Care Home: South Park

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What the care home does well People are assessed properly before they move to the home. This is to check that the home is confident that the staff there have the skills and knowledge to support them properly, should they choose to move there. It also helps to reassure the individual and their family that South Park is the right place for them. People receive good personal care from staff who recognise and understand their needs. People told us `staff are friendly and helpful. They are sensitive to the needs of those living there`. People can have visitors anytime, which helps them to keep in touch with people who matter to them. One visitor told us that they bring their dog with them when they visit. Some people living there have interesting and stimulating lives, which means that not all the days are the same. One person told us their relative went out regularly with the activities person, as getting outside was important to them. There is an experienced registered manager and the company consults with people to find out what they need to do to improve things for the people living there. One person commented in their survey that `the management are excellent`. What has improved since the last inspection? The way medicines are managed on Ebor has now been improved so that it is much easier to check whether medicines have been given to people as they should be. There is ongoing refurbishment in the home and some routine maintenance to enhance people`s experience of living there. There is an ongoing programme to replace people`s beds with electric profiling beds. These have integral bedrails for use when necessary, which help to keep people safe, and also make it easier for people to move, when in bed. What the care home could do better: We have observed that the home did not run as efficiently in the summer, whilst the registered manager had some time off. The organisation could determine how the running of the home could be better maintained, should the manager need to take some time off again. This would help to ensure that standards of care provided at the home would not be compromised again. The home could ensure that staff always speak and behave towards people in a way that respects them as individuals and protects their privacy and dignity. And the home could ensure that when people are assessed as needing special equipment to protect their skin then this should be used at all times, whether they are sitting in a wheelchair or armchair. This would help to make sure their wellbeing was being maintained. The way activities are planned and organised at the home could be looked at to try to ensure that all the people living there have their individual social needs met. This would help people to have more interesting and stimulating lives.The home could look at the present practise of keeping some very frail people who are cared for in bed, locked in their rooms. The home does this to stop unauthorised people from going in to them. This practise though increases people`s isolation and may not be in their best interests. However assessments by outside professionals have been requested by the home to determine whether this practise can continue. The menus could be looked at to make sure that all people, regardless of their dietary needs receive varied and balanced meals. People could be provided with special equipment when necessary to enable them to manage to eat and enjoy their meals independently. And the home could make sure that people in all areas of the home are offered extra drinks. This will improve people`s experiences of living there and promote their wellbeing. The managers could satisfy themselves that all people working at the home recognise `abuse` in all its different forms, and understand their responsibilities should they witness or be told of any incident that may mean people have been put at risk of harm. This would help to keep people safe from harm and ensure these incidents are looked into properly. Some areas of the home, both inside and outside could have some maintenance work carried out to demonstrate that the home is well maintained. The dementia care unit could be better equipped with appropriate items to help promote people`s independence and minimise some of the distress and confusion that people with this illness sometimes feel. The staffing levels, particularly on the dementia care unit could be looked at to make sure there are always enough care staff working there to ensure people can be supervised properly, can have their personal needs met in a timely way and so that staff can spend one-to-one time with individuals, so that interests, identified as part of their assessment, can be maintained. This would promote person-centred care and help people to be valued as individuals. The managers could continue to promote the National Vocational Award as a valuable qualification, which helps care staff to recognise what good care is and how to provide it. The home could consult with health and social care professionals who visit the home to find out from them what they think the home is doing well and how they could improve. The home could ensure that fire safety requirements, made by the fire safety officer earlier this year, have been complied with and they are doing all they should be doing to keep people safe in the event of a fire at the home. Key inspection report Care homes for older people Name: Address: South Park Gale Lane Acomb York North Yorkshire YO24 3HX     The quality rating for this care home is:   one star adequate 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: Jean Dobbin     Date: 0 3 1 1 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 37 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 37 Information about the care home Name of care home: Address: South Park Gale Lane Acomb York North Yorkshire YO24 3HX 01904784198 01904785234 south.park@fshc.co.uk www.fshc.co.uk Ringdane Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 102 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service users in the category of OP are 60 years plus - Jorvik Unit. Service users to include up to 49 DE(E) and up to 49 MD(E) up to a maximum of 49 service users - Ebor Unit. The home also provides 8 day care places plus 8 day care beds. The maximum number of service users who can be accommodated is: 102 