Inspection on 11/05/05 for Park Lodge Care Home

This inspection was carried out on 11th May 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 Care Home 01/07/10

Park Lodge Care Home 14/04/10

Park Lodge Care Home 20/10/08

Park Lodge Care Home 22/10/07

Park Lodge Care Home 15/05/07

Park Lodge Care Home 04/10/06

Park Lodge Care Home 22/05/06

Park Lodge Care Home 05/10/05

Park Lodge Care Home 07/10/04

Park Lodge Care Home 05/05/04

Park Lodge Care Home 16/12/03

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 Care Home 6 Victoria Drive Wimbledon London SW19 6AB Lead Inspector Sharon Newman Unannounced 11 & 12th May 2005 10:00 th 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 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 Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Park Lodge Care Home Address 6 Victoria Drive Wimbledon London SW19 6AB 020 8789 5822 020 8785 7449 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Four Seasons Health Care (England) Ltd Mrs Deidre Wyler Care home with nursing (N) 60 Category(ies) of Dementia (DE) registration, with number Old age not falling within any other category of places (OP) Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th October 2004 Brief Description of the Service: Park Lodge is a registered home providing nursing care for up to twenty older people and residential care for up to forty older people, ten of whom may have dementia. The home is owned and managed by Four Seasons Health Care, an organisation that has similar services across the country. The home is situated in a residential area on the borders of Wimbledon and Wandsworth, close to local shops, churches of a number of denominations and regular bus services. Accommodation is provided over three floors with the home split into four single units. Each unit has a lounge, dining room, bathrooms and toilets. All bedrooms are single. Service users have access to a large garden around the home and a roof top terrace. The home is serviced by two lifts, one lift for service users and the other being a service lift. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Inspection Team: Sharon Newman Sandy Patrick Jeremy Howe Regulation Inspector Regulation Inspector Pharmacy inspector The inspection took place over two days on the 11th & 12th May 2005, and was unannounced. The Registered Manager was present throughout the inspection. The Inspection Team met with service users, their visitors and staff on duty and were made welcome by all. Throughout the two days the Inspectors observed positive interactions between service users and staff, which indicated mutual trust and respect. Service users were seen to pursue a range of activities throughout the home within the six different units. A relative spoken to stated the nursing unit is ‘well organised’ and relatives can be ‘involved in the care if they wish’. Standards of maintenance, cleanliness and hygiene within the home were disappointing on the day of inspection. The Registered Manager is highly regarded by the staff, service users and relatives spoken to at this visit. She stated that she has worked hard to raise standards and improve care at the home. However, the inspection team observed a number of practices at the home which gave rise to concern and are detailed in the main body of the inspection report. Immediate Requirements relating to particular areas of concern issued on the day of inspection are outlined below: 1. A large number of fire doors in both communal and private areas were seen to wedged open. Fire doors must not be wedged open. Regulation 13 (4) (6) 23 (4) (c) (i) 2. Cleaning products, air fresheners and bleach were all found to be stored in unlocked locations. Cleaning Products must be stored in accordance with COSSH Regulations. Regulation 13 (4) (6) 3. The electrical cupboard was found to be unlocked. This cupboard must be kept locked at all times. Regulation 13 (4) (6) 4. A) Used Razors were found to be in communal bathrooms. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 6 B) A broken toilet seat had sharp fittings which presented a hazard. These hazards must be removed to ensure the health and safety of the service users. Regulation 13 (4) (6) 23 (2) (c) 29 Requirements were made at this inspection visit and six good practice recommendations. What the service does well: What has improved since the last inspection? What they could do better: There needs to be an improvement in the care planning documentation as they are not being adequately completed or updated. The documentation seen did not give sufficient guidance for staff on how to meet individual needs. Also, service users have not been consulted about the development and review of their plans. The medication administration records are not being completed adequately the staff need to ensure these are fully completed to ensure service users are not put at risk. The pharmacy inspector found omissions in recording, potentially unsafe storage and an error in administration. These shortfalls might affect the health and welfare of service uses. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 7 Attention needs to be paid to the home’s environment which does not present as homely. The home is not appropriately maintained or cleaned and attention needs to be paid to basic hygiene. Damaged and broken equipment, inadequate cleaning and laundering all present a risk to the well being of service users. Attention needs to be paid to staff training particularly in the areas of dementia care and abuse. The lack of senior staff support seems to have a large impact on the care given to the service users. The staffing structure at the home should to be reevaluated to consider the introduction of a higher proportion of senior staff and a deputy manager. 