Inspection on 09/05/06 for Park Lane House

This inspection was carried out on 9th May 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 Lane House 01/07/08

Park Lane House 06/06/07

Park Lane House 04/01/07

Park Lane House 15/11/05

Park Lane House 07/06/05

Park Lane House 01/02/05

Park Lane House 28/09/04

Park Lane House 31/03/04

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

CARE HOMES FOR OLDER PEOPLE Park Lane House 163 Tipton Road Sedgley Dudley West Midlands DY3 1AA Lead Inspector Mr Jon Potts Unannounced Inspection 9.30am 9 , 17 & 18th May 2006 th th 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 Lane House DS0000025035.V293141.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 Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Park Lane House Address 163 Tipton Road Sedgley Dudley West Midlands DY3 1AA 01902 884967 NONE 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) Mrs Amerion Merion Ramdoo Mr Raganendrano Ramdoo Stephanie Knott Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Old age, not falling within any of places other category (20), Physical disability over 65 years of age (2) Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 2 MD, 2 PD(E) and up to 20 OP not exceeding the total number registered for at any one time. 10/2/06 Date of last inspection Brief Description of the Service: Park Lane House consists of a large detached house that has been extended and converted into a residential home. The home can accommodate 20 elderly residents in 16 single and 2 double bedrooms. The home has two large lounges and a large dining room. The home was found overall to be pleasantly decorated and homely. The home would have difficult accommodating residents with high physical dependencies due to the facilities the premises offers, with steps to some bedrooms and toilets that are too small for wheelchairs. The Provider has installed ramps, handrails and the home does have a passenger lift. The home has a level well-maintained garden on the side of the home, which incorporates ample car parking facilities. The home is situated on the main Tipton Road between Sedgley and Tipton. The home is owned and operated by two individuals who employ a manager to run the home on a day-to-day basis. The manager supervises a deputy, seniors and carers as well as ancillary staff (including cook ands housekeeper). The charges for residency are £336.00 per week, this correct as of the 18/5/06. This fee includes all basic care and food requirements. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit by the inspector to the home was carried out over three days, the second including input form a CSCI Pharmacist Inspector. The first day consisted of time spent monitoring two enforcement notices one related to medication and the second staffing levels, with follow up on the former notice by the pharmacy inspector on the second day who was asked to review what progress the home had made in meeting the Statutory Requirements Notice and other requirements made following the medication inspection carried out on the 10th February 2006. The second and third days also involved the lead Inspector case tracking the care of four residents, two of these recently admitted to the home. Evidence was drawn from case files, staffing documentation, risk assessments, quality monitoring documentation, meal records, policies, activity records, observation of staff and a tour of the premises. Evidence was also drawn from discussion with three residents; two relatives, three staff, the manager, provider and a number of returned CSCI comment cards as well as a questionnaire completed by the manager. What the service does well: What has improved since the last inspection? There has been seen to be some significant improvements since the time of the last inspection this including developing policies and procedures, revision and updating of care documentation, improvement in the management of Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 6 medications, provision of some key staff training, better risk assessment processes in some instances, provision of a fax, and developing of a quality monitoring system. There has also been some redecoration of the premises. This has resulted in a significant reduction in the number of requirements in this report in comparison to the previous report. The enforcement notices have been mostly complied with although there will be continued monitoring of the areas of concern that were previously identified. Whilst the home is still seen to be poor overall due to some key areas of risk, sustained improvement (in conjunction with a robust improvement plan to be provided by the home) should see the home becoming at least adequate by the time of conclusion of CSCI’s next key inspection. 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. Park Lane House DS0000025035.V293141.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 Lane House DS0000025035.V293141.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): 1,2,3,5, The overall outcome for this group of standards is judged to be adequate Information available to prospective service users has improved and is available verbally and in written form. Service users needs are assessed but there is no formal confirmation of the homes ability to meet needs or that they are offered trial visits. The homes performance in this area is better but still needs to improve further. EVIDENCE: The registered provider submitted a revised statement of purpose and service user guide to the CSCI in February 2006 following the last inspection of the home. These documents, following reading by the link inspector, was found to be improved over the previous versions although still containing some omissions/errors as detailed below: Statement of Purpose: - needs to be clearer that the home offers a service primarily to older people in accordance with its registration. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 9 - The criterion for admission need to be clearer with refrence to the need to admit residents within its catergories of registration. - The size of rooms needs to be included. - There needs to be clearer details as to how the provider and manager can be contacted. Service users guide - The arrangements for the making of personal phone call needs to be changed when the homes cordless telephone is operational. - The reference to the HSE (health and safety executive) on page 11 should be removed. - The phone number for the local social services and Primary Care Trust should be included. The documents sent to the CSCI were the same as those seen at the home during the course of the visits by the inspector and discussion with two relatives indicated they were given written (service user guide) and verbal information prior to their relative’s admission, this to their satisfaction. They also stated that they had received a copy of the contract with the home, this seen by the inspector. Respondents to CSCI comment cards also confirmed that they had received contracts, with all the files case tracked containing a signed copy of the same. All seven respondents to the comment cards also stated that they had received sufficent information about the home prior to admission. From sight of the homes contract the judgement by the inspector was that this was acceptable. From case tracking the files of two recently admitted residents there was evdient improvement in the way the home admitted residents (the two tracked both classed as emergencies). The relatives of the one resident stated that the provdier visited them at the service user’s home prior to admission to assess and discuss the admission, this also confirmed by the service user. The relatives stated that Mrs Ramdoo made the service user “ feel comfortable” and that she was “wonderful to her”. The homes assessments were seen to be documented and supported by copies of assessments from admitting social workers. There was however no written evdience of the provider/manager confirming in writing to all prospective residents the home’s ability to meet assessed needs prior to admission, this legally required. Neither of the last two admissions to the home followed the resident having a trial visit, this known from relatives in the one case not to have been possible (although they had visited and had knowledge of the home). All prospective residents must be offered a trial visit to the home wherever this is feasible and these visits must be documented as part of the pre admission assessment. Where a trial visit cannot be offered the reasons for this should be documented. The home should ensure that the service users and their representative’s involvement in pre admission assessments is documented, this to support the evidence found by the inspector that this does happen. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 10 There was some concern that one resident case tracked had not received a multidisciplinary review since 2003 and the manager must liase with the approriate social services departments to ensure that all residents receive a review from their funding body at least annually. Notes of these meetings should be taken by staff in the advent minutes are not sent by the social worker. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 11 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): 7,8,9,10 The overall outcome for this group of standards is judged to be adequate Care plans are adequately well set out but there is room for improvement in respect of some specific interventions and some gaps/out of date information, this despite monthly reviews. Health care needs are well met with the exception of some poor practice in respect of oral care provision. Quality in respect of medication handling was adequate. This judgement has been made using available evidence including a visit to this service. Although there had been significant improvements in many areas of the medication handling, the record keeping, administration and storage procedures still needed to be improved to ensure that the health and welfare of each resident was not compromised Whilst there are some good outcomes in respect of staff upholding resident’s privacy and dignity, there needs to be improvement in some areas of staff understanding. EVIDENCE: Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 12 All case files seen contained care plans that contained detail of social, helath and personal care needs relating to the individual resident, and discussion with the appropraite residents showed that these were on the whole followed through. This an improvement since the previous inspection, although there were some instances where there was information that was out of date or contradictory (i.e. AP’s initial assesment identified a history of falls this not followed through. Information as to oral care in the assessment contradicted the information in the care plan, and what was identified as accurate by AP. HW’s care plan carried no refrence to her current use of a zimmer frame and there was refrence to plaster cast care that was no longer appropraite). There was also areas where behaviours of residents, observed or documented were not part of a behaviour plan (see later in this report under complaints and protection). One plan out the four seen also carried no signature of the resident or their representative. All plans must be up to date, strategies for dealing with behaviours presented by residents must be documented clearly where appropriate, and the signatures of the resident or their nominated representative must be present. In addition falls risk assessments that detail clear strategies for reducing the risk of falls, and injuries should a fall occur must be in place for all residents, this an area of concern that has been raised previously. Discussion with residents in respect of their access to community health care services confirmed records in case files showing that there was regular and on –going contact as and when needed. All seven respondents to the CSCI comment cards indicated that they received (or their relative received) the medical support they needed. Overall the documentation in respect of health care was good with all case files carrying such as tissue viability and nutritional assessments. Two oral care plans did however prove to be inaccurate as in one case the resident was able to brush their own teeth (but had no toothbrush) and in another the resident had no denture mug (to allow soaking of dentures). Discussion with residents provided evidence of the home promoting resident’s privacy and dignity through allowing residents independence and knocking on doors to such as bedrooms prior to entry (the latter also observed by the inspector). Three staff spoken to were also well aware of how to promote these issues through such as talking residents through what they were doing when providing care, covering with towels when coming out the bath, using preferred titles and so on. There were however some issues in respect of restraint