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia Code DE(E); Mental Disorder - Code MD(E) and Old age, not falling within any other category - Code OP Care Homes for Older People Page 4 of 37 Over 65 49 49 53 0 0 0 Date of last inspection Brief description of the care home South Park Care Home is part of the Four Seasons Health Care Group. The service was last inspected on 19 September 2007. The home is situated to the south west of the city of York and within walking distance of local shops and amenities. Buses to the city centre pass close to the home. The home is a purpose built two/three storey building in its own grounds, with parking spaces. There are gardens around the home and two safe, inner courtyards. There is level access and three passenger lifts to the upper floors. The home has two separate units. Ebor is for people with mental health and/or dementia care needs, and Jorvik is for people with general nursing needs. South Park is registered to provide care and support for up to 102 people with these care needs. The home provides a brochure, Statement of Purpose and service user guide for people who express an interest in moving to the home. These are also displayed in the entrance to the home. The last inspection report, written by our predecessor the Commission for Social Care Inspection is also displayed in the entrance area for people to read. The weekly cost to live at South Park on 3 November 2009 is between 533 and 625 pounds on Ebor, and between 518 and 615 pounds on Jorvik. Additional charges are made for hairdressing, chiropody, aromatherapy and for newspapers/magazines and other personal items. Care Homes for Older People Page 5 of 37 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: one star adequate 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 Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk 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. This is what was used to write this report. Care Homes for Older People Page 6 of 37 Information about the home kept by the Care Quality Commission. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were sent to people who live at South Park, to staff and to other professional people who visit the home. 48 were sent to people at the home, and 23 were returned. 20 were sent to healthcare and social care professionals and 1 was completed and returned. 15 were sent to staff at the home and 9 were returned. A visit to the home by two inspectors, which lasted about 10 hours. This visit included talking to people who live there and their visitors, and to staff and the deputy manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. An assessment was also undertaken where some people were observed for one and a half hours to assess both their wellbeing and how the staff interact with them. What was seen is included in the main part of the report. Some time was also spent watching the general activity to get an idea about what it is like to live at South Park. We did this inspection with an expert by experience who spoke to people who are using this service. An expert by experience is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care. Information about what was found during the inspection was given to the deputy manager and the Operations Manager at the end of the visit. The inspection findings were also discussed with the registered manager in the days following the visit. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: We have observed that the home did not run as efficiently in the summer, whilst the registered manager had some time off. The organisation could determine how the running of the home could be better maintained, should the manager need to take some time off again. This would help to ensure that standards of care provided at the home would not be compromised again. The home could ensure that staff always speak and behave towards people in a way that respects them as individuals and protects their privacy and dignity. And the home could ensure that when people are assessed as needing special equipment to protect their skin then this should be used at all times, whether they are sitting in a wheelchair or armchair. This would help to make sure their wellbeing was being maintained. The way activities are planned and organised at the home could be looked at to try to ensure that all the people living there have their individual social needs met. This would help people to have more interesting and stimulating lives. Care Homes for Older People Page 8 of 37 The home could look at the present practise of keeping some very frail people who are cared for in bed, locked in their rooms. The home does this to stop unauthorised people from going in to them. This practise though increases peoples isolation and may not be in their best interests. However assessments by outside professionals have been requested by the home to determine whether this practise can continue. The menus could be looked at to make sure that all people, regardless of their dietary needs receive varied and balanced meals. People could be provided with special equipment when necessary to enable them to manage to eat and enjoy their meals independently. And the home could make sure that people in all areas of the home are offered extra drinks. This will improve peoples experiences of living there and promote their wellbeing. The managers could satisfy themselves that all people working at the home recognise abuse in all its different forms, and understand their responsibilities should they witness or be told of any incident that may mean people have been put at risk of harm. This would help to keep people safe from harm and ensure these incidents are looked into properly. Some areas of the home, both inside and outside could have some maintenance work carried out to demonstrate that the home is well maintained. The dementia care unit could be better equipped with appropriate items to help promote peoples independence and minimise some of the distress and confusion that people with this illness sometimes feel. The staffing levels, particularly on the dementia care unit could be looked at to make sure there are always enough care staff working there to ensure people can be supervised properly, can have their personal needs met in a timely way and so that staff can spend one-to-one time with individuals, so that interests, identified as part of their assessment, can be maintained. This would promote person-centred care and help people to be valued as individuals. The managers could continue to promote the National Vocational Award as a valuable qualification, which helps care staff to recognise what good care is and how to provide it. The home could consult with health and social care professionals who visit the home to find out from them what they think the home is doing well and how they could improve. The home could ensure that fire safety requirements, made by the fire safety officer earlier this year, have been complied with and they are doing all they should be doing to keep people safe in the event of a fire at the home. 