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 Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 1, 2, 3 Service users are provided with comprehensive information about the service. Terms and conditions of residency are not in place for service users. There is an appropriate procedure for the assessment of service users. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User Guide. The Registered Manager reported that these have not been changed since the last inspection. There is a range of information for service users on local advocacy services, the complaints procedure and activities situated on notice boards around the home. The Manager reported that the organisation has not yet finalised the terms and conditions of residency. A letter outlining some contractual obligations is issued to privately funded service users. The organisation must finalise the terms and conditions and these must be issued to all service users. The requirement made at the last inspection is restated. Pre admission assessments were seen within all four service user records examined on the residential unit. Two of the assessments were significantly Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 10 more detailed that the other two examined and provided a better range of information on the service user’s individual needs. Assessments made by the placing authority were also seen to be held on file. This home does not provide intermediate care. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 & 11 Service user plans are in place for all service users. Although some documentation examined was detailed and comprehensive in content some did not adequately identify needs and did not give sufficient guidance for staff on how to meet individual needs. Service users have not been consulted about the development and review of their plans. The Inspectors were informed of and witnessed practices that did not show due respect to the privacy, dignity and respect of service users. The home has arrangements for the ordering, storage, recording and auditing of medication and has access to a pharmacist for advice. Omissions in recording, potentially unsafe storage and an error in administration were found that might affect the health and welfare of service uses. EVIDENCE: Individual service user plans are in place for all service users. Six service user plans were examined in total. Four service user plans and related records were examined from one of the residential units. These were basic and did not contain any information on social needs, daily routines, night time care and some did not contain information on personal care needs. In each case, the care plan related to a small number of needs, mainly health needs. In two cases the needs identified on the ‘care plan index’ were not detailed within the plan. The service user plan for one service user who was known to have a Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 12 serious health need, did not contain any information on this need. The pre admission assessment for one service user identified problems with fluid intake. No plan of care had been developed in respect of this or continence management. Service user plans had been subject to monthly review. One service user plan referred to ‘advice given by the doctor’. However there was no explanation of what this advice from the doctor was. Daily observation and keyworker notes did not give adequate detail. Notes included statement such as, ‘No concerns. Fine today’. Only a very small number of notes gave more in-depth information on the service user. Assessments of risk were seen to be in place on all service user plans examined. However, some of these were in need of review. In one case the risk assessment identified that the service user was at risk of falling, slipping and choking, but did not identify any action that should be taken to minimise these risks. The related service user plan did not make any reference to any of these risks. None of the service user plans seen had been signed by the service user or their representatives. Service user plans would benefit from archiving and information was not always presented clearly. For example one aspect of a service user plan was found in a plastic pocket in the middle of some old daily observation sheets. A form designed to be used following the death of a service user was found within one service user plan and must be removed. Two service user plans examined on the nursing unit were found to be comprehensive and well-organised. However, shortfalls were noted within this documentation. A key worker diary for one service user was found to be blank. A care plan entitled ‘eating and drinking’ was not specific and merely stated ‘encourage plenty of fluids’. A continence assessment did not contain enough detail to ensure the care needs of the individual would be fully met. More indepth information is required in this documentation. One service user who had been identified by the Registered Manager as having aggressive episodes of behaviour did not have a risk assessment in place with regard to this issue. One risk assessment was still in the care plan but was no longer required