that may impact on resident’s dignity (see complaints and protection) and documentation in case files related to sexuality showed a lack of understanding. Documented comments re resident’s sexuality in plans included “ Unable to express sexuality as widow” and similar, this showing a lack of insight into what the issue in hand was (such as a woman expressing their felinity, having make up on, having their hair maintained and so on). In Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 13 addition the home has a number of male residents but no male staff, although there was no indication that any of the male staff objected to female carers. Whilst the standard 11 (see above) was not fully assessed it was noted that not all case files carried information on what the residents wishes for their terminal care were, this an issue raised at a previous inspection, and first raised in September 2004. Medication Medication Policy: The home had produced a new policy and procedures document for the handling of medication within the home. The inspector told the Manager that amendments were still required and the inspector agreed to provide guidance on what improvement were still required. Record Keeping: The MAR charts were viewed and it was seen that the gaps in the administration records had been eliminated with the home effectively using the abbreviations to demonstrate the reason for the resident not receiving their prescribed medication. A lot less handwritten entries were seen on the day of the inspection as the home had introduced a policy of obtaining a printed MAR chart for those medicines received mid-cycle. The majority of these had been written out correctly and corresponded with the dispensing label. It was seen that the home was using the MAR charts to record the receipt of medication. It was seen however, that the home was, at the beginning of the next monthly cycle, not taking into account any medication that was carried over from the previous month. This therefore meant that although there had been significant improvements the system was not wholly robust enough to account for all medication. Administration: The administration of medication to the residents had improved quite significantly. However the auditing of some medication in conjunction with the home’s records showed that the records and the quantities found did not correspond. This could indicate that there are still a few issues with the administration process and the Manager agreed to pursue the matter. There was only one incident found where the administration of the medication did not correspond with the prescriber’s directions. The medication involved was a Salbutamol inhaler and the directions from the GP were two puffs to be inhaled when required. The home appeared to be administering the Salbutamol every morning. The handwritten directions on the MAR chart gave instructions to administer every morning. The Manager was asked to investigate this matter and report her findings to CSCI. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 14 The number of medicines with “as directed” labels attached had been reduced, however there were still a small number of medicines being administered without precise instructions. The home was told that they must concentrate their efforts to ensuring that all medicines received by the home have precise administration instructions. It was also seen that where variable doses had been prescribed the actual quantity administered was not being recorded on to the MAR charts. There was also no direction from the GPs as to when the higher dose should be given. Training: Following the last inspection it appeared that all of the seniors had received some additional training in the handling of medication. A programme of checking the senior staffs’ competency to handle medication correctly had been introduced and written evidence to support this was seen during the inspection. Controlled Drugs: Examination of the Controlled Drugs cabinet found that it had not been secured to the wall properly using rag bolts as advised at the previous pharmacy inspections. However, an examination of the Controlled Drugs register found that the record keeping had remained at an acceptable level and the balances of stock concurred with the quantities found within the cabinet. Storage: The medication cabinet within the office was well organised with the external preparations being kept separate from the internal medication. The mobile drug trolley was also well organised with its contents all being appropriately labelled and not out of date. The medication fridge was still located in the kitchen. The maximum and minimum temperatures of the medication fridge were not being monitored on a daily basis although a maximum/minimum thermometer was present within the fridge; instead the home had reverted back to measuring just the ambient temperature. On the day of the inspection the minimum temperature was observed to be -2°C. As a consequence, this temperature would denature the insulin stored within this fridge and make it unsafe to use. An immediate requirements notice was issued to which the Manager was instructed to remove all of the insulin from the fridge, discard it and replace with a new supply with immediate effect. The Manager was also instructed to ensure that the fridge temperature was maintained at between 2 and 8°C through daily monitoring of the minimum and maximum temperatures. During the inspection, the Proprietor organised the relocation of the medication fridge to Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 15 the office, where there was less of a likelihood of the fridge being subjected to extreme temperatures and thus temperatures within the fridge being more consistent. Other: The checking in process of medication delivered mixed results. On one hand the checking in process had identified that the Community Pharmacist had supplied a number of bottles of liquid that did not contain the amount which was stated on the dispensing label and the home had returned these bottles to the Pharmacy so that the Pharmacy could re-dispense the bottles with the correct quantity inside. On the other hand the home had not returned items which had dispensing labels that did not display precise administration instructions and also a set of Nomad trays had not been returned to the Pharmacy to remove an item of medication that had been discontinued on the 20th March 2006 and had been re-prescribed by mistake. The home was reminded to ensure that all of