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 Care Homes for Older People Page 9 of 37 order line 0870 240 7535. Care Homes for Older People Page 10 of 37 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 37 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 assessed properly before moving to the home, to make sure that their needs could be met if they chose to move there. Evidence: Several care records were looked at as part of this inspection. One in particular related to an individual who had moved to South Park Care Home recently. This record contained a detailed assessment, which had been completed before they moved there, by one of four senior nurses at the home who carry out this assessment. One of the nurses has a mental health professional qualification so she would generally assess people with a mental health disorder, or a dementia-like illness. There was also an assessment completed by a care manager, which described the individuals care needs in good detail. This pre-admission assessment is needed to check whether the home has the facilities and staff have the skills to meet peoples needs. It also helps to reassure the Care Homes for Older People Page 12 of 37 Evidence: individual and their family that staff can support them properly if they choose to move there. This assessment is completed at the persons previous address, whether this is at home or in hospital. People and their families are encouraged to visit the home and meet some of the people living there and the staff working there. This helps them to get a feel of the place and whether it would be the right place for them. Trial stays can also be arranged. The home provides a brochure and written information about the facilities and services they provide. It would be good practise to provide that information in different formats so that people with poor eyesight or impaired understanding can still learn about how the home operates, without having to rely on other people to help them. Twenty three surveys from people living at South Park were returned to us as part of this inspection. Many of these had been filled in with the help of a representative. All except two said that they had received enough information before they moved there, to help them decide that the service was the right place for them. Intermediate care is not provided at South Park, though respite (short) stays can be arranged. Care Homes for Older People Page 13 of 37 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. Whilst peoples health and personal care needs are generally being met, more attention to detail is needed to ensure the care is to a consistently good standard. Evidence: People were observed generally being helped and spoken with by care staff in a kindly and respectful manner. There was a lot of banter and gentle humour. Staff were seen crouching down, when necessary, to speak with people and then listening to their responses and views. People were seen being moved with specialist equipment in a patient, respectful manner, with staff explaining what was happening and providing reassurance during the manoeuvre. People spoken with made comments like Im happy with the care and staff are sensitive to the needs of the people living here. Six care plans were looked at as part of the inspection visit. These describe the care and support people need to live as independent a life as possible and help to ensure that people receive consistent care. These care records looked at were generally written on good detail and clearly Care Homes for Older People Page 14 of 37 Evidence: identified how one person was very different to the next. There were assessments of risk of harm to the individual from, for example, falling, developing a pressure sore, or becoming malnourished, because of a health problem or poor appetite. And also how to manage behaviours, which may challenge the service, like verbal or physical aggression. These assessments had been reviewed regularly to make sure they were still appropriate. Several people were seen sitting on pressure relieving cushions however staff must ensure that when people are helped into a wheelchair, then the cushion is also moved. One person on Ebor became quite distressed because this hadnt been done and they were very uncomfortable. And this also happened to another person there, but they were unable to call out. Specialist mattresses and beds are used to promote peoples comfort and safety and help to prevent pressure sores. We looked at the records of one person with a pressure sore. The management of this sore was recorded in good detail and the home had sought advice from other healthcare professionals to check they were providing the most appropriate care. The home is in the process of changing many of their beds to electric beds with integral bed rails so that people are not at risk of harm from bedrails incorrectly fitted. The care records detailed visits and consultations with healthcare professionals, like the doctor, optician and chiropodist. Comments from people include the home keeps me informed of my relatives illnesses. And medical care is good. They (the home) provides support to the resident for hospital visits. The survey responses also tell us that people are generally satisfied with the care they receive. Practically all the surveys say always or usually to questions like do you get the care you want, do staff listen to you and do you get the right medical support. We noticed these care practises during our visit. One person became tearful and three members of staff went to them immediately. One person sat and talked with the individual, whilst another went and made a cup of tea for them. This demonstrated good, supportive care. Another person was having their foot and leg looked at, by a carer in the lounge. Their