Care Home: Warwick Park House

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What the care home does well People who use the service and their relatives have the information they need to decide whether Warwick Park is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs. People receive a good standard of personal and nursing care. One person wrote " Its lovely here they are really kind". Communication with health care professionals in the community is good. The care people receive is good and provided in a safe and respectful way. Medicines are generally well managed at the home by the nursing staff. Staff at the home ensure people see the doctor or other health care professionals when they need to. The care planning systems and documentation at the home are generally good and means that staff know how to care for someone in a safe and consistent way that meets their individual needs and preferences. People have access to a good programme of activities and are able to maintain contact with their family and friends. People enjoy the activities at the home. People tell us that the food is good at the home and any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. People are safe at the home. Staff have had training to recognise signs of abuse and know how to report any suspicions or poor practice. Warwick Park is a safe and pleasant place to live and work. The manager and her staff group have suitable qualifications and experience to care for people who require nursing and personal care. The home is well managed by the manager and Provider. What has improved since the last inspection? At the last inspection six requirements were made, these were in relation to care planning and the care given by staff, medication practice, staff training, infection control and activities provided. These requirements have now all been met. In addition to this there has been further refurbishment throughout the home with areas being re carpeted and new furniture purchased including digital televisions for each bedroom. What the care home could do better: Staff must ensure that they follow the care as planned and that these plans are kept under review this means people will get the care they need at all times. Medication practice needs some improvement; handwritten prescriptions must be signed and checked by two members of staff so that errors do not occur. When new staff are recruited they must have all the necessary checks performed before they commence work, this includes two written references and a photograph. Key inspection report Care homes for older people Name: Address: Warwick Park House 17 Butt Park Road Honicknowle Plymouth Devon PL5 3NW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Caroline Rowland-Lapwood     Date: 1 1 1 2 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 27 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 27 Information about the care home Name of care home: Address: Warwick Park House 17 Butt Park Road Honicknowle Plymouth Devon PL5 3NW 01752772433 01752773242 warwickparknursing@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Warwick Park Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The home can provide care to 4 persons suffering with Dementia DE(E) named elsewhere. The Home is registered as a Care Home with Nursing for a maximum of 50 Service Users in the categories of PD(E)50, OP 10, TI 4 Date of last inspection Brief description of the care home Warwick Park Nursing home is registered to provide care, for a maximum number of fifty older people with physical frailty, disability or illnesses, who may need nursing care. The home is located in the Honicknowle area of Plymouth and is close to shops and near to a bus route. It is arranged on two floors with the communal lounges and dining room on the ground floor. There is level access to all parts of the home via a passenger lift and ramps. Level access is provided to a large secluded garden with a Care Homes for Older People Page 4 of 27 Over 65 4 10 50 0 0 0 1 3 0 1 2 0 0 9 Brief description of the care home variety of seating areas. There are thirty-two single bedrooms and nine double rooms, most benefit from en suite toilet facilities. The homes service users guide and the last inspection report can be found in the entrance hall of the home and in the homes office. Car parking is available in the grounds of the home. Fees start from £450 per week increasing depending on the level of need required. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection consisted of a visit to the home on thursday 10th December and Friday 11th December 2009. One inspector undertook the inspection, during this time we spoke to the manager who is the person with day to day responsibility for the service, the Registered Nurses and many other members of care and ancillary staff on duty. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. We looked at three staff recruitment records, induction and training records and Care Homes for Older People Page 6 of 27 policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Warwick Park. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Staff must ensure that they follow the care as planned and that these plans are kept under review this means people will get the care they need at all times. Medication practice needs some improvement; handwritten prescriptions must be signed and checked by two members of staff so that errors do not occur. When new staff are recruited they must have all the necessary checks performed before they commence work, this includes two written references and a photograph. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 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 10 of 27 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. The admission procedure is good and means that staff has enough information to decide whether they are able to meet the needs of the person. Evidence: There is a guide to the home, the Statement of Purpose, which gives people an idea of what to expect of the home. People returning CQC surveys told us they had received enough information about this home before they moved in, helping to ensure it was the right place for them. People spoken with during this visit told us they were happy living at the home, one said, Its very good here, another person told us I really think its wonderful I was not looking forward to coming but now I dont want to leave. Surveys from relatives show that the home always or usually give people the Care Homes for Older People Page 11 of 27 Evidence: support expected and agreed. Relatives comments were generally very positive, for example, They look after my mother and I have peace of mind and They cater for all my Dads needs and the staff are polite and cheerful. The home uses an assessment as a way of getting information about peoples needs and preferences before they move to the home. This helps to ensure that individual needs can be met. We looked at three assessments, all gave good information about peoples abilities, needs, usual routines and preferences