Inspection on 12/12/05 for Park Lodge

This inspection was carried out on 12th December 2005.

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 Lodge 29/06/07

Park Lodge 03/05/06

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 Lodge 11-15 Park Road Berrylands Surbiton Surrey KT5 8QA Lead Inspector Margaret Lynes Unannounced Inspection 11:00 12 December 2005 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 Lodge DS0000065224.V274921.R01.S.doc Version 5.0 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 Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Park Lodge Address 11-15 Park Road Berrylands Surbiton Surrey KT5 8QA 0208 390 7712 0208 547 1580 lodgecarehomes@supanet.com 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) The Lodge Care Homes Mrs Paulene Rogers Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (35), Physical disability of places over 65 years of age (35) Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection: 16th May 2005 Brief Description of the Service: Park Lodge is a care home with nursing that provides care for older people. It is situated in a residential area of Surbiton close to the main A3 road. The home has limited parking facilities, but benefits from a large garden. Accommodation is provided over three floors, which are serviced, by a passenger lift and chair lifts. The accommodation comprises of shared and single rooms. All rooms have a wash hand basin. The home has a large lounge area. The home has recently been purchased by the Lodge Care Homes, owned by Care Homes of Distinction. This company also has several other care homes in the Croydon/Sutton/Kingston geographical area. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was carried out over the course of four hours, and focussed on determining if the fifteen requirements that were contained within the last inspection report had been met. It was disappointing to find that the vast majority remained unmet, and this will be commented on below and in the body of this report. Five new requirements have also been made. Of additional concern was the news that the manager has chosen to resign, which will leave the home, unless action is taken urgently, without any management, as there is not a deputy in place, and qualified staffing levels have been cut by the new proprietors. The proprietors must, as a priority, put into place a contingency plan which will ensure that the care of the service users in this home does not deteriorate, and that they produce an action plan which will indicate how the outstanding requirements are to be met. What the service does well: What has improved since the last inspection? With limited action taken to meet the requirements that were made after the last inspection, it is difficult to state that much has improved. Only three of the 15 requirements had been fully met, while a further four partially met – in that some improvements had been made in the relevant areas, but not enough to judge that the Standards/Regulations were being fully complied with. The requirements met related to the need to revise the complaints procedure; the need to ensure that COSHH substances were securely stored, and to make repairs to parts of the staff room. Those requirements partially met related to the need to improve the pre-admission assessment process; staff recruitment documentation; staff knowledge of service user plans and staff access to training. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 6 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 Lodge DS0000065224.V274921.R01.S.doc Version 5.0 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 Lodge DS0000065224.V274921.R01.S.doc Version 5.0 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 3 As stated in the last report, it is important that the home is correctly registered so that prospective service users have the information they need to make a decision about where to live. The last inspection found that the home had admitted several clients who did not fall within its registration category. This meant that there were no indications that the needs of those service users could be met. The home has failed to take steps to rectify this. Although the home has a specific form on which to record its pre-admission assessment, and acknowledging that some improvements had been made, the overall impression was still that the pre-admission assessments were not as thorough or robust as they should be. This means that the home cannot be certain that it can meet the needs of the individuals who wish to move in, while the service users cannot be certain that the home is the most appropriate place for them. EVIDENCE: Currently, Park Lodge is registered for older persons, older persons with a physical disability, and younger adults with a disability. At the last inspection it Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 9 was noted that there were a small number of clients at the home whose primary diagnosis was not amongst those categories mentioned. The proprietors were required to submit a variation application to this effect. To date this has not been done. The home is in the process of changing its service user documentation to the all-inclusive Standex system. As with all such systems, the records are still only as good as the entries made on them. In this instance, while the standard of pre-admission assessments had improved, the assessments were still brief in a number of cases, and full use was not being made of the new system. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 10 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 and 9 While each of the service user files inspected contained an individual plan of care, there was little to evidence that the identified needs were actually being addressed. It was also clear that reviews were not being carried out as regularly as the Standards suggested. While there was a better knowledge amongst more senior staff as to the contents of the plans, it was again disappointing to find that the junior staff did not read them. Without a knowledge of the assessed needs of service users it is hard to see how staff can be aware of the care that is needed; and without documenting the care provided it is impossible to determine if appropriate care is being given. Previous requirements re the need to ensure that service users were weighed monthly and to keep wound care documentation up to date have not been met. It is important that these matters are attended to as planned; as without them staff could miss changes in a service users dietary needs or in their general well-being. Improvement is again needed in the recording of medication given to service users, as gaps/inconsistencies were found. This clearly is not acceptable as mistakes with medication can have serious consequences for service users. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 11 EVIDENCE: The previous report contained a requirement relating to the need for all care staff to be familiar with the service user plans. They needed to be accessible by all, and not just the qualified staff. On this visit there was some improvement as some of the designated keyworkers confirmed that they now read the plans. This did not extend to the junior staff however. It was also disappointing to find that there was little to confirm that staff were following the service user plans to any degree. For example, one identified need for a service user was to have regular (and in this instance regular had been deemed to be on an hourly basis), socialising visits from staff, as the service user was confined to bed. Over the course of nine days, the records showed that such a visit had been carried out on just one occasion. The need to review the plans on a regular basis also extends to the supporting documentation such as risk assessments and moving and handling assessments. One of the latter had not been reviewed for over a year. At the last inspection it was noted that several of the care plans referred to the need to weigh service users monthly, but this was not being done. It was of concern to find on this visit that the records were similarly poor. There was little consistency in recording, and where regular checks had been made, significant loss/gain did not appear to have been further investigated. The wound care recording was also inconsistent. One care plan indicated the need for a wound to be dressed daily. Over the course of one week, two days were unaccounted for. Another plan indicated that a dressing should be checked and reapplied if necessary twice weekly. No entries had been made in the records for over 2 months, however according to the nurse on duty the same care plan was still in force. There is a clear need, therefore, for more attention to detail. As on the previous visit, gaps were found in the medication administration records. An explanation was requested for two of the gaps however the response given was inconsistent with the recording. Again, there is a clear need for more attention to detail, and possibly the need for additional staff training in these areas. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 12 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): Not assessed on this visit. EVIDENCE: Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 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 The required amendment to the complaints procedure was one of the few requirements that was actually dealt with. This means that service users and relatives are provided with information about complaining directly to the Commission. The adult protection procedure was still inaccurate however; it continues to state that any issues under this procedure will be investigated by the manager. This is incorrect, and needs to be revised and cross-referenced with the local Authority’s procedure. Any adult protection issues must be referred to the local Authority for investigation external to the home. EVIDENCE: The manager has added a sentence to the complaints procedure so that it is now made clear to service users and their relatives that they can complain directly to CSCI if they so wish. The staff policy and procedure manual should be updated so that this revised procedure replaces the old one still on display. While the in-house adult protection procedure does make reference to the Local Authority’s multi-agency procedure, it still directs the home to investigate any allegation itself. This is a clear contradiction to the aforementioned multi-agency procedure, and must be rectified. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 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 Due to unmet requirements regarding relatively minor repairs and the standard of cleanliness; plus two new requirements regarding the kitchen extractor fan and urgent repairs to the call bell system, The Inspector was not satisfied that the service users were living in as safe and well maintained environment as they should be. EVIDENCE: The last visit resulted in requirements being made with regard to repairs needed in the staff room; a minor repair needed in a bedroom, the need to ensure that the home was free of offensive odours; and the need to ensure all extractor fans were regularly cleaned. Only the requirement re the staff room had been dealt with, while the Inspector was greatly concerned to discover that the call bell system was not working, leaving some service users in distress. An immediate requirement notice was left - requiring the proprietors to add an additional carer to the rota at peak times until the repairs had been made. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 15 Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 The Inspector was greatly concerned to find that the proprietors had cut the number of qualified staff on each shift from two down to just one, and expected the manager to work as part of the rota. This is unacceptable and has led to overstretched nurses and a deterioration in the quality of the service they provide. While improvements had been made to the recruitment process, the file examined was still lacking a recent photograph of the individual concerned. Once this has been obtained, the Standard/Regulations will be met, and service users as supported as possible by the recruitment policy and practice. At the last visit a requirement was made for staff to be enabled to attend more training, including accessing NVQ courses. While more training has taken place, no carers have enrolled, as yet, to do NVQ training. This means that it is possible that staff skills are not as comprehensive as they could and should be. EVIDENCE: At the last inspection, staffing levels were being maintained to the minimum expected levels - usually two qualified nurses and 4-5 carers on duty in the morning, two nurses with 4 carers on in the afternoon/evening with one nurse and 2 carers on duty at night. The manager explained that for a period the numbers of residents had dropped, and the proprietors felt that only one qualified nurse on each (day) shift was needed. However while the occupancy levels had since risen, the proprietors had not raised the number of nurses on Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 17 duty. This remained at just one during the day, which meant that the manager had to often provide assistance/cover. This is unacceptable and urgent steps must be taken to bring the levels back up to the minimum numbers outlined overleaf. The file of the most recently employed carer was inspected. Once they provide a recent photograph of themselves the Standard and the accompanying Regulations will have been met. Since the last inspection staff have been able to attend a number of courses, including food safety and hygiene, POVA, health and safety and moving and handling. While discussion about NVQ’s has been had with a number of them, none have commenced NVQ courses. The increase in training generally is positive, however further efforts must be made re the NVQ training. The need to ensure that all kitchen staff have had some sort of training in food hygiene remains an ongoing requirement – on this visit it was not possible to evidence such training for each of the kitchen assistants. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 38 As mentioned in the summary, the manager has chosen to hand in her resignation, thus potentially leaving the home in a critical situation. This means that neither the service users nor the Commission can be satisfied that the home will be run in an appropriate manner. It was disappointing to find that the level of staff supervision had not improved. This means that it is feasible that the care practice in the home may not be as good as it could be; and also that staff may have concerns that are not being addressed. The previous requirement re the storage of hazardous substances had been met, therefore it was felt, in this respect, that the home was being maintained to an appropriate level of safety. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 19 EVIDENCE: As there had been no indication (from the manager) of problems since the new proprietors took over, it was of some surprise to learn that the aforementioned had decided to resign, citing difficulties with the new organisation. Given that there is not a deputy in this home, and the number of qualified staff had been reduced (although this report contains a requirement to reverse this), the home will be left in a potentially grave situation. A meeting will be held with the proprietors to discuss the way forward. A number of staff files were examined. While most showed evidence of some supervision, what supervision there had been was brief and very infrequent. In order to ensure that the standard of care practice is of a sufficient quality, and to also ensure that the staff are able to raise and discuss any concerns/queries/issues of their own, it is vital that they are provided with regular 1:1 supervision. As mentioned overleaf, the requirement within the last report regarding the storage of COSHH substances had been dealt with. From this viewpoint, therefore, the Standard was being met. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 X 3 Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 21 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 OP3 Regulation 14 Requirement A pre-admission assessment must be carried out for all prospective service users. The previously set timescale has not been fully met. All care staff must be familiar with the plan of care for each service user. The previously set timescale has not been fully met. The manager must ensure that the action taken to meet the identified needs of service users is documented and thus can be evidenced. The service user plans (and accompanying assessments) must be reviewed on a regular basis. Service users should be weighed on a monthly basis (in accordance with their plan of care) and this must be recorded. The previously set timescale has not been met. The manager must ensure that documentation relating to specific nursing tasks (i.e. wound care) is correctly maintained. The previously set timescale has DS0000065224.V274921.R01.S.doc Timescale for action 12/12/05 2. OP7 15 31/12/05 3. OP7 15 12/12/05 4. OP7 15 31/12/05 5. OP8 12 12/12/05 6. OP8 12 12/12/05 Park Lodge Version 5.0 Page 22 7. OP9 13 8. OP18 13 9. OP19 23 10. OP19 13 11. 12. OP19 OP19 23 23 13. 14. OP26 OP27 16 18 15. OP29 19 16. OP30 18 not been met. The manager must ensure that the medication administration records are correctly completed at all times. The previously set timescale has not been met. The protection of vulnerable adults procedure must be revised as outlined in this report. The previously set timescale has not been met. The hole in the wall in one of the bedrooms must be repaired. The previously set timescale has not been met. Immediate steps must be taken to repair the emergency call bell system. An immediate requirement notice was left to this effect. The extractor fan in the kitchen must be repaired as a matter of urgency. All extractor fans must be thoroughly cleaned on a regular basis. The previously set timescale has not been met. Steps must be taken to eradicate the odour. The previously set timescale has not been met. The proprietors must ensure that the staffing levels are increased forthwith (and as outlined in this report), and in future do not fall below the minimum numbers. The manager must ensure that all new staff supply the documentation listed in the Regulations before commencing work. The previously set timescale has not been fully met. The Registered Provider must ensure that staff have access to relevant training, including NVQ awards and Basic Food Hygiene (this is essential for kitchen staff). The previously set timescale has not been fully met. DS0000065224.V274921.R01.S.doc 12/12/05 31/12/05 31/12/05 12/12/05 31/12/05 12/12/05 12/12/05 12/12/05 12/12/05 31/12/05 Park Lodge Version 5.0 Page 23 17. OP1 10 The Registered Provider must submit a variation to ensure that current service users are reflected in the category of care. The previously set timescale for this requirement has again not been met. 31/12/05 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. 2. 3. 4. 5. 6. 7 8 9 10 11. Refer to Standard OP7 OP8 OP8 OP10 OP10 OP15 OP19 OP33 OP19 OP33 OP34 Good Practice Recommendations It would be good practice to cross reference the service users daily notes with their plans of care. It would be helpful if copies of the continence assessments could be obtained. It would be good practice to carry out a nutritional assessment of service users on their arrival at the home. It would be good practice to ensure that items such as a bath rota are not on public display. It would be good practice for staff to sit with, and not stand over, service users when assisting them with drinks. It would practice for staff to ensure that the food fact files were completed for all service users. Consideration should be given to replacing the aging bath hoist. It would be good practice to publish the results of service user surveys. It would improve the decor in the bedrooms if fitted wardrobe doors could be painted. The Registered Provider should ensure that there is a development plan for the home. The Registered Provider should ensure that a business plan is developed for the home. Park Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Lodge DS0000065224.V274921.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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