shoe and sock had been removed and their trouser leg rolled up. This did not respect that persons dignity. Another person was informed by a staff member in a very loud voice that they were going to the toilet. This too did not respect their dignity. The medication systems on Ebor were looked at. These were generally satisfactory Care Homes for Older People Page 15 of 37 Evidence: with accurate checks being carried out to help to show that people are receiving their medicines appropriately. Nurses attend updating training in medication administration to ensure their practise remains up-to-date. Care Homes for Older People Page 16 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people generally enjoy the meals some people have a better lifestyle than others, depending on which unit they live in. Those who rely on staff as a source of social contact and activity are not having their needs fully met. Evidence: People appear to have different experiences, depending on where they are living in the home. Care staff on Jorvik were available to respond to people living there. There was more choice as to where to sit, and with whom. People were offered drinks through the day, and magazines, newspapers, tissues and other personal items of everyday life were seen in the lounges. There was evidence of activities which people could join in with and a session of bingo was organised part way through the morning. One visitor said the activities person makes sure that my relative gets out regularly as they like to go out. They confirmed that the courtyard area was regularly used when the weather was good. A carer said that several people had recently been to the local park together. It was a great day. The activities person was seen providing hand massage to a person who was unable to join in with the group activities and the care records provided good information about peoples pasts so that activities could be tailored to what interested them. All these things help to make peoples lives more interesting and stimulating. Care Homes for Older People Page 17 of 37 Evidence: We carried out a SOFI on the first floor in Ebor. This stands for Short Observational Framework Inspection and is a tool we use to help us assess peoples wellbeing, when they may not be able to tell us themselves. This assessment showed that care staff on that floor were very busy and people, some of whom were unable to call for help, were left unsupervised for periods. When care staff entered the lounge where these people were sitting they responded in a respectful manner. However they only really spoke with two people who were both able to respond back to them. This meant that people with poor communication, because of their advanced dementia, were not included in any conversations or general banter. A half hour DVD was started, but when this finished a carer just set it going again. The position of the chairs around the edge of the room with the television in the corner meant that only a small number of people could see the screen anyway. A carer took down the halloween decorations in the lounge and during this time we saw good interactions with several people and they were encouraged to look at, and handle the decorations. A second activities person works on Ebor. Apart from taking a person to the hairdressers, we didnt see her on the first floor. Peoples social needs were not being met. One persons records stated cant participate in any social activities. However their records also stated that they liked brass bands, Elvis Presley, and used to run bible classes. So one-to-one activities could still be tailored to their interests. Most people living on the first floor need two people to help with moving. One person asked for the toilet, but because only one carer was available, they had to wait. And although the carer explained the reasons for the delay, the individual couldnt remember this information, so was repeatedly calling for help. This was a very negative experience. People were not offered drinks during the morning, although a number of people were still eating breakfast at half past ten. There was little evidence of homely items in the lounge and the communal areas and corridors are not decorated or furnished in a style that could promote reminiscence conversations between staff and the people living there. Downstairs on Ebor people are more able to move around independently. Staff appeared to be more available and people were observed doing a jigsaw and playing a board game with staff. There was no signage to orientate people both as to the day or date or to help people find their way round or locate the toilets independently. Most Care Homes for Older People Page 18 of 37 Evidence: people were just sitting, though the television was on. Comments from people include there are no trips out. We used to have trips, but not now. Another commented they spent their time waiting for time to pass. Another who likes to stay in their room said no-one comes in to talk, however a visitor commented that staff popped into their relatives room to chat with them. One survey response was there is no activities organiser on Ebor and no-one to take people shopping or have one-to-one time. Another commented we have a minibus which is seldom used. We also observed the practise downstairs on Ebor, where people who were cared for in bed because of their frailty, were locked in their bedrooms. We were told this was to prevent other people who may go into their rooms, without staff seeing them, and cause upset. This way of managing peoples care is not satisfactory. People are isolated and although staff tell us, and records show, that staff visit to carry out personal care, there is little opportunity for social needs to be met. The manager needs to ensure people can maintain a positive lifestyle and choices, regardless of where they are living in the home. However one of these people had had a deprivation of liberties assessment and following the inspection the manager told us that assessments had been requested for the other people cared for in this way, to check whether this practise was appropriate. Staff were observed offering people choices in their day to day lives and listening to their responses. Independent advocates have been organised by the home for people with no-one to speak up for them, so that someone will represent their best interests in a meeting about their care and welfare. Care records identified peoples preferred routines and these were respected as much as possible. People can visit whenever they choose. One survey commented we are always welcomed like family when we visit, (from away). And carers offered to help one person to move to their room, with the aid of a hoist, when their visitors arrived, so that they could have some privacy. The hairdresser visits twice each week and religious services are held at the home each month. One persons care records said that their catholic faith was very important to them and a carer spoken with knew of this and confirmed that the priest visited the individual at least once a week. One person living there has a first langage that isnt English. Their records showed that the home was in the process of finding an advocate who spoke their language. When asked the managers were unsure whether this persons background meant that they had specific preferences about different foods and lifestyle. These sort of things need to be looked into to make sure the home is meeting their diverse needs. Care Homes for Older People Page 19 of 37 Evidence: The dining areas were nicely presented and people were encouraged to eat at the table. The meals are delivered to Ebor in heated trolleys. The expert by experience who visited with us had lunch with people on Ebor and she said the meal was hot, tasty and nicely served. However people were not offered drinks to have with the meal, although a hot drink was offered afterwards. Upstairs on Ebor people had orange juice or water with their meal. Whilst there are two options on the menu it would be good practise for people with impaired understanding to be shown the two alternatives plated up, as this may help them to make the right choice. People needing a soft diet have less choice. One person said we eat what we are given. There is no choice for dessert and we didnt hear anyone being offered any alternative. People however seemed to enjoy their meals, though there were no aids available to promote peoples independence. People were trying to manage and staff were supporting them in a respectful manner, but in some cases a lot of the meal ended up on the table or in peoples laps. The manager should take advice about the aids available to help people, and make sure they are available and used so that peoples life skills can be encouraged and maintained. The home has a four week programme of menus, which the manager told us in her AQAA is altered according to peoples requests. This includes a cooked breakfast and prepared sandwiches for supper. Evidence of both of these were seen. The menu states that fresh fruit is always available though care staff spoken with said that they had to get this themselves from the kitchen when people wanted it, and fruit was not routinely made available. One added that relatives usually brought fruit in. Just two bananas were seen in the main kitchen, though the cook said a fruit delivery was due the following day. The cook also told us that people needing a puree diet have soup and a dessert only at teatime. Whilst the managers said this wasnt the case some survey responses also commented negatively about the pureed meals. The manager must ensure that all people receive a varied and nutritiously balanced diet. Mixed comments were received about the meals. Whilst most people said they always or usually like the meals at the home, others voiced concerns. These include the food is adequate and readily available, there needs to be more variety of meals, especially pureed meals and sandwiches, and more choice of puree diet especially at teatime. Care Homes for Older People Page 20 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are confident that complaints will be sorted out properly, a lack of awareness by some staff about what constitutes abuse may mean that people are still being put at risk of harm. Evidence: The complaints policy is displayed in the entrance area of the home and provided in written information, given to people and their families when they move there. Whilst most people in their surveys said they knew how to make a complaint and that there was someone they could speak with if unhappy about something, five people said they did not know what to do in this situation. The manager must continue to remind people to tell someone if they are unhappy about something, so the home has the opportunity to put things right. The home has received four complaints in the past year. Two of these relate to clothes which were spoilt by the way they had been laundered. Another was about a formal letter sent by the organisation, which the receiver was unhappy with. And the fourth related specifically to care practises on Ebor, which was referred to the local authority for them to look at under their safeguarding policies. The commission has not received any complaints directly. People spoken with and survey comments tell us that people are generally confident that the managers will sort complaints out properly. One person said they had raised Care Homes for Older People Page 21 of 37 Evidence: an issue in the past and was responded to immediately and positively. Visitors on Ebor said they would feel comfortable discussing issues with staff, but had had no cause to complain. They felt issues would be looked into properly. We have been concerned earlier this year about how the home recognises and reports incidents at the home, where people have been harmed or put at significant risk of harm. For example we looked at records during this visit, which showed that earlier this year one person had been put at risk of harm, by the behaviour of a second person. This incident should have been reported to the safeguarding team and to the commission. This had not been done. Following meetings held with managers at the home and the local authority safeguarding team this summer, we asked the home to report any incident where they observed any harm including any bruising on people, which they couldnt account for. This has led to a high number of reports, particularly on Ebor unit. The managers must ensure that there are enough care staff working to ensure people are being properly supervised so that staff can intervene promptly to prevent people coming to harm. Staff told us that they attend training in safeguarding adults. One carer spoken with though, was unsure what constitutes abusive behaviour but knew that it must be reported straight