CARE HOMES FOR OLDER PEOPLE
Higher Park Lodge Devonport Park Stoke Plymouth PL1 4BT Lead Inspector
Brendan Hannon Announced 19 July 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Higher Park Lodge Address Devonport Park, Stoke, Plymouth, Devon, PL1 4BT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 606066 01752 606066 Higher Park Lodge (Plymouth) Limited Mrs Deborah Ann Norman Care 25 Category(ies) of Dementia (25), Dementia - over 65 years of age registration, with number (25), Old age not falling within any over of places category (25) Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Service Users may be admitted who are 60 years of age or above. Date of last inspection 03/02/05 Brief Description of the Service: The service is a limited company called Higher Park Lodge (Plymouth) Ltd. The home is made up of a large detached building, approximately 100 years of age, overlooking Devonport park, with an attached purpose built extension to the rear of this building. The home is close to Stoke village in central Plymouth. A full range of amenities and facilities are within walking distance of the home in the Stoke village shopping area. The home can accomodate up to twenty five residents over three floors. It has a shaft lift serving all three floors though only a few of the residents need to use this facility. The main lounge is by the front entrance of the building and is non smoking. There is a second lounge on the first floor of the building. The dining room area is close to both the kitchen and the dining room on the ground floor. The ground floor of the extension opens onto a patio area. The home does not have a garden area but is adjacent to the large parkland area of Devonport park. There is one double bedroom in the home and all the others are single bedrooms. Due to the age of the original building many of the rooms have high ceilings which helps the home in general to feel more spacious. There is a shaft lift which provides disabled access to all parts of the home. The service offered by the home is primarily for people with dementia or significant mental frailty needs. Some of the residents have some mobility difficulties but mostly the residents are fully mobile. The residents have a mixed range of abilities. The home allows smoking in either the staff area or in the patio area to the side of the home.
Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced. Preparation for the inspection included analysis of resident comment cards, the pre inspection questionnaire, the previous inspection reports and correspondence with the home over the last 12 months. An inspection plan was developed from this information. The inspector was in the home for 7.0 hours between 9.30am and 4.30pm. The inspector was in contact with eighteen of the twenty five residents. The whole of the building was inspected. The registered manager, her husband, both of whom are directors of the company, and the deputy manager were spoken to at length. Care records, health records, medication records and health and safety records were inspected. Some policy and procedure was also inspected. What the service does well: What has improved since the last inspection?
The service has worked hard to continue to improve the paperwork system in the home. This includes gathering necessary care information before a resident is admitted, some additional elements to medication administration recording and management of various health and safety issues. The paperwork systems were seen being used effectively by the management. Renovation and redecoration of the home is ongoing. New carpet has been purchased for hallways and communal areas and will be laid when the painting of the corridors is complete. This redecoration is almost complete. All the
Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 6 bedrooms have been redecorated and re carpeted. The completion of these renovation and development works has considerably improved the comfort of the facilities in the building. A new aid call system has been installed throughout the building. Building Health and safety has continued to improve. Thermostatic control valves have been put on all the baths in the home. These valves make sure that the hot water cannot reach a scalding temperature at any hot tap in the home that a resident can use. Most of the radiators in the building have been covered. These covers make sure that residents cannot suffer a pressure burn from falling against a hot surface. Where further valves and covers remain to be fitted the risk has been assessed and documented and is being well managed till physical adaptations can be made. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 The home provides good information about the service to all potential new residents and their representatives enabling them to make an informed choice whether to use the service. EVIDENCE: Both the Service Users Guide and the homes Statement of Purpose were available. The information in these documents enables potential residents and their representatives to make an informed decision about whether to use this service. The home carries out a pre admission assessment for every new resident that enters the home. The home has its own pre admission form to use to gather information. Residents and care staff were observed and were spoken to during the inspection. Through this observation, looking at care plans, and looking at records, there was good evidence to show that the residents’ needs are being met. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 The delivery of resident’s care is good but is hampered by limited care planning and resident risk assessment. Improvements in these areas will further support the delivery of consistent, high quality care to the residents. Healthcare support and medication administration within the home are good, which helps to maintain the health of the residents. EVIDENCE: Resident’s care plans were sampled. All the residents had a care plan and individual risk assessment in place. The care planning system is clear, practical and easy to understand. The information held in the care plan document was too brief. There was not enough detailed information on either the resident’s assessed needs or the directions given to staff to meet these needs. There also needed to be more detailed information on all the risks affecting the resident and how these are being reduced to an acceptable level. This risk assessment should also include all the restrictions of choice or personal freedoms agreed to be in the residents best interests. An example of such a necessary restriction would be when a resident requires an escort to remain safe when they are outside the home. A more detailed care plan for each resident will further improve the quality of care support provided.
Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 10 There was good evidence of the involvement of healthcare professionals, such as the GPs and district nurses, supporting residents’ health. Medication is adequately managed through the use mainly of a monitored dosage system. Senior staff have received medication administration training. The Registered Manager stated that all the other care staff would also receive this external training. Medication storage and recording was well maintained. Care staff assist residents with the injection of insulin and take blood for the analysis of blood sugar levels. The staff have been trained by the District Nursing service to carry out these procedures. The management of the home was advised to obtain documentary support from the District Nursing service stating the ability of each care staff member to carry out this invasive procedure. Well managed medication administration supports the health of the residents. Most toilet and bathroom doors were found to have appropriate locks. However on some sliding toilet doors there was no lock fittted. All communal toilet and bathroom doors should be fitted with a lock that can provide privacy, and can be overidden from the outside in the event of an emergency. Bedroom doors have not been fitted with locks. Locks should be fitted to all bedroom doors with consideration of the needs of each resident. Where residents are not affected by dementia a lock should be fitted to provide privacy and also security for the resident’s personal belongings. Where it is considered inappropriate to provide the resident with a key, this restriction of resident choice should be documented in the residents individual risk assessment. To ensure the residents safety in the event of an emergency there should be a single master key that will open all key type locks. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,15 The home supports residents’ relationships both in and outside the home. The residents’ nutritional needs are met and residents receive enough good food. EVIDENCE: This section was not extensively inspected on this occasion but will be a central focus of the second inspection during this inspection year 2005 – 2006. The residents’ records describe the quality of the resident’s day and contact with friends and family from outside the home. Relatives of residents were met during the inspection all of whom spoke warmly of the care being received by their relative. These relationships help to maintain the residents quality of life. The food provided on the day of the inspection was seen. Resident’s food likes and dislikes are found out by the service. A four-week menu plan is in place but the food actually prepared is not rigidly dictated by this plan. The food provided is nutritionally balanced and wholesome, and will therefore help to maintain the health and quality of life of the residents. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Residents and the public have access to the complaints procedure and residents are protected from abuse. EVIDENCE: There is a good complaints procedure, which is distributed to residents within resident’s handbooks and this is kept available in the residents’ bedrooms. There is a complaints record detailing even the most minor verbal concerns that have been received to the home and how these have been resolved. Though the homes complaints procedure is available in the residents’ handbook it was advised that it also be displayed in a public area, such as the entrance hallway. The contact details for the CSCI are given in the complaints procedure. The home has all the required adult protection policies in place and all the homes staff have attended adult protection training. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,24,25,26 The quality of the environment in the building is maintained to a good standard helping to give the residents a good quality of life within the home. EVIDENCE: A complete tour of the building was made during the inspection. There is an original older building that has been extended to the rear of the property. No significant maintenance faults were seen in the building during the inspection. The decoration in communal areas was good. The bedrooms have been redecorated and personalised by the residents. Generally the facilities in the bedrooms are good. Over the past year the home has invested in new fire doors, redecoration, beds, mattresses, lighting and carpets. The residents enjoy a well decorated environment to live in. A shaft lift provides full physical disability access to all parts of the building. The home was very clean, hygienic and odour free. The bathrooms, toilets, kitchen and laundry were exceptionally clean and well maintained. Standard 26
Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 14 has been exceeded and the service is commended for cleanliness and hygiene within the home. The Registered Provider stated that all the radiators in bedrooms have been covered to eliminate the risk of pressure burns. However the radiators in corridors remain uncovered. All the radiators in the home should be covered. The Registered Provider stated that all the hot water outlets at baths have had hot water temperature control valves fitted reducing the temperature of the hotwater to a safe level. However hot water outlets at sinks remain to be adapted. All hotwater outlets available to residents should be adapted to eliminate the risk of scalds from hot water. This investment will give the residents a safer environment. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 Resident’s needs are met by enough competent and qualified staff. EVIDENCE: The pre inspection questionnaire and staff records showed that 50 of the care staff have achieved an NVQ2 care qualification. In addition three staff have achieved NVQ3 in care. The Registered Manager has completed a dementia care course and 50 of the staff team are presently engaged on another dementia care course. The residents are better cared for because the staff team is trained and competent to deliver care. The staff were seen throughout the inspection to be relaxed, patient and helpful when assisting the residents. The minimum care staffing level not including management or ancillary staff, is four staff on duty in the morning, three in the afternoon and evening and two waking staff at night. The Registered Manager stated that the staffing level in the home is adequate to meet the needs of the residents. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,37,38 The management of the home is effective and continues to ensure that the needs of the residents are met. EVIDENCE: The Registered Provider and Registered Manager is Mrs Deborah Norman. She has completed the Registered Managers Award, the NVQ4 in care and the D32/33 NVQ assessors award. She ensures that there is an open, positive and welcoming atmosphere within the home. Good interaction between the residents and staff was seen throughout the inspection. The management and staff were seen to be working well together. Well managed and motivated staff provide better quality support for the residents. The home has developed a quality assurance system. The Registered Manager was advised on possible changes that could be made to the present system to increase feedback and therefore make the results more meaningful. Various physical Health and Safety measures that should be put in place in the home are discussed within the environment section of this report.
Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 17 As noted under the environment section infection control is well managed in the home Each member of staff carries their own alcohol hand scrub with them throughout their work to use continuously and thereby reduce the potential for cross infection. The home carries out some limited open sluicing. The home was advised to have available for staff a full set of protective equipment when carrying out this procedure. The fire protection system was generally well maintained. Maintenance checks are being carried out. The home was advised to purchase some appropriate hold open devices to fit to self closing fire doors in order that residents may have their doors safely held open. Staff are receiving appropriate fire protection training. Gas and electrical appliances were being routinely serviced and checked. Good health and safety practice reduce any unreasonable risk, affecting residents or staff, to an acceptable level. Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 x 3 2 4 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x x 3 3 Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations All the residents should have a careplan in place which details all the residents needs and how staff are to meet these needs. Each resident should have a comprehensive and detailed individual risk assessment. This should include all the restrictions of, choice or personal freedoms, agreed to be in the residents best interests. All communal toilet doors and bedroom doors should be fitted with a lock that can both provide privacy, and be over ridden from the outside in the event of an emergency. All hot water outlets available to residents, i.e. sinks, should be fitted at the point of use with water temperature control valves. All the radiators should be covered or replaced with low surface temperature radiators. 2. 10 3. 25 Higher Park Lodge D52-D04 S3537 Higher Park Lodge V226798 190705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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