/attractive meal served to them, each item of the meal needs to be served separately. So that staff receive training appropriate to the work they perform they should receive and be up to date with training appropriate to their role including, dementia, first aid, moving and handling, health and safety, fire awareness, infection control, adult safeguarding and food hygiene. So that the recruitment process is sufficient to protect people, recruitment checks must demonstrate a full employment history has been obtained, together with a satisfactory written explanation of any gaps in employment. To fully safeguard and promote the welfare of people when dealing with their finances there must be enough money in the `pooled float` for people to access all of their money should they wish to do so. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Parkside Residential Home Park Street Wombwell Barnsley South Yorkshire S73 0HQ     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jayne White     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Parkside Residential Home Park Street Wombwell Barnsley South Yorkshire S73 0HQ 01226751745 01226341994 none Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mimosa Healthcare (No4) Limited Name of registered manager (if applicable) Mrs Janet Hall Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Two beds may be used for service users 55 years or over who have dementia. Date of last inspection Brief description of the care home Parkside is a home providing personal care for 36 people with dementia. The home is situated in landscaped grounds shared with two other care homes belonging to Mimosa healthcare. Parkside is located within close walking distance of shops and other amenities of Wombwell. Barnsley town centre is approximately 6 miles away. The manager confirmed that the fee range was 380.50 - 488.38 per week. Additional charges included hairdressing, private chiropody and toiletries. A copy of the previous inspection report was displayed and available in the foyer of the home. Care Homes for Older People Page 4 of 33 care home 36 Over 65 36 0 Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This was a key inspection and comprised information already received from or about the home and a site visit. We visited the home on 27 January 2009 without giving them any notice between 09:00 and 17:00. Another inspector, Mike ONeil was also on the site visit from 09:30 until 12:30 to use a formal way to observe people, because people with dementia are not always able to tell us about their experiences. He spent a period of time, over two hours, sitting with a group of people in a lounge. We were able to observe peoples experiences of living in the home and their interactions with each other and the staff. Mrs Janet Hall, the registered manager was present during the visit. The manager completed an Annual Quality Assurance Assessment before the site visit. Care Homes for Older People Page 6 of 33 This gives the service the opportunity to tell the CSCI how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 30 January 2007 and any plans for improving the service in the next 12 months. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received. The care provided for three people was checked against their records to determine if their individual needs identified in their plan of care were being met. We checked all of the key standards and requirements from the last key inspection. All this information and peoples, representatives and staffs opinions and comments were considered for inclusion in this report. The inspector wishes to thank people living at the home, the staff and the manager for their assistance and co-operation during the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: The management and administration of the home was based on openess and respect, which had a positive affect on the quality of the service people received. Quality assurance systems were in place to promote the health, safety and welfare of people and staff. This was supported by representatives of people and staff alike in their comments that included, (Im) proud to work at Parkside and for my manager, Mrs Hall who deserves a medal, I enjoy working at Parkside, my manager Mrs Hall is very supportive at all times. She is a very approachable manager, who is there day or night for staff backing. A pleasure to work for and Janets marvellous. The admission process was managed well, as people were assessed prior to their admission to the service. This was highlighted by a relative comment, (weve) visited lots of places, but here, the manager knew her job inside out, shes brilliant. From the admission assessment a well documented plan of care was established and reviewed, which meant the health and personal care needs of people were identified, that told staff what support people needed. Overall, people were treated with respect, dignity and privacy. Illustrating this were some of the comments made by peoples representatives, which were, theres a personal touch, mums immaculate and theyre on the ball and theyre treated lovely. On the whole, people were assisted to make choices and decisions about their daily life and there was some provision for people to take part in social/leisure activities to enjoy a fulfilling quality of life. There was an open visiting policy, which helped in maintaining good relationships between people, their representatives and the service. The meals served were good quality and offered choice. A complaints procedure was in place that enabled people and their representatives to feel confident that any concerns they had would be listened to. Staff had an understanding of the procedures to be followed to safeguard people. Staff said they would, refer to manager and appropriate bodies if need be, following company policy and procedure. On the whole, the living environment provided a well maintained, clean, tidy and comfortable environment for people to live and enjoy. Staff were in sufficient