the medication was correct prior to the start of the next administration cycle. It appeared that the diabetic care of two residents within the home by the home and outside agencies was poor. Both residents blood sugars were regularly seen to be very high, which meant that the residents were experiencing thirst and were having to visit the toilet very often. On speaking to both residents t appeared that they were very sensible with their diet but it was noted for one resident that the juice being offered by the home was not sugar free, the home was asked to rectify this. The high blood sugar levels for one of the residents was affecting her sight and was having to visit the ophthalmologist for treatment. The home need to request that these residents receive specialist input from either a diabetologist or a diabetic specialist nurse in order for the residents to achieve their optimum blood sugar levels. It was also noted that the District Nurses were pre-loading insulin into syringes and storing them in the fridge. The Nursing and Midwifery Council recognises that in residential homes this is poor clinical practice. Also because the District Nurses were only visiting the home once or twice a week the residents were only having their blood sugar levels monitored once or twice a week. The home must consult with healthcare professionals to discover how often these residents should be monitored and discuss with them ways of achieving the frequency of monitoring. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 16 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 overall outcome for this group of standards is judged to be adequate Residents, based on their comments, do find the home offers a lifestyle that is in keeping with their preferences, this enhanced by worthwhile and enjoyable activities promoted by the home. Contact with such as relatives is encouraged through hospitality and access to privacy as needed. Choices are made available to the resident group although there are occasions were these are maybe compromised, although not in respect of meal provision which, based on the views of the residents, was to a good standard. EVIDENCE: There was documentation within the residents cases files summarising what their usual preferred daily routines were, these found to be generally accurate following discussion with the residents they related to. Comment cards received indicated satisfaction with the activities offered by the home with 5 out of 7 stating that there were always activities they could take part in with 2 stating that this was usually the case. Comments from some relatives indicated that the home was good at organising seasonally events such as an Easter bonnet parade and summer fayre. There were activities seen to be happening on every day the inspector visited, these consistent with the pictorial activities programme on display in the dining area. The home does employ some Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 17 sessional activity organisers, these sessions enjoyed by the residents based on the comments in feedback forms seen at the home. The home has a visitor’s policy in the home’s service users guide, this stating that there are no restrictions on visiting times (consistent with comments made by relatives spoken to). There is scope for privacy with visitors able to see residents in their bedrooms, dining area or either of the two lounges at the home (this once again confirmed by relatives spoken to who also stated that staff always offered hospitality in the form of drinks when visiting). There were some positive comments from some residents spoken to as to staff respecting their choices, and staff spoken to were well aware of the need to show respect for residents. There was also evidence of residents having choices presented to them in terms of such as meals and daily routines (as confirmed by residents and records). The inspector did however observe a resident prevented from going out this due to concern as to his safety, this not documented within a risk assessment. Some of the residents also stated they would have chosen to have keys to their bedroom doors (when asked), these not having been provided. Access to a telephone without recourse to staff was also limited by the fact that the cordless telephone in the one lounge was not working. Whilst staff spoken to cited choice of carer as a matter that needed to be considered, the male residents had no option other than a female carer, this as no males were employed at the home. Sight of the homes menu showed that a nutritionally balanced meal was provided with records of fortified diets (such as milk and butter in mash) clearly documented, and in accordance with nutritional assessments. All residents spoken to stated that there was a choice of meals available, and that they were asked by the cook as to their choice of main meal prior to its serving, these choices also clearly documented. The serving of the meal was observed on one of the days and was seen to be appetising, with residents at the time confirming that they were enjoying it. Comment from residents spoken to and from 6 respondents to comment cards also indicated a high level of satisfaction with the quality of the meals available to them. One resident stated that they were “ smashing, sometimes gorgeous”. There was seen to be three residents needing assistance to eat, this appropriate assistance seen to be provided by the staff. Liquidised meals currently comprise all differing foods mixed together, where they would look more appetising if liquidised separately, this also allowing easier access to different tastes for the resident concerned. One resident stated they had no supper (although she did state that this would be her choice) with two others confirming they did have supper. It was not possible to verify this through records as they are not currently documented. The manager was also advised to develop menus in a pictorial format. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 18 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 The overall outcome for this group of standards is judged to be poor Residents and their relatives are confident that complaints will be listened to and acted upon. There are some areas where policy and practice does not fully safeguard residents from abuse. EVIDENCE: There have been no complaints received at the home or the CSCI since the time of the last inspection in February 2006 although one was raised with the manager at the time of this inspection, this to be investigated by the home and pending an outcome. The manager’s initial response to this concern was seen by the inspector to be appropriate. The homes complaints procedure was seen to be on clear display in the home’s dining area and is included in the home’s service user guide (The manager was advised to consider developing a large print and pictorial version of the complaints procedure), this having been given to the 2 relatives spoken to (who were also confident that any concerns would be resolved by management). Two of the residents spoken to were confident that any complaints would be dealt with satisfactorily and response from comments cards indicated that 5/7 felt staff always listened and acted upon what they said and all seven were aware of who to complain to. The home was seen to have policies and procedures in respect of adult protection in addition to the local authorities procedures and discussion with staff indicated that they had a good awareness of what abuse was and what they should do if they witnessed the same. This does evidence learning from Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 19 recent training they have received (as all these staff had received training), although there are still 11 staff that require this training (based on information in the pre inspection questionnaire). Staff also had a good awareness of what restraint was but there was concern in respect of an incident where a resident was prevented from going out alone (see earlier comments in previous section). Staff should be given a better awareness of restraint and how to ensure that they have access to strategies for its avoidance, these possibly documented in behaviour plans wherever possible. Where restraint (in any form) is to be used it must be documented and agreed within a multidisciplinary forum. Whilst all employed staff where seen to have been subject to an enhanced disclosure there was concern that there were other persons seen during the course of the inspection that had unrestricted access to the home. Disclosures for these persons, or a system of supervising them whilst at the home must be actioned. The manager was advised to consider displaying photographs of the staff, this so that it is easier for residents and visitiors to identify them by name should there be concerns or compliments. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 20 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): 19,23,26 The overall outcome for this group of standards is judged to be adequate The premises were judged to be on the whole safe and generally well maintained as well as clean, pleasant and hygienic. Whilst evidence indicates that residents are satisfied with their rooms, they are not always provided with keys to the same. EVIDENCE: The home presents as a homely environment with two sitting areas in addition to the dining area. There were no obvious hazards to resident’s safety although the presence of steps to some bedrooms on the first floor was seen to create some difficulties for one resident when traversing them (with the assistance of a staff member). The manager is to carry out a risk assessment in respect of these steps. There was also comment from a resident on the last day of the inspection (via an activity feedback form) that the lighting in the dining room was not sufficient to allow them to see properly when undertaking craft work. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 21 The home has forwarded a refurbishment programme to the CSCI, this in need of on-going review, as some of the work detailed within it has been completed (redecoration of a number of bedrooms). Some redecoration is required due to the recent fitting of a new call system throughout the building. Areas highlighted to the manager that would benefit the home is the inclusion of resident’s names on bedroom doors, signage for such as bathrooms and toilets and breaking up the long and plain corridors to provide points of orientation towards the rear of the property. Residents spoken to were happy with their bedrooms although not all items detailed within the national minimum standards are always provided. If this is acceptable to the resident it would not be seen as problematic, although the manager was advised to undertake an audit of each room recording where all elements of standard 24 (this detailed the said items of furniture expected) are met and identifying the reasons why they are not met (i.e resident does not want a table in the room for example or provsion of the same may present a risk). If items are as listed in this standard are not provided, why they are not provided i.e keys to bedroom doors and so must lead to discussion with the resident/representative and then documentation of non – provsion in risk assessments where appropraite. Some of the residents spoken to who did not have keys to bedroom doors did state they would like these. The premises are clean with no mal odour with returned comment cards from seven respondents indicating that the home was always clean and fresh. Recent improvements in respect of infection control (including development of some policies and procedures) have helped to reduce risk and staff spoken to were well aware of what they should do to prevent the same (effective hand washing stated by all three staff as a priority). The majority of the staff team have received training in infection control. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 22 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 The overall outcome for this group of standards is judged to be adequate. Having regard to the size of the care home, and the number and needs of service users, there is still insufficient care staff at times. There are still staff in need of training input to evidence their competency, although overall training provision has improved, as have recruitment practices, although the latter do not fully safeguard residents. EVIDENCE: The registered providers were issued with a statutory enforcement notice stating that they shall having regard to the size of the care home, and the number and needs of service users, provide sufficient care staff at all times; this prior to this inspection. Sight of the staffing levels over three weeks (this through site of rotas and comparison to staffing available on three separate days) showed that these fluctuated between levels on the first week that met the expectations of the recommended staffing tool to some deficiencies during the