Inspection on 03/02/06 for Park Avenue Care Centre

This inspection was carried out on 3rd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Park Avenue Care Centre 15/05/08

Park Avenue Care Centre 18/06/07

Park Avenue Care Centre 29/06/06

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 Vacant Unannounced Inspection 3rd February 2006 09:00 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 Park Avenue Care Centre DS0000058005.V278052.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.V278052.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.V278052.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22 September 2005 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 samll garden to the rear of the property and some off-street parking to the front and side. Park Avenue Care Centre DS0000058005.V278052.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 8.75 hours. Since the last statutory inspection on 14th July 2005 an additional visit was made to the22nd September 2006 to review progress made with meeting requirements and recommendations. 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 left in the home for distribution. At the time of writing this report two feedback forms were received from visiting health professionals and five from relatives. Comments made on these were positive about the service provided. What the service does well: What has improved since the last inspection? What they could do better: Care must be taken to ensure correct storage of all medicines including topical preparations. Accurate medicine administration records must be kept including Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 6 recording the amount given when a variable dose was prescribed. Management should ensure staff are provided with local medicine policies and procedures. All complaints made about the service must be fully investigated in line with the home’s policy and procedure. Management must ensure that any review of accident records includes an action plan to show how risks identified will be reduced. The policy and procedure on adult protection must be reviewed to ensure it provides clear guidance as to the action staff must take in the event of an allegation or suspicion of abuse being reported. Management must ensure staffing levels adequately meet the needs of the residents and adhere to the levels agreed with the Commission at all times. Management must ensure reports are sent to the Commission as required by regulation 26 and 37. An immediate requirement was left with the provider in relation to poor recruitment practice. The Commission will monitor and review compliance with this and improvements made to recruitment procedures. 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.V278052.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.V278052.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): 1 and 4. Standard 6 does not apply to the home. A service user guide was provided which complied with regulation. Residents received written confirmation that the home could meet their assessed needs at the time of admission. EVIDENCE: Since the last inspection the service user guide had been updated. A copy of the revised document was given to the inspectors. Residents received written confirmation that the home could meet their needs based on assessment. Copies of the letter were seen on resident files. Park Avenue Care Centre DS0000058005.V278052.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 and 9. Improvements had been made to medication management and care planning and this should enhance resident care. EVIDENCE: Four care plans were inspected and showed improvement had been made to care planning since the last inspection. Care plans had been prepared to address needs identified through assessment. The care plans on the middle floor were a bit confusing as each care plan did not address one specific need and clearly show how this was being met. For example the care plan for delivery of personal care also referred to pressure area care and diabetic care. All the care plans inspected had a care plan prepared in relation to breathing yet the assessment did not indicate the resident had and breathing issues. The manager should discuss this issue with staff. Care plans had been reviewed and there was evidence on some of the files seen of resident or relative involvement in preparing these. Medicines were being stored in a clinical room in the basement. The temperature in this room was being monitored and was mostly satisfactory. The records showed that the room temperature was running between 24 and 26 C degrees. If during the summer months the room temperature increases a Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 10 cooling unit may need to be provided. Records for receipt, administration and disposal of medicines were satisfactory. On the top floor external medicines were not stored correctly. On the administration charts the actual dose administered was not recorded when a variable dose was prescribed. A local medication procedure had been written and a copy was given to the inspectors. This procedure was not seen on the two units inspected and did not include guidance on how to record the amount given when a variable dose was prescribed. Currently unused medicines were returned to the supplying pharmacist for disposal. Requirement 1 and recommendations 1 and 2. Park Avenue Care Centre DS0000058005.V278052.