Inspection on 29/06/06 for Park Avenue Care Centre

This inspection was carried out on 29th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Park Avenue Care Centre 15/05/08

Park Avenue Care Centre 18/06/07

Park Avenue Care Centre 03/02/06

Park Avenue Care Centre 14/07/05

Park Avenue Care Centre 24/01/05

Park Avenue Care Centre 19/10/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Park Avenue Care Centre Park Avenue Care Centre 69 Park Avenue Bromley Kent BR1 4EW Lead Inspector Ms Pauline Lambe Key Unannounced Inspection 29th June 2006 09:30 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 Park Avenue Care Centre DS0000058005.V293167.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. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Park Avenue Care Centre Address Park Avenue Care Centre 69 Park Avenue Bromley Kent BR1 4EW 020 8855 0055 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) Park Avenue Healthcare Ltd Arlette Beebeejaun Care Home 51 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (18) of places Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2006 Brief Description of the Service: Park Avenue Care Centre opened in April 2004 and is located in a residential area of Bromley. Accommodation and facilities are provided over four floors, with access by passenger lift. The basement houses various services, such as training room, hairdressing salon, kitchen and laundry. The remaining three floors accommodate service users, all in single bedrooms with en-suite facilities. The ground floor has 15 beds and the first floor 18 beds, both of these are for residents with dementia who need nursing care. The second floor has 18 beds for older people who need nursing care. The home has a small garden to the rear off-street parking to the front and side of the property. The fees ranged from £575.00 - £670.00. Residents paid privately for person items, hairdressing, newspapers and chiropody care Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors from the Commission undertook this inspection over 8.25 hours. Since the last statutory inspection on 3rd February 2006 an additional visit was made to the service on 3rd May 2006 by an inspector and Bromley Social Services adult protection co-ordinator. This was done as part of an adult protection investigation. This inspection included talking to residents, relatives, management and staff. Time was spent inspecting records such as care plans, medicine, accidents, complaints, recruitment procedures, safety records and other records required to be kept by regulation. Comment cards were left with some residents and relatives and were sent to some relatives prior to the inspection. Positive feedback was received from relatives and others about the quality of service provided. What the service does well: What has improved since the last inspection? What they could do better: Improvements were needed to wound care planning and to ensuring staff implemented these. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 6 Management must provide a medicine policy and procedure relevant to this home. Activity records should show which residents attended the organised activities. Management must ensure complaints are responded to comprehensively answering all issues raised by the complainant. Fire safety training must be provided annually for all staff and attention must be given to ensuring window restrictors are used on windows above the ground floor at all times. Risk assessments must be completed for all residents prior to fitting bedrails. Equipment such as hoists and assisted baths must be serviced regularly and in line with safety regulations. 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. Park Avenue Care Centre DS0000058005.V293167.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 Park Avenue Care Centre DS0000058005.V293167.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): 3. Standard 6 did not apply. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Resident’s had their needs assessed prior to admission. EVIDENCE: Resident’s needs were assessed prior to admission and information was obtained from funding authorities. Letters were seen in the files to show that residents received confirmation that the home could meet their assessed needs. Park Avenue Care Centre DS0000058005.V293167.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, 8, 9 and 10. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Overall care plans were satisfactory with some improvements required to wound care documentation. Residents were supported to access healthcare services and the management of medication was good. However staff must have access to local procedures. Management must develop medicines procedures specifically for this home. Resident’s privacy and dignity was maintained. EVIDENCE: Six care files were viewed. Care documentation had improved since the last inspection. Care plans seen generally included specific information about the individual’s needs and preferences and were reviewed regularly. Improvements were needed to wound care plans. One resident had a wound on his ankle but did not have a care plan relating to this issue. Another resident had a wound care plan in place but the records indicated that staff were not following this in relation to the frequency of dressing changes. There was evidence in some of the care plans seen that relatives had been consulted. New documentation was being introduced, which should provide a more person centred approach to care planning. See requirement 1. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 10 There were records in files of visits from other professionals such the GP, chiropodist, dentist and optician. Residents said they could see a GP when needed. At the time of this inspection the dentist was visiting the home and gave positive feedback about the assistance offered by staff during his visits. The management of medicines were assessed on the ground floor unit and were found to be good. Records of receipt, administration and disposal of medicines were up to date and well maintained. Since the last inspection an extractor fan had been fitted to one wall. Staff had monitored the temperature in the medication storage area and this was kept within recommended limits. A local procedure about administration of medication was available to staff. Other medication procedures were for generic use throughout the company. Management must develop medicines procedures specifically for this home. A Copy of these procedures were sent to the pharmacy inspector for comment and to see if they comply with regulation. This issue will be reassessed at the next inspection. See requirement 2. All of the bedrooms were for single occupancy with en suite shower and toilet. Staff were observed interacting appropriately with residents and a number of residents said that staff were helpful and “very nice”. Park Avenue Care Centre DS0000058005.V293167.