course of the second and third week (primarily due to staff sickness) with a loss of up to 33 available care hours. Discussion with the manager and provider as to current staffing levels centred on the need for at least four care staff on the morning shift (for dependency levels at the time of the inspection). Consideration also needs to be given to the fact that if staff are involved in food preparation on the afternoon shift at tea time, this time cannot be classed as care hours and would impact on the staff available to residents at this time, albeit for a short Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 23 period. The appropriate allocation of staff can be provided within the hours allocated for current dependency levels as defined by the department of health recommended staffing tool. The staffing levels must be maintained in accordance with the expectations of the residential forums staffing tool. The provider must check the staffing requirement when there is any change in dependency levels and ensure the available care staff hours change accordingly. Copies of the staff rotas must be also be forwarded to the CSCI every week for monitoring. The inspector carried out a check on the files of staff employed since the time of the last inspection and found the pre employment checks to be adequate with the exception of the home employing staff with a POVA check but not a full disclosure. If there are concerns as to maintaining satisfactory staffing levels the registered provider/manager must liaise with the CSCI before employing staff without a full disclosure, and also submit a risk assessment that identifies: - The reasons why staff need to be employed without a full disclosure; - The steps that have been taken to reduce risks to an acceptable level including all recruitment checks carried out, the receipt of a POVA check and what steps are to be taken to supervise the staff member until the disclosure is received by the home. The home was seen to have a training plan, and whilst there are still areas in respect of mandatory training that are still required (with two staff having no mandatory training at all), there was clear evdience to show that training was been provided and tha manager stated that training sessions in appropraite areas are booked for the near future. A previous requirement in respect of staff and managers having tissue viability training is still to be met. It was positive to note that newly employed staff have received induction training to NTO (National Training Orgainsiation) standards although this needs review to reflect the revised Skills for Care standards now in place. The manager was advised to contact a training provider for further advice. On another positive note there is now 11 out of the 16 care staff with qualification to NVQ level 2 in care, this exceding the minimum standard. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 24 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): 31,33,35,36,37,38 The overall outcome for this group of standards is judged to be poor Residents and relatives have confidence in the manager. Whilst there are still a number of significant weaknesses in respect of the homes management systems, these have improved since the time of the last inspection. Development of a quality assurance tool it is hoped will assist in allowing the home to identify its weaknesses and capitalise on its strengths. EVIDENCE: The manager is not qualified although has enrolled on the appropraite training. The manager is developing a better awareness of the management role and has demonstrated an openess as to the shortcomings of the service, with a interest and willgness to improve. Comments from all the staff and residents spoken to indicated that they were confident in the manager’s abilities. The manager has worked at Park lane House for numerous years and the contact Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 25 professional training would give her with other home managers should prove invaluable. The manager has developed systems for the monitoring of the quality of the home’s practices as well as compliance with national minimum standards as well as the home’s plans policies and procedures, although this system is still in the process of full implementation. These systems need to be robustly employed with continued use of questionaires to stakeholders; ensuring staff continue to read, sign and date all written policies and procedures operational within the home; and the that the provider carries out unannounced monthly regulation 26 visits the home (to interview service users, relatives and staff in private, to inspect the premises, records of events and complaints to form an opinion on the standard of care provided; A report detailing the outcomes must be prepared following each such visit and a copy must be provided to CSCI and the Manager). Residents are encouraged to manage their own money if they wish, although those spoken to ask relatives to support them with this. The home will safe keep small amounts and there are systems in place to record transactions and accounts for spending. The home also has documented inventories of resident’s property in place. The home has a policy of not acting as an agent for any resident in respect of their financial affairs. Whilst there was some concern as to resident’s not having keys to lockable facilities in their rooms, none of the resident’s spoken to was concerned about this at the times they spoke to the inspector. Staff supervision at the home has consisted of seniors observing staff ‘ on the job’ and then following this with discussion afterwards. Discussion with staff evidenced some understanding of this developing into a one to one system where this would be expanded to further reflect on practices of the individual beyond what was observed. The manager stated that this approach was to be continued. Records were seen to have improved since the last inspection, although there was still room for further improvement in a number of key areas, these as identified throughout this report and within the requirements. There were two incidents noted during the course of the visit that were notifiable (in accordance with regulation 37). The registered provider/manager must notify the CSCI of any event listed under Regulation 37 of the Care Home Regulations 2001 as soon as practicably possible after the event. The home has a health and safety policy that complies with requirements and legislation, and a consultancy has been employed to complete risk assessments. Discussion with staff indicated an awareness of their responsibilities in respect of safe working practices although there are still gaps in training provision. Comments in respect of risk detailed earlier in this report should also be noted. Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 26 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 2 3 2 X 1 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 27 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 OP1 Regulation 4 Requirement The registered provider must ensure that all information as detailed in Schedule 1 of the Care Home Regulations 2001 must be available in the homes Statement of Purpose. The following areas still require inclusion/attention. - It needs to be clearer that the home offers a service primarily to older people in accordance with its registration. - The criterion for admission need to be clearer with refrence to the need to admit residents within its catergories of registration. - The size of rooms. - Clearer details as to how the provider and manager can be contacted. 2. OP3 14 The manager must liase with the approriate social services departments to esnure that all residents receive a review from their funding body at least annually. DS0000025035.V293141.R01.S.doc Timescale for action 31/07/06 31/07/06 Park Lane House Version 5.1 Page 28 3. OP3 14 4. OP7 15 The provider/manager must confirm in writing to all prosepective residents the home ability to meet assessed needs prior to admission. Care plans must be accurate and also include the following: - Strategies for dealing with behaviours presented by residents; - The signatures of the resident or their nominated representative. The following must be present and complete for all residents: Falls risk assessments that detail clear strategies for reducing the risk of falls, and injuries should a fall occur. 18/05/06 30/06/06 5. OP7 13 15/06/06 6. OP8 Requirement first made Feb 2005. Still some residents without such assessments in case files despite there been a documented history of falls. 13, 14, 15 An oral care plans in case files must be followed or provision made for residents to be able to maintain their dental hygiene. i.e. provision of toothbrushes, denture mugs etc. The policy and procedures document for the safe handling of medicines within the care home must be amended and updated to include the issues identified by the Pharmacist Inspector. A copy of the amended document must be sent to CSCI for reference. Previous requirement made 08/07/05, 15/11/05 and 10/02/06 30/06/06 7. OP9 13(2) 31/07/06 Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 29 8. OP9 13(2) A formal protocol for assessing and monitoring residents wishing to self-administer must be developed. Previous requirement made 08/07/05, 15/11/05 and 10/02/06 31/07/06 9. OP9 13(2) 10. OP9 13(2) The records of medication handled within the home must be robust enough to ensure that all medication is accounted for. The prescriber’s directions must be adhered to without fail. If it appears that the directions are not appropriate for the circumstances of the resident then the GP must be consulted. Previous requirement made 08/07/05, 15/11/05 and 10/02/06 15/07/06 31/07/06 11. OP9 13(2) All “as directed” doses must be confirmed in writing by the prescriber and the MAR sheets must be amended accordingly. Previous requirement made 08/07/05, 15/11/05 and 10/02/06 15/07/06 12. OP9 13(2) 13. OP9 13(2) 14. OP9 13(2) The home must regularly audit the medication to ensure consistency of supply and to ensure the integrity of the MAR charts is maintained. When a variable dose is prescribed the home must obtain written direction from the prescriber for when the higher dose would be used and the home must record what dose was administered on the MAR charts. The difference in the administration of the Salbutamol DS0000025035.V293141.R01.S.doc 15/07/06 15/07/06 15/07/06 Page 30 Park Lane House Version 5.1 15. OP9 13(2) 16. OP9 13(2) inhaler carried out by the home and the GP’s directions must be investigated and the finding reported to CSCI. The home must discard all of the 18/05/06 insulin found in the fridge on the day of the inspection and provided evidence that this requirement was adhered to. The home must obtain with immediate effect a new supply of insulin and ensure that it is stored at a temperature of between 2 and 8°C by daily monitoring using a maximum and minimum thermometer and recording both the maximum and minimum temperatures. 09/05/06 The medicated creams/ointments not designated for selfadministration, which are being stored in the residents rooms must be removed and stored within the home’s locked facilities. The home must ensure that all medication, which has not been designated for selfadministration must be kept secure so that unauthorised persons do not have access to them. This is a repeated requirement first made 08/07/05. 17. OP9 13(2) 18. OP9 13(2) The prescription check and the medication received checking in process must be reviewed and update to ensure that incorrect medication does not enter the monthly cycle. The home must engage the diabetic healthcare specialists to ensure that the diabetic residents optimal blood sugar levels are attained DS0000025035.V293141.R01.S.doc 15/07/06 15/07/06 Park Lane House Version 5.1 Page 31 19. OP9 13(2) The medicated creams/ointments not designated for selfadministration, which are being stored in the residents rooms must be removed and stored within the home’s locked facilities. The home must ensure that all medication, which has not been designated for selfadministration must be kept secure so that unauthorised persons do not have access to them. This is a repeated requirement first made 08/07/05. 09/05/06 20. OP11 12(3) Residents must be given the opportunity to make known their wishes in the event of terminal care / death. These where made known must be recorded. Part Met at November 2005 and at this inspection. Requirement first made and not fully met since September 2004. The provider must ensure that the cordless phone available in the one residents lounge works All liquidised foods should be presented so that it is possible to see what foods are present as opposed to all foods liquidised in together. The manager is to respond in writing in respect of the concerns raised at the time of the inspection. To ensure that staff have a better awareness of restraint i.e. what it is and how ensure strategies for its avoidance (documented in behaviour plans) DS0000025035.V293141.R01.S.doc 31/07/06 21. 