away. Another member of staff knew to report an incident, but said if they heard people shouting (for example) in a bedroom, then they wouldnt go in to intervene. They said they had had some abuse training in the past, but none recently. We were told that care staff attend training each year by completing a workbook. However in view of the high numbers of safeguarding events, not all of which have been reported appropriately, the manager should determine whether this training is effective. And all staff who work at the home must know their responsibilities should they witness or be told of an incident where a person living there may have been harmed. We saw two care records with evidence of a mental capacity act assessment to determine whether a person could make a decision about an aspect of their care. We saw evidence of the use of an IMCA (Independent Mental Capacity Act Advisior) to make sure a persons best interests were being considered when a meeting was held to discuss their care. And evidence of a Deprivation of Liberty safeguarding referral was also seen. This was so that outside professionals can look at the restrictions placed on a persons freedom to check that these restrictions are reasonable and necessary, in order to keep the individual safe from harm. The use of these systems and referrals help to show that the home is considering peoples wishes and choices. Care Homes for Older People Page 22 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home is generally clean and comfortable some improvements are still needed to improve peoples experience of living at South Park. Evidence: South Park Care Home is purpose built. The home has two inner courtyards, which are accessible to people from both units and visible from various parts of the home. These spaces though are untidy, overgrown and look uncared for. They do not give an impression of a well maintained home and are not an attractive place in which to sit. Jorvik has three floors with most communal areas and services like the kitchen and laundry on the ground floor. Peoples private rooms, which are predominantly for single use are on the first and second floor and there is a vertical passenger lift to aid access. Those private rooms looked at on Jorvik had been personalised and contained items that matter to people to make them seem more like home. There are a number of different lounge areas including a conservatory, and small sitting areas are also available on the first and second floors. These areas are attractively decorated and furnished and the unit was noted to be clean and warm, with no unpleasant smells. We noticed though that staff cannot use mobile hoists in the bathrooms. This means that only people who can transfer on to an integral bath chair can currently have a bath. Other people who need the mobile hoist can only have a shower. The manager Care Homes for Older People Page 23 of 37 Evidence: tells us that these people can still have a bath on Ebor unit. This is not satisfactory. The company need to look at this and make sure that the bathing facilities on Jorvik can be used by all people who might choose to have a bath, rather than a shower. Ebor has a keypad entry, from the main reception area and has two floors, with another passenger lift for access. There are less communal areas on these units, with just one main lounge and separate dining room on each floor. This means that if people want to sit quietly, then they stay in their room. The ground floor also has a small room described as a sensory room, however this seemed poorly used. Equipment was being stored there, whilst waiting to be unpacked and one of the items, used to promote a relaxing environment was broken. Ebor was noted to be generally clean although there was a smell of stale urine noticeable in parts of the unit. This was present throughout the day. The manager needs to ensure that the systems in place to manage and eradicate these smells are sufficient. On the day of the visit, due to sickness, only one domestic was working on Ebor unit. The senior manager told us that some monies have been allocated next year for Ebor, to make the environment there more suitable for people with dementia . Currently the decor and signage does not help people to find their way around or to promote their independence. Peoples private rooms are generally kept locked so if an individual can find their room, then they cannot get in. This does not promote peoples independence nor help people to maintain their life skills. The paintwork on the walls on both units were quite damaged in places, where they had been banged by equipment used for moving people. Some chair coverings on Ebor were noted to be stained and needing renewal. Bath panels on Jorvik need fixing and there is evidence of a water leak in one bathroom ceiling. Whilst all except one survey response said that the home was always or usually fresh and clean, the comments included some redecoration is needed, and in summer it is far too hot on Ebor. One member of staff also commented on the difficulty of working there in the summer because of the heat. The senior manager said that the home had bought air conditioning units, but couldnt use fans because of the risk these posed to people living there. The home needs to take further advice if necessary about how to maintain a comfortable temperature for the people living and working at the home. The environmental health officer inspected the homes kitchens earlier this year and Care Homes for Older People Page 24 of 37 Evidence: awarded a three star scores-on the-door rating for food hygiene management, which equates to good. The laundry areas were looked at and found to be satisfactory. The manager makes sure that appropriate aids are available and used to make sure that people living and working in the home are protected against infection. Care Homes for Older People Page 25 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped by kind and respectful staff who understand what good care is, but there are not always enough of them to make sure people can be kept safe and have their needs met in a timely way. Evidence: All the staff spoken with were pleasant and friendly and were seen speaking with people living there, and their visitors, in a kind and respectful manner. People spoken with and the survey responses were full of praise for the staff, who they felt were bright and cheerful. Comments include