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, 14 and 15. There was improvement in the provision and recording of activities and involvement of residents in making personal choices. A number of residents commented that meals had improved but some concerns were raised about the choice of evening meal. EVIDENCE: The home employed a full time Activities Coordinator. Activities records were maintained for each of the residents. Records indicated that residents had taken part in exercise classes, music and movement sessions, cookery and word games. An entertainment programme was displayed and some of residents commented that they had enjoyed some of these sessions. The activities room was well equipped with arts and crafts and sensory materials. Some of the relatives and residents expressed concerns about the level of “mental stimulation” provided but did acknowledge that some of the residents were reluctant to take part in activity sessions. During feedback it was agreed that the manager would make activity records available to residents and relatives. There was some evidence that residents were involved in care planning, meal choices and could decide how and where they spend their day. Residents were able to bring personal belongings into the home to keep in their rooms. From Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 12 talking to residents the inspectors got the impression that residents were not able to return to bed during the day. See comments under standard 27. Residents said this was because there were not sufficient staff on duty to accommodate this. The home had an access to records policy. A number of residents said that food had improved and they generally enjoyed their meals. Breakfast on the day of this inspection included cereal, toast and a choice of cooked meal. During lunch it was evident that a choice of meal was provided this included the dishes listed on the menu and a range of alternatives such jacket potato, omelette and salad. Some of the residents said that the evening meal was repetitive consisting of soup and sandwiches. The menu included a cooked choice but it was unclear whether residents were offered this. Recommendation 3. Park Avenue Care Centre DS0000058005.V278052.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 18 Complaints were generally well managed but some improvements were needed to the homes adult protection procedure to ensure the safety of residents. EVIDENCE: The homes complaints procedure was displayed. A system was in place to record all complaints received in the home and to show how they had been managed. Six complaints had been received since the last inspection. All of the complaints had been investigated in line with the homes procedure. The records also showed that staff had contacted the complainant at a later date to ensure they had no further concerns about the issue raised. The commission have been made aware of an ongoing complaint involving the manager and a care manager. The initial handling of this complaint was poorly managed. Since the last inspection the home had received twelve thank you letters from relatives. The home has an abuse policy and procedures. The current procedures must be reviewed to ensure that staff have clear guidance regarding what action to take in the event of an allegation being reported. Staff had a understanding of what abuse was and the need to report any suspicion of abuse to senior staff on duty. At the time of this inspection one allegation of abuse towards a resident had been reported and was being investigated by the police. The commission will be informed of the findings. Requirement 2 and 3. Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 14 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 The home was clean, tidy and satisfactorily maintained. EVIDENCE: The home was clean, tidy and odour free. Maintenance issues identified at the previous inspection had been met and no new issues were identified. From a brief view of the kitchen this area was clean and tidy and equipment was in working order. The cook maintained good records in relation to food hygiene matters. An environmental health visit was made to the home on 01.03.05. All of the issues identified during this visit had been addressed. Park Avenue Care Centre DS0000058005.V278052.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, 29 and 30 Concerns were identified in relation to staff recruitment and staffing levels. Failure to address these issues could compromise resident safety. Access to training for staff was satisfactory. EVIDENCE: The off duty rosters for the two weeks commencing 23.01.06 did not indicate that the staffing levels agreed with the Commission at the time of registration were always met. On the day of the inspection there were inadequate staff numbers on the first and second floor. On the first floor one member of staff was trying to serve and assist with breakfast on her own whilst the other two carers were getting residents up. Staff told the inspector that they were aware on the previous day, that they would be short of staff on the early shift on this floor. There was no evidence to suggest that action had been taken to cover the shift. After this matter was discussed with the registered provider a staff member was moved from the ground to the first floor. On the second floor a number of residents and relatives raised concerns about the “morning rush” and inadequate staffing levels. In the minutes of two relative meetings it was recorded that relatives had raised concerns about staffing levels. In view of the concerns identified and comments made by residents, relatives and a care manager in relation to staffing levels the Commission will meet with the provider to review staffing levels within the home. Four staff recruitment files were inspected. One of the four files contained all of the information required by regulation. The information missing from the other files included two written references, one of which should have been Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 16 from the last employer and confirmation that nursing staff were included on the nursing and midwifery register. One file included two references dated 2003 yet the staff member did not commence work in the home until 2005. The staff member had supplied both of the references. There was no evidence to show that the provider had requested their own references or taken steps to ensure that the references were authentic. An immediate requirement was issued. The registered provider was required to ensure full compliance with regulation when recruiting staff and to review all existing staff files to meet regulation. On the interview notes seen it was recorded that a number of applicants had a poor standard of English language but were still employed. This issue was raised with the Commission by a number of relatives. Some staff were reluctant to talk to the inspectors and it was therefore difficult to obtain their views of the service. Minutes of staff meetings seen did not indicate that staff were given the opportunity to voice opinions about the service. Training records were inspected and these showed that a wide range of training had been provided for staff since the last inspection. Some of the topics covered were Dementia care, wound management, accident recording and moving & handling. The manager or a member of staff had provided most of the training. Staff had access to a resource room with relevant and up to date clinical information. Requirements 4 and 5. Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 17 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, 36 and 38. Quality assurance and staff supervision were satisfactory. A number of concerns were identified which could compromise the health and safety of residents. EVIDENCE: The home had a good system in place for monitoring the quality of service provided. This included monthly audits of medication, health & safety and care plans. Regular unannounced visits were made to the home during the day and night and comprehensive reports were seen relating to the visits. Satisfaction surveys were regularly sent to residents and relatives to obtain their comments about specific and general issues such as the quality of meals provided. At the time of writing this report the Commission received a copy of the last satisfaction survey, which included an action plan as to how management would address shortfalls identified. Regulation 26 visit reports were seen but none of these had been sent to the Commission in recent months. Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 18 A supervision matrix was seen showing dates booked for staff supervision. Four supervision files were inspected and showed that staff received regular supervision. More effort should be made to show how training needs identified during supervision would be addressed. For example one file seen showed the employee needed training on how to manage challenging behaviour but it was not clear how this need would be addressed. A selection of safety records inspected, with the exception of some fire safety records, showed that adequate systems were in place to ensure the safety of residents and others. There was no evidence to show fire drills had been held at night and only one member of staff had received fire training in the last six months. The manager was recording all accidents that occurred in the home on a monthly basis. The records indicated that more accidents had occurred on the ground floor unit over the past three months compared to the other two units. Despite this there was no evidence to show that any action had been taken to reduce or prevent accidents. Resident files inspected on the second floor included a comprehensive risk assessment for the use of bedrails. On the first floor staff said that one resident who had bedrails fitted had the ability to climb over these. Also on this floor all resident files seen included a signed relative consent form to use ‘constraint’ but the form did not always specify what ‘constraint’ would be used or in what circumstances. On the first floor a number of beds fitted with bedrails also had pressure relief mattresses. This reduced the height of the bedrail and could compromise resident safety. From inspecting the accident records it was evident that the Commission were not being notified of all events listed under regulation 37. Requirements 6, 7, 8, 9 and 10. Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 19 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 3 X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 3 X 1 Park Avenue Care Centre DS0000058005.V278052.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13 Requirement The Registered Person must ensure accurate medicine administration records are maintained including variable doses. Arrangements must be made to ensure external medicines are stored correctly. The Registered Person must ensure that the complaints procedure is followed for all complaints received about the service and the staff employed. The Registered Person must review and update the homes adult protection procedures to ensure that staff have clear guidance of what action to take when an allegation or suspicion of abuse is reported. The Registered Person must ensure that the staffing levels agreed with the Commission prior, to registration of the home, are adhered to at all times. The Registered Person must comply with the Immediate requirement issued on 03/02/06. DS0000058005.V278052.R01.S.doc Timescale for action 27/03/06 2 OP16 22 27/03/06 3 OP18 13 27/03/06 4 OP27 18 24/02/06 5 OP29 19 03/03/06 Park Avenue Care Centre Version 5.1 Page 21 6 OP33 26 7 OP38 13 8 OP38 37 9 OP38 13 10 OP38 23 The first progress report to be sent to the Commission by 10/02/06. The Registered Person must ensure reports are sent to Commission monthly in line with this regulation. The Registered Person must ensure accident reviews include the action taken to prevent a recurrence and to reduce the number of accidents in the home. The Registered Person must ensure the Commission receives all relevant regulation 37 reports. The Registered Person must ensure that risks to the health and safety of residents are identified and as far as possible eliminated. Staff must be made aware of the risks associated with the use of bedrails and use this equipment appropriately. (Timescale of 14/11/05 was not met). The Registered Person must take adequate precautions against the risk of fire by ensuring all staff receive suitable training and practice fire drills. 27/03/06 27/03/06 24/02/06 20/03/06 27/03/06 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 OP9 Good Practice Recommendations The Registered Person should ensure the local medication procedure is made available to all staff, includes guidance on how to record when a variable dose in prescribed and the arrangements made for disposal of medicines. The DS0000058005.V278052.R01.S.doc Version 5.1 Page 22 Park Avenue Care Centre 2 3 OP9 OP15 procedure should be dated and signed and include a review date. The Registered Person should ensure they have a safe system in place to dispose of medicine in view of the changes made to the Pharmacy contract. The Registered Person should ask and record resident’s choice of evening meal. Park Avenue Care Centre DS0000058005.V278052.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. 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