22. OP14 OP15 16(2)a(i)b 16(2)i 30/06/06 30/06/06 23. OP16 22 18/06/06 24. OP18 13(6)(7) 18 31/07/06 Park Lane House Version 5.1 Page 32 25. OP18 13(4)c 26. OP18 13, 18 are employed wherever possible. Where restraint is to be used it must be documented and agreed within a multidisciplinary forum. All persons working at the home that are not part of the regular staff team, but may have unrestricted access to service users must be subject to an enhanced disclosure. All staff receive training in awareness of abuse. 7 staff have done, 11 have not (based on managers records in Pre inspection questionaire) First Required prior to August 2003. 30/06/06 30/06/06 27. OP19 23 28. OP24 16, 23 The homes refurbishment programme must be reviewed to include on going progress towards its achievement and also: - The inclusion of residents names on bedroom doors: - Signage for such as bathrooms and toilets - breaking up the long and plain corridors to provide points of orientation. The home undertakes an audit of each room recording where all elements of standard 24 are met and identifying the reasons why they are not met. If items are as listed in this standard are not provided why they are not provided i.e keys to bedroom doors and so on. This issues should be discussed with the resident/representative with documentation of non – provsion in risk assessments where appropraite. First Required prior to August 31/07/06 31/07/06 Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 33 29. OP19 13(4)a 30. OP25 23(2)h 31. OP27 18(1)a 2003. To carry out a risk assessment in respect of the steps on the upstairs corridors in respect of the hazards this present those residents that have to transverse them. To improve the lighting in the dining area so as to provide residents with sufficient lighting for activities. The registered persons shall having regard to the size of the care home and the number and needs of service users provide sufficient care staff at all times. Action taken to meet assessed staffing deficits shall be confirmed in writing to the CSCI and staffing levels shall be kept under regular review. The above was the subject of a statutory notice served on the registered persons on the 11/4/06. Recent sickness has compromised the staffing levels present at the home. The staffing levels must be maintained in accordance with discussions at the time of the inspection and as summarised in the body of this report. 30/06/06 31/07/06 18/05/06 32. OP29 19 Copies of the staff rotas must be forwarded to the CSCI every week for monitoring No staff are to be employed 18/05/06 without a disclosure without the registered manager/ provider completing a risk assessment and discussing the same with the CSCI. This risk assessment is to identify how the risk to service users will be reduced / removed DS0000025035.V293141.R01.S.doc Version 5.1 Page 34 Park Lane House 33. OP30 18 from the employment of staff for which the home does not have a full enhanced disclosure. Staff and managers must be provided with tissue viability training. To be booked by the date set Requirement first made September 2004 Training booked for the 31.5.06. The training for all staff in respect of mandatory areas (i.e. first aid, food hygiene and so on is to be continued. The manager holds an NVQ 4 (or equivalent). (Manager has not enrolled on a course At June 2005 Deputy manager nominated for this course) At November 2005 Deputy Manager to begin December 2005. At May 06 registered manager– enrolled but not commenced. 31/05/06 34. OP30 18 31/07/06 35. OP31 9 18 31/12/06 36. OP33 17, 18 First Required prior to August 2003. The registered provider manager 31/07/06 must ensure that all staff read, sign and date all written policies and procedures operational within the home. Requirement first made February 2005 37. OP33 26 Part Met at May 06 The provider must arrange for unannounced monthly regulation 26 visits to be made to the home to interview service users, DS0000025035.V293141.R01.S.doc 21/06/06 Park Lane House Version 5.1 Page 35 relatives and staff in private, to inspect the premises, records of events and complaints to form an opinion on the standard of care provided. A report detailing the outcomes must be prepared following each such visit and a copy must be provided to CSCI and the Manager. 38. OP38 37 New Requirement at Feb 06 The registered provider/manager must notify the CSCI of any event listed under regulation 37 of the Care Home Regulations 2001 as soon as practicably possible after the event. 18/05/06 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 OP1 Good Practice Recommendations The following revisions should be made within the homes service users guide. - The arrangements for the making of personal phone call needs to be changed when the homes cordless telephone is operational. - The reference to the HSE (health and safety executive) on page 11 should be removed. - The phone number for the local social services and PCT should be included. The home should ensure that the service users and their representative’s involvement in pre admission assessments is documented. All prospective residents must be offered a trial visit to the home wherever this is feasible and these visits must be documented as part of the pre admission assessment. Where a trial visit cannot be offered the reasons for this should be documented. DS0000025035.V293141.R01.S.doc Version 5.1 Page 36 2. 3. OP3 OP5 Park Lane House 4. OP9 It is recommended that all medication within the storage areas be organised so that each service users medication is kept together. It is recommended that the home secure the Controlled Drugs cabinet to the load-bearing wall through the back of the outer cabinet using expanding rag-bolts. To ensure that any comments regarding a residents wishes re sexuality are accurate and not assumptions. To record what residents are offered for supper. To develop menus in pictorial formats. To develop the homes complaints procedure in large print and pictorial format. To display the photos of all staff in a communal area so as to assist residents and relatives to identify they by name. 5. OP9 6. 7. 8. 9. 10. OP10 OP15 OP15 OP16 OP18 Park Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 37 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Lane House DS0000025035.V293141.R01.S.doc Version 5.1 Page 38 - 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. 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