to enable staff to plan and deliver care appropriately. The home does not provide intermediate care. Care Homes for Older People Page 12 of 27 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 people receive is provided in a respectful and person centered way. The care planning systems at the home are generally good and reflect how health and personal care needs are identified and met in a safe way. However some improvements are needed to ensure staff carry out this care properly. The management of medicines is satisfactory, however one aspect identified must be improved to ensure peoples safety. Evidence: Surveys received by people living at the home said they always or usually get the care and support they need. Health care professionals who visit the home are satisfied with the standard of health care provided. One health care professional comments that the home is proactive in recognising issues and problems and will seek early support advice or intervention to resolve issues. When we looked at the care of the three people we found that their health care needs are generally met. These people are registered with a doctor and see the chiropodist optician, physiotherapist or any other professional needed when necessary. Care Homes for Older People Page 13 of 27 Evidence: We looked at these peoples care plans and found that most were relevant and contained the information needed to care for the person properly. However,one persons care plan clearly stated that they were at risk of dehydration and should be offered drinks every hour, the fluid chart in the persons room had not been completed to show this had actually taken place therefore suggesting the person has been left to sleep and the care plan not followed properly.This practice puts people at risk. Most care plans contained a social profile but not all; the activities co-ordintaor has been working hard to develop this part of the care planning process so that activities can be matched to individuals choices. Staff were able to describe how individual care is delivered and had a good knowledge of the individual needs of each person. We saw people being moved properly with the appropriate equipment needed in a kind and sensitive way. The management of medications is generally performed well at the home. We looked at where medications are stored in trolleys or locked cupboards. The senior trained nurses are responsible for management of the medication from receipt to disposal. Medicines are supplied mainly in a monitored dose system. The medication trolleys were clean, tidy and securely stored. A spot check of controlled drugs was performed and found to be correct and managed well. The records of administration were clear. Several people had hand written prescriptions which were not signed, this is not good practice and people could be at risk of error. To aid identification of the person to receive medication the records have photographs of each individual person living at the home who were in receipt of medication. All medications for disposal are recorded and signed for on collection as per the company and government policy. We received feedback from some health care professionals it said people are always treated with respect. We saw evidence of this, for example, staff were heard to talking to people in a kind and sensitive way and were seen knocking on bedroom doors before entering. During the inspection people looked cared with the finer details such as eye care, nail care and appropriate foot wear present. People told us that they were pleased with the attention they received from the majority of the staff. One person said I could not get better care even if I was the Queen of England. We spoke with on person who has diverse religious needs, she confirmed that the staff respected her wishes but still invited her to all the activities and celebrations at the home to attend if she wished to. Care Homes for Older People Page 14 of 27 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. People who use this service enjoy a peaceful, pleasant yet varied life, with family and local community links maintained and encouraged. Various activities are made available on a regular basis. Good quality meals are provided. Evidence: There is a full time Activities Organiser, a full timetable of events is in place. One to one activities take place in the mornings for those people who stay in bed, this maybe reading to them, giving them a mini manicure or just simply talking with them. Many of the people spoken with originated in the locality and have links with local churches, these links are encouraged and support is given to maintain them. Some of the people said they preferred to remain in their rooms reading or watching television but added that they joined selected activities from time to time. A good stock of books and DVD/videos are held. There are also opportunities for painting, knitting, quizzes, bingo and craftwork. One person said of the activities organiser, She is lovely full of fun. When asked about food peoples responses varied from Food is generally good it depends really, Cant complain about the food, Good food here, and Food not Care Homes for Older People Page 15 of 27 Evidence: that good , it varies. All spoken with said that they were given sufficient to eat and mentioned the availability of evening drinks and snacks. The dining tables were laid with menu, linen tablecloths and napkins, a bowl of fresh fruit, condiments and a choice of water or orange juice. During the morning people are advised of the choices for lunch and tea but if the selection is not to their liking they may choose from a wide range of alternatives. Some people chose to eat in their bedrooms or in a lounge where assistance was given as necessary in a suitable manner. Care Homes for Older People Page 16 of 27 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. People can be confident that their complaints will be listened to and staff understand the principles of adult protection, which helps to protect people from abuse. Evidence: People responding with CQC surveys knew how to make a complaint and knew who to speak with should they have any concerns. People felt the manager, and the staff were approachable and would listen to them and always act on what they say. Relatives were also aware of how to make a complaint and told us that concerns were responded to. Outside professionals were confident that complaints or concerns were responded to appropriately. The Commission has received two complaints about this service since the last inspection, each has been investigated in a professional and timely way. Training records showed that staff receive adult protection training to ensure they are aware of the issues and know who to raise any concerns with. Staff spoken with said they had attended training and had a good understanding of adult protection matters and understood their personal responsibility to report incidents of concern. People spoken with confirmed that they were happy living at the home and all said they