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Care and Social Services Inspectorate Wales
Care Standards Act 2000
Inspection Report
Manor Park
Green Street Holt
LL13 9JF
Type of Inspection – Focussed Date(s) of inspection – 8 January 2014
Date of publication – 27/01/2014 You may reproduce this report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers
Please contact CSSIW National Office for further information Tel: 0300 062 8800
Email: [email protected]
www.cssiw.org.uk
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Summary
About the service
Manor Park Residential Home is privately owned and situated in Holt. The property is a three storey building with a passenger lift to all three floors. The responsible individual is Veronica Rose Jepson (known as Nicki) and the registered manager is Karen Wadman. The home is registered with the Care and Social Services Inspectorate Wales (CSSIW) to provide accommodation and personal care for up to 28 older people with dementia.
What type of inspection was carried out?
We, CSSIW carried out an unannounced inspection on the 8 January 2014. It was a focussed inspection from 10.30 am to 3.15 pm looking specifically at the quality of life for people living at Manor Park. Prior to the inspection we had sent the home a self assessment form that they had completed and returned within the required timescale. We also sent out questionnaires to people who live, work or have relatives in Manor Park. We received completed questionnaires from four relatives and one member of staff. People who live at the home would not be able to complete a questionnaire without assistance. The responses received in the questionnaires are incorporated into this report. On the day of the inspection we reviewed three care records and undertook a brief tour of the home. We spoke to the responsible individual, the manager, three staff, four people who lived at Manor Park and one relative who was visiting. We also used undertook a short observational framework (SOFI), which is an assessment tool used by CSSIW to observe care practice.
What does the service do well?
The responsible individual is aware of up to date practice in relation to dementia care environments and is continually improving the home in line with this guidance.
What has improved since the last inspection?
Work in some areas has already been completed to improve the environment for people with dementia.
What needs to be done to improve the service?
The home is non compliant with the Care Homes (Wales) Regulations 2002 15 (1) regarding care plans. A non compliance notice has been issued. The home is non compliant with the Care Home (Wales) Regulations 18 (1) (c) (i) regarding staff training. A non compliance notice has been issued. Good Practice Recommendations
Systems should be put in place to improve the laundry service to make sure that people are only receiving and wearing their own clothes. National Minimum Standard 14.4. Serious consideration should be given to providing training in person centred care for the manager and staff. National Minimum Standard 23. Due to the nature of the homes registration, serious consideration should be given to the
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manager and staff attending advanced training in dementia. National Minimum Standard 23.
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Quality of life
Overall people can be confident that their needs can be met at Manor Park. The majority of people living at the home were not able to tell us about their experiences. We spoke to four people who were able to tell us that they were satisfied with the care they received at the home. People told us they were well looked after. People said they liked the food. We saw that people clearly had a good relationship with staff and were treated with courtesy and respect. We observed the lunchtime meal being served. We saw that people were offered choices of meals and drinks. People were encouraged to eat meals and alternatives were offered to tempt people who were reluctant to eat. We saw assistance being offered discreetly and staff talking to people while doing so. People cannot be confident that their records are person centred. We looked at three care records. We saw that these contained details of people’s needs but were not person centred. There was no evidence that efforts had been made to find out about people’s life histories and used this to inform a care plan. On one record we saw that the person had moved into the home in November 2013. A copy of the funding authorities care plan was on file but the home had not developed their own care plan to give staff information and guidance about the person’s needs and how these were to be met. The manager told us that it was normal practice for the care plan not be in place for several weeks until the home had become familiar with people’s needs and in the interim staff were able to read the pre admission assessment. This is a breach of the Care Homes (Wales) Regulations 2002, 15 (1) and a non compliance has been issued. There was no information on care records on care records about people’s diagnosed medical conditions including diabetes, Parkinson’s or seizures. Following the inspection, the manager told us that they had sourced specialist care plans to cover these topics and they would be completed as soon as practicable. On one record there was no risk assessment for falls although this had been identified in information supplied by the funding authority. One survey completed by a relative described staff as, “always friendly and welcoming”. Staff were described as, “lovely, friendly and caring”. Three relatives who completed our questionnaires rated the laundry service as ‘average’. Comments included that the wrong clothes had been found in people’s rooms. A visitor spoken with during the inspection, (who had not completed a questionnaire), confirmed that they had on rare occasions seen their relative dressed in someone else’s clothes. This does not afford people dignity and respect. We noted that the home did not employ housekeeping staff to manage the laundry. This work was undertaken by care staff in between caring responsibilities. We discussed this with the manager who was aware of the issue. Relatives who completed our questionnaire raised concerns about the lack of appropriate activities. Two people rated the provision of activities as average, one as poor and one as very poor. Some relatives noted that staff did not always have time to sit and talk to people as they were usually very busy. The manager told us that the home did not employ anyone to undertake activities but this was done by care staff. We have noted elsewhere in this report that care staff are also responsible for the laundry. The manager said that the home had specialist equipment for activities, but on the day of the inspection we only saw normal size dominos and a normal size jigsaw being used. The manager told us that they had obtained some specialist reminiscence equipment, including posters, that were waiting to be displayed. We saw that staff were engaging with people encouraging them to exercise to music in the morning of the visit. A list of
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activities for the week was put up after we arrived. It included the exercise and a visit by the hairdresser. The manager told us that an entertainer visited every month and people were supported to go out on trips. People had been to the Blackpool illuminations and on a boat in Chester during 2013. Arrangements were being put in place for people to be offered support to go to the local pub if they wanted to for meals. This had been tried over Christmas and had been very successful. The responsible individual told us that she visited the home at least twice a week and spent time with people, including offering activities and one to one time. They were advised to record this and consider including it on the activities programme.