numbers to fully meet peoples needs at all times and there was low staff turnover. Staff felt they were well trained and told us that in the main their induction told them everything they needed to know to do the job when they started and they were given training relevant to their role, helped them understand and meet the needs of people they cared for and kept them up to date with new ways of working. They commented, Mimosa provides very good training and regular. Just completed my level 3 in care. Many staff are level 2 & 3 qualified. Several more in progress with level 3 and if I didnt feel I had the right experience, support or knowledge, I wouldnt take on the job role. Parkside has always had high standards which myself and colleagues maintain. Care Homes for Older People Page 8 of 33 What has improved since the last inspection? What they could do better: 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 4. Care Homes for Older People Page 9 of 33 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were assessed prior to their admission to the service, which enabled staff to be aware of peoples needs so they knew how to support the person on admission. Evidence: When we looked at information in the AQAA it stated a full needs assessment is carried out and that existing tools had been improved so the assessment gathering process would improve. To confirm this we looked at three peoples files to check a full needs assessment had been undertaken. We concluded a needs assessment was carried out that the person and their representative had been involved in. In one instance, information was also obtained from the placing authority. The information from the needs assessment had been used to put together a plan of care for people. Care Homes for Older People Page 12 of 33 Evidence: We spoke with the relative of someone living at the service. They said, (weve) visited lots of places, but here, the manager knew her job inside out, shes brilliant and Id recommend it to other people. When staff were asked in surveys what the home did well, one commented, we are full most of the year, with a waiting list. A lot of residents have come to Parkside on recommendation, which speaks volumes in my opinion, supporting the comments made by relatives. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 people were well documented in a plan of care that the person or their representative had been involved in. On the whole, medication practices protected peoples health and welfare. Overall, people were treated with respect, dignity and privacy. Evidence: When we spoke with relatives they were generally pleased with the care and medical support their relatives received. They said, (theyre) adjusting communication methods, theres a personal touch, mums immaculate and theyre on the ball and theyre treated lovely. Some people were not able to say whether they were being well cared for. These people were well dressed in clean, age appropriate clothing and attention had been paid to their hair and nail care. This indicated respect and dignity by staff when caring for them. Care Homes for Older People Page 14 of 33 Evidence: When we asked staff in their surveys what they thought the home did well, they commented, provide a high standard of care. We looked at three care plans. On the whole, the persons health and personal care needs were well recorded and there was evidence that the people and their representatives were involved in drawing up and reviewing of the plans. There were some gaps in recording information, in particular, in two of the files the moving and handling information in the actual assessment was not completed and in one the actual outcome of the assessment for removal of bed rails wasnt completed. These were highlighted to the manager to address. The care plans identified that a range of health care professionals visited people to assist in maintaining their health care needs. The records viewed showed that in two instances pressure areas present on admission had healed. When we spoke with staff they showed a good knowledge of peoples diagnosis and their health, personal and social care needs. Their surveys told us they were always given up to date information about the needs of the people they cared for. One commented, in my job role it is my duty to set up care plans for a percentage of residents and to keep these up to date and evaluated. To help staff give the proper care, pride is taken in my care plans. When we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind, warm manner. They used touch to offer support and this seemed to provide comfort to people. Staff spoke clearly and at a steady pace with people. They encouraged people to be active in their own care and activity. Staff showed calmness and supported people in a pleasant way when people were being verbally aggressive towards them and other people. However, we did see some interaction that could have been handled better. On one occasion staff didnt communicate with or provide verbal reassurance when providing care and lifting a person in a hoist. When we spoke to a team leader they said all team leaders administering medication had received training in safe handling of medication. They said the manager assesses their competence approximately every 4 - 5 months and Boots do a 6 monthly audit of their medication. On the whole, medicines were safely stored in locked cupboards, however, medication received for the next month, although in sealed bags were left in the locked medication room without an additional lockable storage and this is not consistent with safe storage guidelines. Care Homes for Older People Page 15 of 33 Evidence: We looked at the recording and administration of medication on a sample basis for three people. On the whole, medication received was clearly recorded on the persons medication administration record and medication administered, signed for. It was noted the amount of medication left over from one month was not carried forward to the next months, which made the audit trail of that medication difficult to achieve. In one instance the actual medication that had been administered needed to be clearer on the medication administration record, as the prescribed dosage was 1/2 or 1 tablet. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, people were assisted to make choices and decisions about their daily life and there was some provision for people to take part in social/leisure activities to enjoy a fulfilling quality of life. There was an open visiting policy, which helped in maintaining good relationships between people, their representatives and the service. The meals served were good quality and offered choice, but the presentation of liquidised meals could be improved. Evidence: Because people with dementia are not always able to tell us about their experiences, during this visit we also used a formal way to observe people. We spent a period of time, over two hours, sitting with a group of people in a lounge, where we were able to observe peoples experiences of living in the home and their interactions with each other and the staff. During the observation we found that the majority of peoples moods were positive. However, it was noted that one person was asleep for a period of nearly two hours. Clearly, during this time the person had no contact with staff or other people, which can have a negative affect on their wellbeing/mood. When the person was woken by Care Homes for Older People Page 17 of 33 Evidence: staff they smiled, became alert and spoke with staff. If staff were to spend more time with this person, even for frequent short periods, their engagement with the world around them would improve significantly and therefore so would their mood. As a consequence staff need to make efforts to include as many people as possible in conversation and day-to-day life. On the whole, however, staff did encourage people to communicate with each other and provided some social activities to enable this. Staff spoke clearly and at a steady pace with people and encouraged them to be active in their own care and activity. A friendly, lively and welcoming feel was evident. Some people were sat with others sharing stories with each other and their visitors and the sound of laughter was nice to hear. Some activities were occuring during the inspection. We saw staff sat with some people talking to them and others making an effort to provide a stimulating environment for people. Upstairs, nearly everyone was involved in exercise by throwing a soft ball to each other. Despite these efforts, because people with dementia are not always able to tell us about their experiences and what they might like to do, the social/activities care plan needs to contain more detail and be more person centred, so that staff and the service can determine/plan how those needs can be met. The AQAA highlights activities with people on an individual basis is something they could do better and they do need to address this, so that all people experience positive wellbeing. The dining areas were welcoming, being bright and clean. We saw the lunch time meal being served. On the whole, it was a positive and pleasant event, with food being nicely presented and drinks available. The environment could be improved by providing table cloths and condiments on tables. In addition, the presentation of meals for people who needed their meals liquidising could be improved. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure was in place that enabled people and their representatives to feel confident that any concerns they had would be listened to. Staff had an understanding of the procedures to be followed to safeguard people, but these need reinforcing with training. Evidence: Representatives of people could access the complaints procedure because it was displayed in the foyer. It clearly described the procedure for people should they have any concerns. It was clearly written, easy to understand and explained what the procedure would be and how long the process would take. When we spoke to relatives they said if they had any concerns they would feel comfortable in talking with the manager and that they knew any concerns would be dealt with. When we looked at staff surveys it told us that in the main staff knew what to do if people or one of their representatives had concerns about the home. One commented, to refer to manager and appropriate bodies if need be, following company policy and procedure. When we looked at the complaints record and spoke with the manager it told us no complaints had been made. Care Homes for Older People Page 19 of 33 Evidence: The AQAA confirmed there were policies/procedures/codes of practice in place to protect people from abuse. The knowledge of the manager in respect of safeguarding adults was satisfactory, even though no allegations had been made. The service had the local adult safeguarding policy and procedure for South Yorkshire. When we spoke to staff about reporting any allegations they were clear they would report any allegations that were made or incidents of harm they saw. There was a programme of training for staff to receive adult safeguarding training, however, when we spoke with staff and looked at their records 2 out of the 3 staff had not received this training. This identifies staff training in such a key area needs monitoring and arranging when necessary to inform and refresh staffs knowledge of their responsibilities in safeguarding people. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, the living environment provided a well maintained, clean, tidy and comfortable environment for people to live and enjoy. Evidence: When we looked round the home the physical environment on the whole, was suitable for the needs of people that lived there. The main lounges and dining areas presented a pleasant and homely environment for people to live and they were well lit. There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible, but these could be more domestic in appearance to make them more inviting to use. In addition, the upstairs bathroom should be considered in the improvements in the next 12 months as the enamel of the bath was worn, which would not invite people to want to use the bath. When we looked in some of the bedrooms they were comfortable and some people had personalised these with pieces of their own furniture and possessions. Bed linen was clean and in a good condition. The AQAA told us in the last 12 months environmental improvements had included a new carpet in both ground and first floor lounges, new flooring to a bathroom and a wet room installed on the first floor, two new chairs had been donated by relatives and the service had purchased 2 new flat screen TVs. Care Homes for Older People Page 21 of 33 Evidence: We did note a slight odour on entering the home in the morning, but relatives told us they felt the home was clean and didnt have that smell. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were in sufficient numbers to fully meet peoples needs at all times. There was low staff turnover and on the whole recruitment procedures demonstrated checks had been done to make sure staff were suitable to care for people. On the whole, peoples needs were met, but some staff were not up to date with training appropriate to the work they perform. Evidence: The manager said that on the whole staffing levels included 6 staff on a morning and afternoon shift, including one team leader. One of those staff was always on duty upstairs and the rest including the team leader on duty downstairs, where people had more complex needs. When we looked at staff surveys it confirmed there was generally enough staff on duty to meet peoples needs. They commented, in an ideal world more staff. Some residents need one to one in the unit I work, but this is not always possible. Overall, we do very well and try to divide time with all residents, generally there is enough staff but there is always sickness to cover or annual leaves. At Parkside shifts are usually fully manned as staff are always willing to pick up over time and help one another - team work and there are enough staff during days, but sometimes not enough staff during nights. When we spoke with staff they said, good staff team, sufficient staff on duty, theres good team work and Im very happy here. The good work of the team was shown in the low turnover of staff. Only 2 staff Care Homes for Older People Page 23 of 33 Evidence: had left employment in the last 12 months, which meant a consistent staff team was in place, which is important when caring for people with dementia. When we spoke to people and their representatives they had confidence in the staff that cared for them and there was always staff available when they needed them and they listened and acted on what they said. When we observed staff on duty, they worked hard, were patient and showed empathy to people. They had good relationships with the people that lived there. The AQAA told us training opportunities were provided that tried to deliver a programme that met statutory requirements and National Minimum Standards. It stated all catering staff had received training in safe food handling. The manager said nearly 71 of staff held NVQ Level 2 in Care, with a further 21 working towards it, which meant they met the required 50 ratio. She told us a risk assessment had not been conducted to assess whether the level of training provided to staff in first aid would be sufficient to protect people in the event of an emergency/incident. When we looked at staff surveys they told us that in the main their induction told them everything they needed to know to do the job when they started and they were given training relevant to their role, helped them understand and meet the needs of people they cared for and kept them up to date with new ways of working. They commented, Mimosa provides very good training and regular. Just completed my level 3 in care. Many staff are level 2 & 3 qualified. Several more in progress with level 3 and if I didnt feel I had the right experience, support or knowledge, I wouldnt take on the job role. Parkside has always had high standards which myself and colleagues maintain. We looked at 3 staff training records to confirm information in the AQAA and what staff had told us in their surveys. These told us staff were given an induction booklet to complete, which meant staff completed a Skills for Care Induction when they had achieved this. Other training included moving and handling, health and safety, infection control, fire awareness and food hygiene. However, not all staff had undertaken the recommended mandatory training or specialised training for staff in caring for people with dementia. The AQAA stated there was a recruitment policy in place and that everyone who had commenced employment in the last twelve months had satisfactory pre employment checks, including two written references and ensuring a CRB and POVA first check was undertaken prior to commencement of employment. This was confirmed when we Care Homes for Older People Page 24 of 33 Evidence: looked at staff records and looked at their surveys. One commented, CRBs and references are fully carried out at Parkside, although sometimes it can take a while. However, care must be taken to make sure a full employment history is in place with written verification of any gaps in employment. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home was based on openess and respect, which had a positive affect on the quality of the service people received. Quality assurance systems were in place to promote the health, safety and welfare of people and staff, but some staff were not up to date with health and safety training appropriate to the work they perform. The homes financial procedures did not fully promote the welfare of people. Evidence: People expressed satisfaction with the service they received, as did their representatives. The manager was experienced in the care of people with dementia and had achieved her NVQ Level 4. The manager was very positive about the inspection process and is committed to improving the service at Parkside and meet the National Minimum Standards and Care Home Regulations. In the main, staff surveys identified the manager met with staff regularly and gave Care Homes for Older People Page 26 of 33 Evidence: support and discussed how they were working. Comments included, (Im) proud to work at Parkside and for my manager, Mrs Hall who deserves a medal, I enjoy working at Parkside and my manager, Mrs Hall is very supportive at all times. She is a very approachable manager, who is there day or night for staff backing. A pleasure to work for. These comments were verified when we spoke to staff. Representatives of people also had the same opinion. One commented, Janets marvellous. This told us her direction and leadership promoted a relaxed and friendly atmosphere. The majority of the sections in the AQAA were completed and the information gave a reasonable picture of the current situation within the service, including identifying improvements, so that the quality of life for people is improved. The AQAA stated 3 monthly audits for health and safety, domestic services, fire and maintenance took place and the manager told us audits were in place for care planning. We also saw surveys were used to identify representatives opinion of the service provided. We looked at this and all comments were positive. The home handles money on behalf of some people. We saw that account sheets were kept, receipts were seen for transactions and a second individual signed to say they had witnessed the transaction, although on recent transactions this had lapsed and was raised with the administrator. However, the system being used was unsafe. This was because notes were being kept on records and in peoples money wallets that said owes ... to float or float owes .... However, the float didnt have any money, because it was only for 100 pounds and the amount borrowed by people had exceeded this. This meant for people to have their money when they wanted, money was being taken from another persons wallet. This was despite some of those people who were borrowing money having money in their own bank account. The service had addressed a previous requirement by apportioning interest to each person who held money in the joint bank account. The AQAA stated maintenance of equipment was in place for portable electrical equipment, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, emergency call equipment and gas appliances. It did not confirm the date for servicing of the premises electrical circuits was up to date and the manager was asked to act on this. Discussions with staff and their training records highlighted not all staff had received statutory training in health and safety and fire safety, however, a review of evidence suggests this had not yet resulted in placing people at risk (see staffing). Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. Care Homes for Older People Page 27 of 33 Care Homes for Older People Page 28 of 33 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 15 12 Regulation 12 (1) (a) Each item served at meal times must be served separately for people. So that people who need liquidised meals have a well presented/attractive meal served to them. 27/02/2009 2 29 19 Schedule 2 21/02/2009 Recruitment files must demonstrate a full employment history has been obtained, together with a satisfactory written explanation of any gaps in employment. So that the recruitment process is sufficient to protect people. 3 35 12 Regulation 12 (1) (a) The float must contain sufficient money for people to be able to have access to all of their money at any time should they wish to do so, to stop the practice of 27/03/2009 Care Homes for Older People Page 30 of 33 borrowing money from other people. To promote and make proper provision for safeguarding peoples financial interests. 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 9 So that all medicines are stored safely in accordance with good practice guidelines, medicines received for administration for the next month should be stored in a lockable cupboard. To provide a clear audit trail of medication, where the amount of prescribed medication can be different when it is taken, for example, 1 or 2, the amount administered should be recorded. To improve the audit trail and more easily identify remaining stock, the amount of medicines carried forward from one month to another should be recorded on the current medication administration record. So that people know why staff need to intervene and assist them in their daily life, staff should explain what they are going to do and ask permission from the person before they provide or assist them with any care. To improve peoples quality of life, staff should make efforts to include as many people as possible in conversation and day-to-day life. This also links to standard 14. The social/activities care plan needs to contain more detail and be more person centred, so that staff and the service can determine/plan how for each person they are able to make sure all people have the opportunity to exercise choice in relation to social and leisure activities. So that staff receive training appropriate to the work they perform all staff should receive training in adult safeguarding. A risk assessment should be completed to assess whether the level of training provided to staff in first aid would be Page 31 of 33 2 9 3 9 4 10 5 12 6 12 7 18 8 30 Care Homes for Older People sufficient to protect people in the event of an emergency/incident. 9 30 So that staff receive training appropriate to the work they perform they should receive and be up to date with training appropriate to their role including, dementia, first aid, moving and handling, health and safety, fire awareness, infection control and food hygiene. Care Homes for Older People Page 32 of 33 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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