felt safe at the home. Care Homes for Older People Page 17 of 27 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. Warwick park provides a safe, clean and comfortable home with a good standard of furnishings, which offers a pleasant environment for people to live in. Evidence: The home has car parking facilities and pleasant gardens to the rear of the home. The main entrance is provided with information and an administration person is able to greet and open the door to people arriving at the home. Secure locks to the doors are provided for the safety of the people living there. Communal areas consist of two lounges, a dining room and an eating area within the second smaller lounge. A television is on in the main lounge during the course of the day. Bedrooms are available on the ground and the first floor of the home. A passenger lift serves the first floor of the home. People living here were happy with accommodation provided. People are encouraged to personalize their private bedrooms with their own furniture, and other items such as pictures and photographs. Many areas have been re carpeted since the last inspection and every room now has a digital television. The home was found to be clean and a good supply of aprons and gloves are available to staff to use to prevent the spread of infection. There is a team of five Cleaners to Care Homes for Older People Page 18 of 27 Evidence: cover the home seven days a week, four of whom have obtained an NVQ qualification. The home now has a dedicated sluice facility on the ground floor this is an improvement made since the last inspection, staff said it has been a great asset in the prevention of infection control. The laundry is well equipped, clean and well organized. A red bag system is used for any soiled laundry ensuring staff are protected. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. All maintenance records are up to date and evidence the regular servicing of equipment in the home. Care Homes for Older People Page 19 of 27 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. Staffing levels are sufficient to ensure that peoples needs are met in a timely way. People benefit from having experienced, competent and friendly staff who have a good understanding of their needs. Recruitment practice must be improved to ensure people safety. Evidence: People returning surveys to us told us that staff were always available when needed. During our visit people told us, they are pretty good, I dont usually have to wait long. People living at the home were generally very happy with staff attitude and approach, We received many positive comments, including, They are very good, Staff are marvellous, and really good. We looked at the files of three members of staff included the most newly recruited to ensure that the home operates a robust recruitment procedure, which protects people. These did not contain all of the required documentation to ensure that people living at the home are protected from unsuitable staff. One file had no photograph and only one reference, another had no dates of previous employment. Staff surveys showed that they were well supported when they first started working at Care Homes for Older People Page 20 of 27 Evidence: the home. We were told that the induction provided covered everything they needed to know. Staff spoken with during our visit said they felt well supported and that good training opportunities were available to them. Records at the home show that new staff receive a structured induction. All staff are up to date with mandatory training such as Moving & Handling, Protection of Vulnerable Adults, Fire Prevention, and Infection Control. Care Homes for Older People Page 21 of 27 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 home is well managed by the Manager. There are good arrangements in place to involve people in the running of the home. The systems in place to ensure that peoples personal monies are correctly managed should be improved. Health and safety is well managed. Evidence: The home has a full time manager and a newly appointed deputy both these senior staff members are qualified nurses. An administrator has responsibility for supporting the home with paper work requirements to include for example drawing up the contracts of care for the people in the home. Two directors of the Company undertake the responsible individual role and visit the home very regularly. One of the directors was at the home on both days of the inspection. Care Homes for Older People Page 22 of 27 Evidence: A quality audit of the whole of the home was undertaken last year, it is planned that questionnaires will be sent out in the near future to people living at the home to seek their thoughts about further improvements. Regular meetings are held for people living at the home to discuss any changes or seek suggestions about how the home may improve. Procedures for managing any finances of the people in the home are in place. People are encouraged and able to manage their finances should they so wish with a safe storage facility provision provided. Where this is not possible the home is able to offer support and hold money in safe keeping if required. A random audit confirmed that finances were being held securely but balances were not always correct. Two records checked showed monies to be under and over what should have been there. These are minor discrepancies and whilst no inference of deceit is inferred this process should be improved to ensure all balances are correct at all times. Staff are receiving regular supervision which covers all aspects of practice, career development and the philosophy of care in the home. Mandatory training is provided for all staff at the home, training records showed staff were up to date with this. Fire safety is generally well managed, for example fire equipment such as fire extinguishers and fire alarm are serviced and tested regularly. Records showed that maintenance of equipment and systems, such as gas and electrical systems, and equipment such as the passenger lift, and hoists were up-todate. Care Homes for Older People Page 23 of 27 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 24 of 27 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 7 15 The care plans must be up to date and staff must carry out what the plan states. This will ensure people get the care they need to keep them safe and well. 31/01/2010 2 9 13 Hand written prescriptions 31/01/2010 must be checked and signed by two people. This will ensure people are kept safe. 3 29 19 Staff files must contain all the necessary checks as prescribed by the regulations. This will ensure people are cared for by people suitable to do so. 31/01/2010 Care Homes for Older People Page 25 of 27 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 35 Improvements are needed to ensure the correct balance is shown on all accounts held for people. Care Homes for Older People Page 26 of 27 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). 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