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Quality of staffing
The inspection did not look at this section in detail and it will be looked at during a future inspection. However, we noted that neither the manager, responsible individual or staff were familiar with the principles of person centred care. We have been notified by our professional colleagues in the local authority that in depth dementia training was offered to the home in 2013 but they were unable to accept this due to staff shortages. This meant that staff may not be fully aware of the complex issues relating to providing good quality and appropriate care services to people with dementia. People cannot be confident that staff have access to training appropriate to their work. Training records showed that not all staff had completed mandatory training and some mandatory training had been allowed to expire. The range of training available was limited. This meant that staff may not have access to up to date information about good practice. This is a breach of the Care Home (Wales) Regulations 18 (1) (c) and a non compliance notice has been issued. .
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Quality of leadership and management
The inspection did not look at this section on this occasion; it will be looked at during a future inspection.
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Quality of environment
The inspection did not look at this section in detail and it will be looked at during a future inspection. People can be confident that the home provides a comfortable environment. The responsible individual, invited us to see the improvements that had been made since the last inspection. They were aware of good practice guidance in relation to environments providing care for people with dementia and the home was being refurbished and improved. This meant that all the bedrooms and the dining room had been redecorated and consideration given to providing an appropriate colour scheme to promote a calm atmosphere for people. Three bathrooms and toilets had been refurbished and high standing toilets installed. This meant that there was no need for additional equipment to make the toilets accessible. We saw that pull cords were plastic so that they could be easily cleaned and reduce the risk of healthcare related infections.
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How we inspect and report on services We conduct two types of inspection;
baseline and focussed. Both consider the experience of people using services.
Baseline inspections assess whether the registration of a service is justified and
whether the conditions of registration are appropriate. For most services, we carry out these inspections every three years. Exceptions are registered child minders, out of school care, sessional care, crèches and open access provision, which are every four years.
At these inspections we check whether the service has a clear, effective Statement of Purpose and whether the service delivers on the commitments set out in its Statement of Purpose. In assessing whether registration is justified inspectors check that the service can demonstrate a history of compliance with regulations.
Focussed inspections consider the experience of people using services and we will look at compliance with regulations when poor outcomes for people using services are identified. We carry out these inspections in between baseline inspections. Focussed inspections will always consider the quality of life of people using services and may look at other areas.
Baseline and focussed inspections may be scheduled or carried out in response to concerns. Inspectors use a variety of methods to gather information during inspections. These may include;
Talking with people who use services and their representatives
Talking to staff and the manager
Looking at documentation
Observation of staff interactions with people and of the environment
Comments made within questionnaires returned from people who use services, staff and health and social care professionals
We inspect and report our findings under ‘Quality Themes’. Those relevant to each type of service are referred to within our inspection reports. Further information about what we do can be found in our leaflet ‘Improving Care and Social Services in Wales’. You can download this from our website, Improving Care and Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW regional office.
Care Homes for Older People (GIRPT01E1.0001038077) Version 8.1 July 2012
Care and Social Services Inspectorate Wales
Care Standards Act 2000
Non Compliance Notice Care homes for older people
This notice sets out where your service is not compliant with the regulations. You, as the
registered person, are required to take action to ensure compliance is achieved in the timescales specified.
The issuing of this notice is a serious matter. Failure to achieve compliance will
result in CSSIW taking action in line with its enforcement policy.