the staff that I see are very good to my relative and the carers are very approachable. Another commented all the staff, both admin and nursing have been first class in the care of my relative. Whilst these responses are very positive others write about the numbers of staff available each shift. These comments include staff all work tremendously hard and often seem to be under pressure. And at weekends staff seem to be at a minimum. One staff member said in their survey that we never get time for the residents on a one-to-one basis. However despite these comments all except three survey responses said that staff were always or usually available when they were needed. We do not know on which unit the people completing these surveys live though. The rotas provided by the home showed that there were no planned reductions in staffing levels on a weekend. Care Homes for Older People Page 26 of 37 Evidence: The availablility of staff seemed to vary though according to whereabouts in the home people were living. On Jorvik there were two nurses and seven care staff working an early shift, for thirty six people. Staff seemed to be very available and were seen to respond promptly to people when they needed help. On Ebor there were two nurses and six carers to help forty four people, with a third nurse sometimes working too. These numbers were split between the two floors. One nurse working on Ebor has a mental health qualification. Staff on the top floor appeared very busy and as observed whilst carrying out the SOFI, people were left unsupervised, when they had no way of summoning help. There was little for them to do and staff were generally too busy to talk with them or help with meeting their social needs. People did not get offered extra drinks. Downstairs on Ebor staff were more available, however people need closer supervision and distraction because they are generally able to walk around and their behaviours may challenge the service. More staff would enable people to have more one to one time so that their social needs can be better met and would also enable people to be better supervised. And more staff could mean the service neednt keep private rooms locked, particularly those where more frail people are cared for in bed, in order to protect them from other residents. Male and female care staff are employed at South Park. However less than the recommended 50 of those have achieved a National Vocational Qualification Level 2 in Care. The organisation needs to continue to promote this qualification as it helps carers to recognise what good care is, and how it is to be delivered. Three staff recruitment files were looked at. Two of these belonged to people who had recently started working at South Park. These records showed that proper checks including two references and a police check had been completed by the organisation before they were allowed to start working at the home. Good recruitment processes help to make sure only suitable people are employed. The file of one person, who had worked at the home for several years, was also looked at. Some updated records were missing, however the home obtained evidence during the day from the companys head office to confirm that the updated checks had been completed properly. Staff told us they completed a three day induction when they started working there. The home keeps a computerised training record to identify when staff need to attend refresher training. One staff member wrote in their survey that training given is excellent. And a nurse commented that she had been supported to complete a Care Homes for Older People Page 27 of 37 Evidence: diploma module in Dementia Care at York University, to ensure her knowledge was up to date. Well trained staff are more likely to provide the right care and support as they have a better understanding of why they do what they do. Care Homes for Older People Page 28 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home is generally run in the best interests of the people living there, more staff and more robust health and safety systems would help to enhance peoples lives and promote their safety. Evidence: There is an experienced manager in charge at South Park who has been registered with the commission to confirm her ability to manage a care home. She has completed extra management qualifications to help her in her role. One visitor said they had been visiting their relative at the home for a long time and the general trend is of improvement. People spoken with, who were able to answer, knew who she was and said she was approachable and available. One person wrote in their survey that the management are excellent. One carer said that the manager regularly walked around the home and they would feel quite comfortable going to speak with her if they had any concerns. The manager has a deputy who like the manager, is not counted in the staffing numbers so that they can address management issues. Care Homes for Older People Page 29 of 37 Evidence: The manager had several months away from work earlier this year and the deputy was in charge in her absence. The company has a senior management structure in place and more management support for the deputy at this time may have helped with dealing with issues at the home. The company has a quality monitoring scheme, where people living at South Park and their families are surveyed about how the home is running. These results are analysed and displayed in the home for people to look at. A letter is also sent to all people surveyed, informing them of the results, which also contribute to the homes action plan. Plans for changes, as a result of the surveys, also need to be made available so that people know that their views have been listened to. Local doctors are asked their views about the home runs each year, but the service should also consider surveying other professional people who visit, to get their views on what the home does well and how it can improve. The home holds residents and relatives meetings, though the last meeting, for which we were given minutes, was held in February this year. We were told that these meetings are poorly attended and the managers need to determine if there is a better way of sharing the sorts of information discussed at these meetings. The manager tells us that newsletters have been used recently to try to keep people and their families informed about matters discussed. Minutes of the meetings are also made available in reception for people to read. Senior managers employed by the organisation carry out and record monthly visits where they check that the home is running well. The managers also have to gather data each month to show that staff are monitoring peoples health and wellbeing properly. The home keeps some peoples personal monies on their behalf and maintains financial records and invoices to demonstrate that they are managiing these monies well. These records were looked at at the last inspection and were found to be robust. We have had no concerns raised about the way this process is managed so we did not look at these records during this visit. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. Hazardous products are stored appropriately and records maintained as required. Care Homes for Older People Page 30 of 37 Evidence: Monitoring arrangements are in place to ensure the delivery of safe hot water and minimise the risk of Legionella. The home employs a handyman who carries out regular checks so as to maintain the safety of the premises. The fire safety officer in his inspection, has identified some areas where the home is not doing all it should be doing to keep people safe if there were to be a fire at the home. Some fire safety records could not be found on the day of the visit. The company have provided us with a timescale for meeting these shortfalls however we have asked them to provide us with confirmation from the fire safety officer that they are satisfied with the homes proposals. Robust fire safety systems are needed to keep people safe in the event of a fire. Care Homes for Older People Page 31 of 37 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 32 of 37 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 8 13 Where people are assessed 13/12/2009 as needing specialist equipment to minimise the risk of developing a pressure sore then care staff must ensure that the equipment is always used, regardless of which chair they are sitting in. This will ensure their health and wellbeing is being promoted at all times. 2 10 12 The way staff speak with, and support, people must always ensure that the individuals privacy and dignity is being promoted. This is so that people are always treated in a way that is respectful. 13/12/2009 3 12 12 The practise of keeping 31/12/2009 people who are nursed in bed on Ebor, locked in their rooms, to protect them from others, must be reviewed. Page 33 of 37 Care Homes for Older People 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 This is so that it can be determined whether this way of working is in these peoples best interests in promoting as good a quality of life as possible. 4 12 16 People throughout the home 31/01/2010 must have access to a range of activities that are suitable for their abilities and interests. This is to make their lives more interesting and make one day different to another. 5 15 16 Those people requiring 31/12/2009 pureed meals must receive a varied and balanced meal at teatime. This is so that all people living at the home receive a varied and nutritionally balanced diet. 6 18 13 All staff employed at South Park must have up to date knowledge and understanding about what abuse means, and what they must do if they witness or are told of an incident where someone may have been harmed. 31/12/2009 Care Homes for Older People Page 34 of 37 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 This is so that incidents are reported promptly and systems can be put into place to keep people safe. 7 27 18 Staffing levels at the home 31/12/2009 and particularly on Ebor unit must be reviewed and kept under regular review, to ensure there are enough care staff available when people need them. This is so that people can be supervised properly and all their needs can be met. 8 38 23 Fire safety systems at the home must meet with the fire safety officers requirements. This is so that the risk of harm to people is minimised, in the event of a fire at the home. 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 18/12/2009 1 12 The monthly activities programme should be a true reflection of the activities on offer, so that people can rely on the information being accurate and can look forward to favourite events, knowing that they are likely to take place. People should be provided with adequate drinks to maintain their wellbeing and reduce the risk of health problems. 2 15 Care Homes for Older People Page 35 of 37 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 3 15 The home should consider assessing peoples ability to manage their meals independently and then providing special equipment where appropriate, to help promote their independence and life skills when eating their meals. Advice should be sought about the homes temperature control systems in summer to make sure that the home is at a comfortable temperature to live and work in. The bathing facilities on Jorvik should be looked at so that people who need a mobile hoist for transferring can still have a bath, on the unit in which they live. This would ensure peoples preferences and choices can be respected. The inner courtyards should be better maintained and more attractively presented so that people can benefit from the outdoor space. The home should carry out an internal check of the decor of the home and carry out the minor repairs and redecoration so that the home looks well maintained. The home should be more pro-active in managing unpleasant smells that are identified at the home. This will make the home a more pleasant place both for people living there and their visitors. Staff should be encouraged and supported to attain a National Vocational Qualification in Care as this can help them to understand good care and how to deliver it. The home should consider surveying health and social care professionals to gain their views on how the home operates. This may identify the need for changes to improve the service. When the annual customer satisfation surveys identify areas that could be improved on, then the home should write an action plan explaining how they will bring about these improvements. Displaying this for people to read will help to let people know that they have been listened to. 4 19 5 19 6 19 7 19 8 26 9 28 10 33 11 33 Care Homes for Older People Page 36 of 37 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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