as it referred to a problem that has since been resolved. This documentation should have been archived. Reviews of wound assessments were seen not to have been taking place, thus making it difficult to assess if the wound was improving or not. Full records were seen to be kept relating to visits from health care professionals. These were specific to each individual service user. There was evidence of multidisciplinary input from physiotherapists, GP’s, wound care specialist nurses and dieticians. The Manager said a community psychiatric Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 13 nurse visits regularly. A physiotherapist was seen to be visiting the home on the day of inspection. The inspectors were informed by the Manager that local outreach clinics are going to be held at the home by a psychogeriatrician. The written medication policies and procedures were found to be adequate on the last inspection and were not reviewed on this visit. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The person in charge and three staff members were interviewed, six service users rooms were checked and eleven service users medications counted and compared to the records of receipt and administration. From these discussions and observations the allergy section on the administration record was not completed for three services users. One service user had missing entries on the administration record indicating administration/non-administration of medication. In three instances the quantity of medication carried over had not been recorded making it difficult to audit the use of these items. External preparations in five service users rooms and Steradent tablets in one service user’s room were seen with no risk assessments potentially putting service users at risk. Six items, four of which had expired, were found that were no longer currently prescribed. One medication had been given twice daily instead of two tablets once a day All other records had been completed accurately and provided evidence that all other medication had been administered correctly, changes to medication clearly identified, and regular audits had been performed. Service users reported that they were able to rise and retire at a time of day of their choice. Mealtimes are flexible and hot drinks and snacks are available throughout the day and night. Service uses confirmed that they make choices about their personal toiletries. Toiletries, including talcum powder, bubble bath and shampoo were found in communal bathrooms. These were not labelled and staff could not identify them as belonging to any named service users. The use of communal toiletries is unacceptable. Personal items should be stored in private areas. The Inspectors witnessed an incident where a service users’ actions did not ensure their privacy with regards to personal hygiene. This was discussed with the Manager. The Manager reported that this was an identified problem in caring for this service user. There was no reference to this in the service user plan. Although the service user was responsible for their own actions, the Inspection Team felt that staff on duty did not take appropriate action to maintain the service users’ privacy and dignity at the time of the incident. Service users in one unit were seen to be wearing plastic aprons at meal times. This practice is unacceptable and alterative arrangements should be made. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 14 Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 12, 13, 14 & 15. Activity provision was not adequately recorded and limited evidence was seen, although staff reported that a range of activities are offered. Service users are able to maintain contact with family and friends. Service users are offered a choice of wholesome food, although this choice is limited for some service users. EVIDENCE: The home does not employ an activities officer, however individual activity programmes have been developed for each unit. Staff on the units reported that they followed these and that ad hoc activities were organised according to individual and group wishes. On the second day of the inspection staff and service users were holding a quiz. The Manager reported that many service users accessed activities outside of the home. There was limited evidence of activity provision, participation and enjoyment. Social needs were not identified within service user plans. The home has good links with the local Roman Catholic church and service users are supported to attend church services. There are currently no regular religious services held at the home, although the Manager reported that services are held on special occasions. One family member stated that their relative attends church regularly and this was organised by the care staff at the home. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 16 A hairdresser visits the home twice a week and a relative said that a mobile library visits the home once a month. The inspection team examined records of service user meetings which are held within each unit on a regular basis. These indicated that service users were able to voice their opinions on the service. There is a flexible visitors procedure and service users can receive visitors at any time. Service users were seen to receive visitors throughout the inspection. The Manager reported that service user and relative meetings are held annually and that one was due shortly after the time of the inspection. The Manager is hoping to establish a ‘Friends of Park Lodge’ committee, and is currently promoting this idea. One relative has asked that a support group be developed for relatives to meet on a regular basis. This is to be discussed at the next relative and service user meeting. Service users are able to bring personal belongings and furniture to the home with the agreement of the Manager. Service user plans did not adequately record personal choices and preferences with regards to care, including meal times and night time requirements. Service users reported that they are able to rise, retire and eat when they wished to. Staff on duty reported that some service users spend the day in their wheelchairs. In one case a staff member reported that this was because the service user’s relative had requested this. This practice could be seen as abusive and may pose a risk to the service user’s health and well being. Service users must be given the opportunity to sit in other chairs throughout the day. Where there is an identified need for a service user to remain in their wheelchair, this must be recorded within the service user plan and a risk assessment should be in place. Advice of health care professionals and the wishes of the service user must be sought and recorded. The use of wheelchairs to restrain service users is unacceptable. There is a four week cyclical menu. This offers a varied and balanced diet. There is no choice on the main menu, although an alternative menu is offered each day. This includes omelettes, salads and jacket potatoes. The Inspection Team were informed that there is no special vegetarian menu, and vegetarian service users usually have meals from the ‘alternative menu’. The choices on this menu are limited for service users who are not able to eat the majority of meals from the main menu. An alternative vegetarian menu should be created to offer a greater choice of meals. All meals are prepared by catering staff and service users are able to have a cooked breakfast each day should they wish. Each unit is equipped with a small kitchenette. These are used for the preparation of hot drinks and some snacks. Not all food was stored appropriately within these kitchenettes. An Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 17 unlabelled plate of butter and an opened packet of cheese were found in one kitchenette fridge. The main kitchen was clean and appropriately equipped. The chef on duty reported that they worked at the home three days a week. Another chef is employed to work full time. The part time chef is currently undertaking a qualification on food hygiene. This must be obtained without delay. This chef should not be preparing food without this qualification. Through discussions with the Inspectors, it was felt that the chef would benefit from attending training on diabetic diets. Food storage, delivery and serving temperatures had been recorded, with the exception of weekends. Food temperatures must be recorded daily. The cutlery and crockery used throughout the home did not match and the Inspector observed that dinner places laid at the table in one unit consisted of several different sets of cutlery and crockery. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 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 standard(s) 16 & 18 Procedures regarding abuse and whistle blowing are in place. Appropriate checks have not been made on all staff and they have not received information or training on recognising and reporting abuse. EVIDENCE: The home has adopted the London Borough of Wandsworth Protection of Vulnerable Adults procedure. Four Seasons Health Care also have their own procedures on abuse and whistle blowing. Some staff on duty reported that they were not aware of these. Not all staff have undertaken training in recognising and reporting abuse. The Inspectors were made aware of some practices which could be seen as abusive. For example service users being pushed in wheelchairs without foot plates and staff using shampoo to wash service users. There was evidence that the Manager has addressed these issues through meetings and written memos. However, it is concerning that staff have undertaken such practices. All staff must receive training in Protection of Vulnerable Adults and must be aware of the procedures relating to this. The home has had one formal complaint since the last inspection visit and has been conducting an investigation into this using it’s complaints procedure. Three staff recruitment records were examined. The criminal record check for one staff member had not been returned. This was discussed with the Manager who had limited information on the current criminal record checks guidance and was not aware of the new procedure for checking staff against the Protection of Vulnerable Adults list. The Manager must ensure that they Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 19 are aware of the latest guidance. Satisfactory Protection of Vulnerable Adults checks must be in place prior to employment. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 23, 24, 25 & 26. The environment is not appropriately maintained or cleaned. Damaged and broken equipment, inadequate cleaning and laundering present a risk to the well being of service users. The environment does not present as homely. EVIDENCE: Accommodation is provided on three floors. The home is divided into six interconnecting units. Two of these are allocated for service users requiring nursing care. Each unit is equipped with a small kitchenette, a lounge and dining area. All bedrooms are for single occupancy. There is sufficient number of bathrooms and WCs available throughout the home. Areas of the building have been subject to recent decoration, although many areas have some decorative needs. Carpets in some lounges and communal hallways were stained and badly worn. Woodwork and paint work were damaged. The Inspection Team found a high number of maintenance needs which included badly damaged and broken cabinet doors and drawers throughout the building, marked units, damaged lino and carpets (which Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 21 presented a trip hazard). There was also a badly damaged toilet seat and broken equipment found stored within bathrooms. Radiators within corridors and some rooms were not appropriately covered to protect service users from the risk of scalding. In one unit lounge, where twelve service users live, there were only nine chairs and one small coffee table. Chairs and furniture throughout the home did not match and the home did not present as homely. One bedroom which has been used for single occupancy for several years still contained the dividing curtain used when the room was shared. Staff reported that the service user did not use the curtain. One service user’s bedroom was seen to be well-personalised and they said they ‘liked their room’. A relative stated that a new carpet had been provided before their family member moved in to the room. Although the home is large, the use of storage space was inappropriate. Equipment, furniture and old packaging was found in bathrooms and other communal rooms. In one bathroom an incontinence pad was found on an open shelf. In another bathroom a vacuum cleaner was stored in a cupboard above shoulder height. The home was not adequately cleaned and areas of communal and private accommodation was dusty and dirty. Equipment left in a sluice room on a drying rack was dirty with what appeared to be faeces. Bars of soap were seen to be used in WCs instead of liquid soap to prevent spread of infection. In a large number of WCs there was no paper towels and in one WC there was no toilet paper. The Inspection Team identified a high number of concerns with regards to the environment and cleanliness. Indicating that no regular checks are made to ensure safety for those living at the home. There are two allocated smoking areas for service users. One smoking area is not shut off and smoke from this area drifts into other communal areas. The Registered Person should consider the relocation of this area to protect service users from passive smoking. The Manager reported that the main users of this smoking area are visitors. The Registered Person should consider changing this arrangement so that the well-being of service users is put before the comfort of their visitors. There is a separate laundry and sluices on each unit. The laundry assistant on duty told the Inspector that they washed clothes on washes at 30° or 40°C. They indicated to a laundry basket which included nightclothes and underwear which they informed the Inspector they were going to wash at 30°C. It is Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 22 essential that clothing is washed at appropriate temperatures to ensure infection control. Cleaning products, including bleach and high pressurised containers of air freshener were found stored within unlocked cabinets and were left out on shelves. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 23 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30. The staffing structure and number of senior staff does not sufficiently support the management of the home. Staff are given a good range of written information but are not directed, supported or supervised on a daily basis. The lack of this support has led to poor practice where service users’ needs are not met. EVIDENCE: There is only one senior support worker at the home and the post of Deputy Manager has not been recruited to. The Nursing units are overseen by a qualified nurse. The Inspection Team observed a number of practices at the home which gave rise to concern. These included poor recording of information within service user plans and poor cleanliness. Information from staff memos and team meetings indicated there are other areas of poor practice and these were discussed with the Manager. There is evidence that the Manager has provided some written guidance to support staff to understand their roles and responsibilities. This includes shift plans to help direct staff within the units. The Inspection Team acknowledges that considerable work has been undertaken to address some poor practices. However, the Inspection Team felt that the lack of senior staff support has a significant impact on service delivery. Nursing staff are not responsible for the four residential units and must not be given duties overseeing these. Without sufficient senior staff support to supervise, direct and work alongside care staff poor practice will continue. The Manager does not have the time to fulfil her role and to oversee staff in such a large home on a daily basis. The Registered Person must re-evaluate the Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 24 staffing structure at the home and must consider the introduction of a higher proportion of senior staff. There is a programme to support staff to achieve their NVQs. The Manager reported that 63 of staff are qualified to NVQ Level 2 or above. Four Seasons Health Care have a comprehensive training programme and staff at the home are able to access relevant training. The training needs of the staff team were not considered in depth at this inspection. However, identified training needs included dementia and abuse. One staff member spoken to said they had been provided with ‘very good training’ at the home and that ‘staff get on well’. This staff member demonstrated a very good rapport with service users and relatives. There are appropriate procedures for the recruitment and selection of staff. Three staff recruitment files were examined. These contained the correct documentation and information, with the exception of one staff file which did not contain a criminal record check. Refer to Standard 18 of this report (Section – Complaints and Protection). Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 25 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36, 37 & 38 The appointment of a deputy manager and more senior staff will benefit the running of this home and enable the Manager to provide a more clear leadership role. Hazards observed during the inspection visit present a risk to the health and safety of the service users. EVIDENCE: The Manager is experienced and has obtained the NVQ Level 4, she said she is committed to raising standards for the service users in her care. Evidence was seen of up-to-date fire safety checks, portable appliance testing and electrical installation checks. Gas safety records were also found to be in order and the passenger lift has been regularly serviced Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 26 Sharp kitchen knives were found within one kitchenette and were not locked away. The service user plans identified that one service user residing in this unit was at risk from sharp knives. An Immediate Requirement was made at the time of inspection for the home to ensure that cleaning products, including bleach and pressurised air fresheners are stored securely. An Immediate Requirement was also issued to ensure an electrical cupboard, containing exposed wires and labelled as dangerous, is kept locked. It was found to be unlocked at the time of inspection. A large number of fire doors were wedged open in a way which would prevent them from closing in event of a fire. This poses a serious risk to health and safety. The Inspection Team recognises that service users are restricted by heavy doors. Therefore these fire doors should be equipped with devices that hold them safely open. An Immediate Requirement was issued in respect of this concern at the time of the inspection visit. An Immediate Requirement was issued to ensure used razors are not kept in communal bathrooms as they could present a serious risk to service users. An Immediate Requirement was also made in respect of a broken toilet seat that was found to have sharp fittings which could present a risk to service users. Not all accidents and incidents concerning service users have been reported to the Commission for Social Care Inspection. The Manager has produced written guidance for staff on the type of incident and accidents which would lead to notifications being made. This guidance was inaccurate and staff must be aware that they must notify the CSCI of any event that adversely affects the well being of service users. Radiators in corridors and some communal rooms were uncovered and did not sufficiently protect service users from the risk of scalding. The Requirement made at the last inspection is restated. Refer to Standard 24. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 27 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x x x 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 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 1 2 2 x 2 2 1 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 2 x x x 2 2 1 Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 28 YES Are there any outstanding requirements from the last inspection? 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 OP2 Regulation 5 (1) (b) Requirement The Registered Persons must ensure that every service user is issued with terms and conditions of residence which must include details of the rooms to be occupied. (Previous timescale of 01/02/05 not met). 1) The Registered Person must ensure that service user plans include information on social, health and personal care and all identified needs. 2) Service users must be given the opportunity to participate in the development and review of their service user plan. Plans must be signed by the service user (or if necessary their representative) as an indication of their agreement. 3) The Registered Person should ensure that files are archived and remove any inappropriate documentation. (Previous timescale of 01/02/05 not met for care plan requirements) The Registered Person must ensure that assessments of risk are sufficiently detailed and identify action to be taken to minimise risks. Risk Timescale for action 1st July 2005 2. OP7 12 (1) (2) & (3) 15 (1) (2) (a) (b) (c) &(d) 16(2)(m) & (n) 1st July 2005 3. OP 7 13(4) & (6), 15 1st June 2005 Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 29 4. OP9 13 (2) Assessments must be kept under regular review. The registered person must ensure that staff complete the administration record appropriately for all medication administered by staff within the home. The registered person must ensure that there are risk assessments for all items of medication