Further advice and information is available on CSSIW’s website
www.cssiw.org.uk
Manor Park
Manor Park Green Street
Holt LL13 9JF
Date of publication – 27/01/2014
You may reproduce this notice in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers
Please contact CSSIW National Office for further information Tel: 0300 062 8800
Email: [email protected]
Care Homes for Older People (GIRPT01E1.0001038077) Version 8.1 July 2012
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Care and Social Services Inspectorate Wales
North Wales Region Government Offices
Sarn Mynach Llandudno Junction
Conwy LL31 9RZ
03000625609 03000625030
Home: Manor Park
Contact telephone number: 01829 270318
Registered provider: Manor Park Residential Home Ltd
Registered manager: Karen Wadman
Number of places: 28
Category: Care Home - Older Adults
Dates of this inspection from: 8 January 2014 to:
Dates of other relevant contact since last report:
Date of previous report publication: 27 September 2012
Inspected by: Sue Hale
Care Homes for Older People (GIRPT01E1.0001038077) Version 8.1 July 2012
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Quality of life
Non compliance identified at this inspection and action to be taken
Action to be taken Timescale for completion
Regulation number
All people living in the home must have a care plan as soon as practicable. Care records should be person centred.
15/03/14 15 (1)
Risk assessment must be in place where risks are known. They should include measurers put in place to reduce or manager risk.
01/02/14 13 (4) (c)
The service is in breach of the Care Homes ( Wales) 2002 Regulations 15 (1) regardiing care plans. The evidence includes: One care record looked at showed that the person had moved into the home on the 21 November 2013. It had been a planned admission and a pre admission assessment had been undertaken on the 19 November 2013. When we visited on the 8 January 2014 the home had not developed a care plan giving staff information about the person’s health, personal and care needs. The manager told us that this was normal practice and staff used the pre admission assessment form to find out about people’s needs. There was no information about the persons’s life history and plans were not person centred.. There was no information on the person’s record about a diagnosed medical condition, no care plan relating to this or a nutritional care plan linked to this condition. On a second care plan we saw that there was no care plan or risk assessment for a recent health problem. The evidence indicates that there is a delay of some weeks before care plans are developed. The impact on people may be that staff are unaware of all the person’s needs and these may therefore not be met. The service is in breach of the Care Homes ( Wales) 2002 Regulations 13 (4) ( c ) regarding risk assessments. The evidence includes:
On one record we saw that the person had a history of falls. There was no risk assesment in relation to this.
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There was no risk assessment in place in relation to risks associated with known health conditions including diabetes and a possible diagnosis of epilepsy. The evidence indicates that record keeping about known risks is not robust. The impact on people may be that risks to their health and welfare are increased by the poor record keeping and lack of awareness of staff on how to reduce risks.
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Quality of staffing
Non compliance identified at this inspection and action to be taken
Action to be taken Timescale for completion
Regulation number
All staff should receive training appropriate to their work. Training courses should be booked by the date given. Fire safety training must take place as soon as possible. A member of staff qualified in first aid must be available on every shift.
15/03/14 18 (1) (c) [i]
The service is in breach of the Care Homes ( Wales) 2002 Regulaitons 18 (1) ( c ) (i) regardiing staff training..
The evidence includes: Training records supplied by the home showed that 16 staff were employed. Five staff had not completd any fire safety trainiing. 12 staff had not completed any fire safety training since July 2011. This meant that no members of staff had completed up to date fire safety training. One member of staff had completed health and safety training in July 2009 and one person had completed this in May 2010. This meant that 14 staff had not completed any training in health and safety. Records showed that 12 staff had completed training in first aid. However, three courses had been completed in 2009, five in 2010, two in 2011 and two in 2012. It was not clear from records how long the course attended was valid for, some courses are valid for three years. Four staff have not completed any training in first aid. We could not evidence that a member of staff qualified in first aid was available on every shift. Records showed that four staff had not completed any training in infection control. One person had completed this training in 2009, six in 2010 and five in 2011. Training records showed that the home did not provide any training on specific medical conditions such as diabetes, continence, Parkinsons although people with such condiitons were accomodated at the home. Records showed that the home did not provide staff with any training on how to support people at the end of their life. Records showed that seven staff had completed training in how to manage medicines safely. However, two people had completed this in 2010, four in 2011 and one in 2012. This means that staff may not be up to date with current good practice advice.
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Although the home is registered to accommodate people with dementia only three members of staff have completed training in the Deprivation of Liberty ( DoLs), legislation and its implications for people living at Manor Park. This training took place in 2009. The evidence indicates that the home offerers a limited range of training and has allowed mandatory training to expire. The impact on people may be that staff do not have up to date knowledge and skills.
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Quality of leadership and management
Non compliance identified at this inspection and action to be taken
Action to be taken Timescale for completion
Regulation number
None
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Quality of environment
Non compliance identified at this inspection and action to be taken
Action to be taken Timescale for completion
Regulation number
None