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 to 15. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Suitable and varied activities were provided and resident choice was promoted. Residents were satisfied with the meals provided and with the visiting arrangements. EVIDENCE: The home employed a full time activities coordinator who was responsible for facilitating regular activities and entertainment. Most activities took place in the activities room but some sessions such as exercises to music took place on the units. Individual activity records were maintained for residents but it was not always clear how many of the residents had taken part. Staff should ensure that records clearly reflect the activity sessions that each resident took part in. Some trips out had been arranged but were cancelled due to cost implications. Arrangements were being made to register all residents with the local dial a ride service in an effort to improve trips out of the home. Weekly entertainment such as singers and magicians visits had taken place and future planned sessions were displayed on the notice board. Relatives said they were made to feel welcome when they visited and were kept informed about issues involving their resident. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 12 There was some evidence that staff promoted resident choice. Residents said they were able to choose where they spent their day, what they ate and what to wear. Staff were observed offering residents choices. Lunch was observed on the ground and first floor units. A choice of meal was offered and residents were supported to eat where necessary. Residents spoken with were satisfied with the food provided. Comments included “The food is very good, I get a choice”, “the food is marvellous” and “the food has improved and I get a choice of meal”. This inspection took place on a very hot day and staff were observed offering and encouraging residents to drink plenty of fluids. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 13 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 and 19. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. The complaints procedure was followed but one complaint was not responded to in an appropriate manner. Staff had a good understanding of adult protection but the provider must ensure critical incidents are followed up internally once the investigations are completed. EVIDENCE: The home had received two complaints since the last inspection. The manager had investigated and responded to both of these in writing. The response to one of the complainants was not considered satisfactory, as the majority of the concerns raised were not answered. The manager told the inspector that a meeting had been held with the complainant to discuss all of the issues but there was no evidence of this meeting on file. See requirement 3. Comment cards received from residents and relatives indicated they knew how to make a complaint. The home had an adult protection procedure. The procedure provided adequate guidance for staff about the action they should take should an allegation of abuse be reported. The procedure was not dated and did not include a review date. The manager said the procedure was under review and she would advise senior management to include a review date on the revised document. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 14 Since the last inspection three adult protection concerns were reported. Staff from social services investigated two of these concerns and the recently appointed adult protection advisor for the company investigated one. Two allegations were not substantiated and one was ongoing. Although two of the allegations were not substantiated some recommendations were made in relation to record keeping and ensuring residents past history was taken into account at the time of admission. Since these incidents the provider has employed an adult protection advisor for the company and has been requested to ensure an internal investigation is undertaken following critical incidents occurring in the home in an effort to prevent a recurrence. Most staff had attended training about protection of vulnerable adults. Staff were aware of the need to report poor practice and allegations of abuse to senior staff. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 15 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 and 26. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. The home was maintained to a satisfactory standard and all areas were clean, tidy and free of offensive odours. EVIDENCE: The premises were maintained to a satisfactory standard. The inspectors were told that an environmental audit had been carried out during the previous week. The manager was advised that the temperature display panel, showerhead and the light outside the first floor bathroom were not working. The radiator thermostat valve in room 30 was broken. See requirement 4. Residents and relatives said the home was kept clean and tidy and this was the situation on the day of the inspection. Facilities were provided for staff to prevent the spread of infection. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 16 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 to 30. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. The home adhered to the staffing notice agreed with the Commission and over 50 of care staff had achieved NVQ 2 or above. Records seen showed that staff had access to training relevant to their role. Recruitment procedures complied with regulations. EVIDENCE: The staff team comprises of a full time manager, deputy, trained nurses, care assistants, domestic and ancillary staff. The number and skill mix of staff on the day of the inspection complied with the staffing notice. Rotas seen for a three-week period showed that the home had complied with the staffing notice agreed with the Commission over this period. Over 50 of care staff had achieved NVQ 2 or above with plans in place to provide this training to all care staff. The home had complied with an immediate requirement issued at the last inspection to audit all staff files. Three staff files were assessed and found to comply with regulation. Inspectors found that a number of staff were difficult to understand due to their poor command of the English language. This could make communication with residents difficult particularly those with sensory impairments or dementia. Relatives and residents seen also raised this issue as a concern. Management should ensure they listen to and if necessary act on these comments on behalf of residents particularly and relatives. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 17 Access to training for staff was good. Regular sessions were held in the home on a weekly basis some of the training was provided by senior staff and some by external trainers. Records indicated that staff had attended training sessions such as health and safety, falls management, death and dying, medication and nutrition. Staff spoken with said they received the training needed to fulfil their role. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 18 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): 31, 33, 35 and 38. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. The home had a registered manager in post and quality assurance systems were satisfactory. Records of personal allowance monies held for residents were good. Health and safety records were mostly good but some concerns were identified in relation to the use of window restrictors, bedrails and fire safety training for staff. EVIDENCE: The manager was registered with the Commission and has been assessed as having the skills and experience needed to manage this service. Regular meetings were held between the manager and trained staff. The minutes from the meetings in May 2006 showed that there was little input from the staff that attended. Records seen showed that the last meeting for care staff took place in February 2006. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 19 The home had a good system in place to monitor the quality of the service provided. This included weekly pressure sore audits and monthly audits of medication, health & safety and care plans. The manager said that satisfaction surveys were sent to residents and relatives annually to obtain feedback about the service. The Commission received a copy of the last satisfaction survey, which was undertaken in December 2005. Regulation 26 visit reports were supplied to the Commission regularly. Following inspections management compiled an action plan to address requirements and recommendations. The action plan was last updated on 27.06.06 and a copy was given to the inspectors. The home did not routinely keep personal money for residents. The only exceptions to this were where residents did not have any relatives and had an appointee. The inspector was advised that currently the home was holding the personal allowance for two residents. Individual records were kept for all money received and spent. Receipts were kept for all money spent for the benefit of the resident for example hairdressing and chiropody. One resident had a substantial amount of savings that were held in a non-interest bearing account. Consideration should be given to moving this money into an interest bearing account for the benefit of the resident. A random selection of health and safety records were examined for example fire safety, gas, electricity and lifts. Service certificates seen for hoisting and assisted baths were dated 1.8.05. The inspector was told that the equipment had been services but the certificates were not available. The manager was asked to fax these to the Commission. Following the inspection contact was made with the home regarding this issue and the inspector was told that the equipment had not been serviced as the company were changing the service contract. Therefore the manager was required verbally to have this equipment serviced by 17/7/06 and to inform the Commission in writing that this had been done. An immediate requirement was sent to the home by recorded delivery on 10/7/06 regarding this matter. See requirement 5. All of the records seen were satisfactory. Fire drills were held at times to include both day and night staff but records seen indicated that fire safety training had only been provided for two staff during the last year. Three windows on the top floor were fully opened when the inspectors arrived in the home and one window was fully open when the inspectors left. See requirement 6. Accident records seen were well maintained and provided adequate information about the event. It was not clear why one resident had bedrails as no risk assessment had been completed. See requirement 7. Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 20 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 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 3 X 3 3 3 X X 2 Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 21 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. 1. Standard OP7 Regulation 15 Requirement The Registered Person must ensure that wound care plans are prepared and implemented by staff. The Registered Person must develop local procedures relating to all aspects of medicine management. The Registered Person must ensure that full and detailed responses are made to complainants. The Registered Person must ensure the bathroom on the first floor is repaired and available for residents use. The Registered Person must ensure equipment provided for resident use is maintained in good working order. An immediate requirement has been issued to the provider to have the hoists and assisted baths must be serviced by the date set and written confirmation must be sent to the Commission to confirm compliance. The Registered Person must ensure that: DS0000058005.V293167.R01.S.doc Timescale for action 11/08/06 2. OP9 13 11/08/06 3. OP16 22 11/08/06 4. OP19 23 11/08/06 5. OP38 23 17/07/06 6. OP38 13 05/08/06 Park Avenue Care Centre Version 5.1 Page 22 7. OP38 13 Staff receive annual fire safety training • That window restrictors above the ground floor are used at all times The Registered Person must 11/08/06 ensure that risk assessments are completed prior to fitting bedrails. • RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Park Avenue Care Centre DS0000058005.V293167.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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