and Steradent tablets in service users rooms. The registered person must ensure that all items of medication that are expired or no longer in use are removed and disposed of appropriately. The registered person must ensure that the allergy section on the administration record is completed for all service users. The registered person must ensure that all medication is given as the prescriber directed. The Registered Person must ensure that where possible personal items and toiletries are stored in individual rooms. Items stored within communal areas must be labelled for identification. The Registered Person must ensure that accurate records of activity participation and enjoyment are maintained. The Registered Person must ensure that service users are given the opportunity to be seated in chairs rather than wheelchairs. Wheelchairs must not be used as a form of restraint. Any decision for a service user to remain in their wheelchair must be based on 1st June 2005 5. OP9 13 (2) 1st June 2005 6. OP9 13 (2) 1st June 2005 7. OP9 13 (2) 1st June 2005 1st June 2005 1sr June 2005 8. OP9 13 (2) 9. OP10 12(4) 10. OP12 16(2)(m) & (n) 12(1), (2), (3) & (4), 13(7) 1st June 2005 1st June 2005 11. OP14 Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 30 12. OP15 13(4) & (6), 18(1)(c)(i ), 19(1)(a) 13(4) & (6 16(2)(g) their wishes and should be subject to advice from relevant health care professionals. The Registered Person must ensure that any person preparing food has completed a food hygeine course. The Registered Person must ensure that food temperatures are taken and recorded on a daily basis. The Registered Person must ensure that there is sufficient number of matching cutlery and crockery. The Registered Person must ensure that all staff are trained in recognising and reporting abuse. The Registered Person must ensure that the Manager is aware of the procedures for making criminal record and POVA checks on staff. Satisfactory checks must be received prior to the commencement of employment. The Registered Persons must ensure radiators and pipework are guarded throughout the home (Timescale of 01/03/05 not met). 1) The Registered Persons must ensure that all maintainence issues outlined in Standard 19 of this report are addressed. 2) The Registered Person must ensure that regular checks are made on the environment. The Registered Person must ensure that storage of equipment, furniture and other items does not present a risk to service users. 1) The Registered Person must take adequate measure to 1st July 2005 13. OP15 1st June 2005 1st September 2005 1st July 2005 1st June 2005 14. OP15 15. OP18 13(4) & (6), 18(1)(c) 13(4) & (6), 19(1)(a) 16. OP18 17. OP19 13 (4) 1st September 2005 1st September 2005 18. OP19 23(2)(b) & (d) 19. OP25 13(4) & (6), 23(2)(l) 13(4) & (6), 16(2) 1st June 2005 20. OP25 1st June 2005 Page 31 Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 (e) (j) 21. OP26 13(4) & (6), 23(2)(d) 18 (1) (a) 12 (1) (a) 12 (5) (a) 37 22. OP27 23. OP33 24. OP38 13 (4) (6) 25. 26. OP38 OP38 13 (4) (6) 23 (4) (c) (i) 13 (4) (6) 27. 28. OP38 OP38 13 (4) (6) 13 (4) (6) 23 (2) (c) 13 (4) (6) 23 (2) (c) 29. OP38 ensure infection control. 2) The Registered Person must ensure that clothes and linen are laundered at appropriate temperatures. The Registered Person must ensure that the building and all equipment used is cleaned appropriately. The Registered Persons must ensure that adequate numbers of appropriately trained staff are on duty at all times The Registered Person must ensure that the Commission for Social Care Inspection is notified of all events in accordance with Regulation 37. The Registered Person must assess the risk of storing sharp knives in kitchenettes on the units and must take appropriate action to minimise any risks. The Registered Providers must ensure that fire doors are not wedged open. The Registered Providers must ensure that cleaning Products must be stored in accordance with COSSH Regulations. The registered Providers must ensure the electrical cupboard must be kept locked at all times. The Registered Persons must ensure that the used razors found to be in communal bathrooms are removed. The Registered Providers must ensure that the broken toilet seat with sharp fittings has been removed. 1st June 2005 1st September 2005 1st June 2005 12th May 2005 12th May 2005 12th May 2005 12th May 2005 12th May 2005 12th May 2005 30. 31. Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is strongly recommended that the quantity of all medication carried over from one month to the next be recorded on the administration record. It is recommended that plastic disposable aprons are not used for service users at mealtimes. It is strongly recommended that the home appoint dedicated staff to provide activities within the home. It is recommended that the kitchen areas within each unit of the home be fully refurbished. It is recommended that the fire exit stairs located in the garden of the home are re-decorated. It is recommended that an alternative closed off smoking area is found to prevent smoke from drifting throughout the communal areas of the home. 2. 3. 4. 5. 6. OP10 & 15 OP12 OP19 OP19 OP24 Park Lodge Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 33 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Care Home G54-G04 S19112 Park Lodge V221924 110505 Stage 4.doc Version 1.30 Page 34 - 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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