CARE HOMES FOR OLDER PEOPLE
Higher Park Lodge Devonport Park Stoke Plymouth Devon PL1 4BT Lead Inspector
Brendan Hannon Unannounced Inspection 9th February 2006 10:00 X10015.doc Version 1.40 Page 1 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 Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 Page 2 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 DS0000003537.V274502.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Higher Park Lodge Address Devonport Park Stoke Plymouth Devon PL1 4BT 01752 606066 01752 606066 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Higher Park Lodge (Plymouth) Limited Mrs Deborah Ann Norman Care Home 25 Category(ies) of Dementia (25), Dementia - over 65 years of age registration, with number (25), Old age, not falling within any other of places category (25) Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users may be admitted who are 60 years of age or above. Date of last inspection 19th July 2005 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 accommodate 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. This helps the home in general to feel more spacious. There is a shaft lift that 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 DS0000003537.V274502.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. Preparation for the inspection included analysis of the previous inspection report and correspondence with the home over the last 6 months. An inspection plan was developed from this information. The inspector was in the home for 5.5 hours between 10.00am and 3.30pm. The building was partially 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 and training 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 Registered Manager is developing a new care plan and risk assessment format for use in the home. The paperwork systems were seen being used effectively by the management.
Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 Page 6 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. Ongoing renovation and development of the home has considerably improved the comfort of the facilities. 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 DS0000003537.V274502.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 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 the following standard(s): 4,6 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 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 DS0000003537.V274502.R01.S.doc Version 5.1 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 the following standard(s): 7,9,10,11 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. EVIDENCE: Resident’s care plans were sampled. All the residents had a care plan and individual risk assessment in place. A new care plan format has been designed but has not yet been introduced. The information held in the existing care plan documents 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 going out of the home. A more detailed care plan for each resident will further improve the quality of care support provided. Medication is adequately managed through the use mainly of a monitored dosage system. Most staff have received medication administration training. The Registered Manager stated that the remaining four care staff would also
Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 Page 10 receive this external training. Medication storage was adequately maintained but the home’s management is advised to ensure that dosettes are always appropriately sealed. Medication recording was adequate. Care staff assist residents with the injection of insulin and take blood for analysis of blood sugar levels. The staff will be 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. Adequately managed medication administration supports the health of the residents. The home tries to support residents who are nearing death to remain in the comfort of the home. The Registered Manager stated that additional staffing would be provided at such times to ensure that the resident is never left alone. The home has a thorough policy and procedure covering death and palliative care. Standard 11 has been exceeded and the home is commended for the quality of the service provided in this area. Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14,15 The home supports residents’ relationships both in and outside the home. The residents’ nutritional needs are met and residents receive enough good food. EVIDENCE: The residents’ records describe the quality of the resident’s day and contact with friends and family from outside the home. Relatives of residents spoke warmly of the care being delivered. The residents participate in a range of activities. A new activity record has been established as well as being recorded in the resident’s personal record. Activities include chairobics, music and Bingo. The home provides trips out. Resident’s food likes and dislikes are found out by the service. A record of the food provided is kept in the homes main diary. 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, which will help to maintain the health and quality of life of the residents. Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 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 the following 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. The homes complaints procedure is displayed in 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 DS0000003537.V274502.R01.S.doc Version 5.1 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 the following standard(s): 19,21,24,25,26 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: The building was only partially inspected on this occasion but was thoroughly inspected at the last inspection in July 2005. There is an original older building that has been extended to the rear of the property. The quality of decoration and facilities in communal areas and bedrooms was found to be good. Over the past year and a half the home has invested in new fire doors, redecoration, new 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 Registered Manager stated that all the radiators in bedrooms have been covered to eliminate the risk of pressure burns. The remaining radiators in the corridors and communal areas remain to be covered. The Registered Manager stated that almost all the hot water outlets at baths and at sinks available to residents have had hot water temperature control valves fitted reducing the temperature of the hotwater to a safe level. The Registered Manager stated
Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 Page 14 that all the window openings above ground floor have been restricted to allow ventillation but eliminate the risk of falls from a window. This investment has given the residents a safer environment to live in. Toilet and bathroom doors have appropriate locks that can be overriden from the outside in the event of an emergency. Bedroom doors have not been fitted with locks. All bedroom doors should be fitted with a lock that can be locked from the inside to ensure the residents privacy, from the outside through use of an individual key to ensure the security of the residents personal belongings, and all these locks should be supported by a single master key to enable ease of access in an emergency. After fitting, when keys are retained due to the risk to the resident, this restriction should be documented in the residents individual risk assessment. Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Resident’s needs are met by enough competent, qualified and vetted staff. EVIDENCE: The pre inspection questionnaire and staff records showed that 50 of the care staff have achieved an NVQ2 care qualification. In addition two staff have achieved NVQ3 in care. 60 of the staff team have completed a dementia care course. The residents are better cared for because the staff team is trained and competent to deliver care. Staff personnel records were sampled and the required records were in place. The Registered Manager stated that there was a Criminal Records Bureau clearance in place for all the employees. 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 was advised to add her name to the rota record to show where she has covered a shift on the rota pattern. The Registered Manager stated that the staffing level in the home is adequate to meet the needs of the residents. Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36,38 The management of the home is effective and continues to ensure that the needs of the residents are met. EVIDENCE: The Registered Manager is Mrs Deborah Norman. She has completed the Registered Managers Award, the NVQ4 in care and the D32/33 NVQ assessor’s 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. The staff are receiving annual appraisals and one supervision session per year. A simplified system of supervision was advised in order that the frequency of sessions be increased to al least four sessions per year. Well managed and motivated staff provide better quality support for the residents. The home should further develop the quality assurance system. Possible changes that could be made to the present system to increase feedback from
Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 Page 17 some residents and relatives were discussed with the Regsistered Manager. The completed quality assurance system should be described in a procedure. The company was advised to establish a system of monthly unannounced regulation 26 visits by a representative of the company and from outside the management of the home. A short report on the visit should be given to the Registered Manager and to the CSCI. Most of the residents of the home need support to manage their personal money. This support is provided by relatives of the residents or through the Court of Protection. The home does not hold any money on behalf of the residents. Any money spent on behalf of the residents is invoiced from their representatives at the end of the month. Balance sheet are in place documenting expenditure and monthly reimbursement to the home. Health and Safety is discussed in the following section. As noted under the environment section infection control is well managed in the home. The home carries out some limited open sluicing. The home has made available a full set of protective clothing for staff carrying out open sluicing. The fire protection system is generally well maintained. Maintenance checks are being carried out. The home has purchased six magnetic hold open devices for self closing fire doors since the last inspection. Staff are receiving appropriate fire protection training. Gas and electrical appliances are being routinely serviced and checked. A mains wiring certificate is in place for the home. Good health and safety practices reduce any unreasonable risk, affecting residents or staff, to an acceptable level. Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 2 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 3 X 3 Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO 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. 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 OP7 Good Practice Recommendations All the residents should have a care plan 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 bedroom doors should be fitted with a lock that can be locked from the inside to ensure the residents privacy, from the outside through use of an individual key to ensure the security of the residents personal belongings, and all these locks should be supported by a single master key to enable ease of access in an emergency. All the radiators in the home should be covered or replaced with low surface temperature radiators. The quality assurance system should be further developed to contain a policy and procedure, and to find methods to
DS0000003537.V274502.R01.S.doc Version 5.1 Page 20 2. OP24 3. 4 OP25 OP33 Higher Park Lodge 5 OP36 get extensive feedback on the service from relatives and as far as possible residents. A policy and procedure for supervision of care staff and an effective format to use in supervision sessions should be introduced for all care staff. Supervision should take place at least four times per year. Higher Park Lodge DS0000003537.V274502.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Ashburton Office 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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