Inspection on 15/05/07 for Park Lodge Care Home

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 04/10/06

Park Lodge Care Home 22/05/06

Park Lodge Care Home 05/10/05

Park Lodge Care Home 11/05/05

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 Inspection 10:00 15 and 16th May 2007 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 Care Home DS0000019112.V335816.R01.S.doc Version 5.2 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 Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park Lodge Care Home Address 6 Victoria Drive Wimbledon London SW19 6AB 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) 020 8789 5822 020 8785 7449 park.lodge@fshc.co.uk www.fshc.co.uk Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Deidre Wyler Care Home 60 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (60) of places Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2006 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. Fees range from £455 to £590 per week. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one and a half days. Two regulation inspectors and a pharmacy inspector visited the home on the 15th May 2007. One regulation inspector returned to the home on 16th May 2007 to complete the inspection. The new manager was present throughout the inspection and the inspection team spoke to residents and staff on duty. Documentation looked at included medication records, staff recruitment information, residents care plans and health and safety documentation. A tour was also taken of the premises. The manager is also completing an Annual Quality Assurance Assessment (AQAA) which is a self assessment survey. However this did not arrive prior to completion of this report. The pharmacist will send out a separate report with their findings. Surveys were left at the home for residents, staff, relatives and health professionals to complete. Four were returned from relatives and two from staff before this report was completed. A new manager is in post and she acknowledges that there is a lot of work that needs to be carried out to improve standards at the home. As found at previous inspections there was little evidence of improvement in many areas. Requirements have again been carried over from previous statutory inspections. What the service does well: What has improved since the last inspection? What they could do better: Care plans are still not person centred and there was little evidence of residents participation in care plans. Care plans for health needs including Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 6 continence and diabetes care are not always detailed enough to ensure that residents needs can be met. Where risks have been highlighted a plan on how to meet these needs had not been put in place and risk assessments were not in place. Also risk assessments for activities such as smoking need to be drawn up with the residents. Although evidence of district nurse and GP visits was recorded there was not always enough evidence to demonstrate that other professionals have been involved in residents care. These include continence specialists, dieticians and diabetes nurse specialists. Staff training to help meet the health care needs of residents needs to take place. This includes training in wound care, continence and diabetes care. Dementia care training is taking place and all staff need to undertake this training. Although a part-time activity co-ordinator has been employed there were no activities going on at the time of inspection and feedback from residents about activities indicated that they wished to be offered more. Issues arose around the area of protection as the home did not have a copy of the new London Borough of Wandsworths adult protection procedures and staff training in this area is not up-to-date yet for all staff. It was also concerning to find that staff are reluctant to whistleblow to highlight bad practice. This is discussed in the main body of the report. There was a strong and unpleasant smell of urine throughout the home. Many staff within the home also commented upon this. This does not create a pleasant or homely atmosphere. The inspection team were also informed that the home does not have sufficient cleaning staff. Many areas of the home were dirty and dusty with bins found to be overflowing with rubbish. Many items of furniture need to be replaced for example chairs as they are worn and stained and furniture is chipped and broken. Redecoration of the home must take place as it does not present as a homely comfortable place to live. Staff complained of feeling demoralised, stressed and tired and reported that working long days was exhausting. On one unit three of the staff were working long days. Many staff felt that they couldn’t give adequate care in these circumstances. The high needs of residents is discussed in this report and the importance of ensuring that they are receiving the support they require and that staffing levels remain sufficient. Although it is acknowledged that staff training is taking place there was insufficient evidence on the day of inspection to show that all staff are up-todate in mandatory areas. This was discussed with the new manager who said this was a priority to her and she will need time to address this. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 7 As stated in the previous inspection report the home must ensure that one-toone staff supervision is taking place at least six times a year and that staff are adequately supported and directed in their roles. All necessary information in the staff recruitment files needs to be in place to ensure that residents are not placed at risk. There were some issues with health and safety which are discussed in the Management section of this report. 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. The summary of this inspection report can be made available in other formats on request. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service have a needs assessment carried out before they come to the home. However, they are not sufficiently detailed enough to ensure that the residents needs can be met. Residents are not consulted regarding changes to their living arrangements. EVIDENCE: Assessments of need were seen in all the care plans looked at and they covered areas including health and social needs. However they were not all fully completed and some terminology was subjective and might be deemed offensive such as: ‘can be demanding and unfriendly’ or ‘can be rude’. One assessment stated that the resident was ‘low in mood’ but did not suggest why this might be or what specialist support may be needed to help alleviate this. Further inappropriate comments stated that a resident ‘expresses their sexuality inappropriately’. It did not state what this statement meant and Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 10 there was no indication of the support that may be required. Another comment stated ‘has learning difficulty’ but again did not specify what this meant and what support was needed. Assessments were observed to have been completed by the referring social workers and nursing needs assessments had been completed for those who need nursing care. However the inspection team were informed that some of the residents needs have changed and they require far more support and in some cases nursing care. However these assessments have not been carried out yet and it is unclear if their needs are being fully met as staffing levels have not increased. Also, staff stated the plan is that if nursing care is needed these residents will be moved to another floor. However, they and their families want to remain where they are. The service should consider how these people can be supported to stay where they are and the additional care brought to them rather than them being moved. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are more organised and information has been archived which makes the information easier to find. However the care plans are not person centred and there is not enough information to demonstrate that health care needs are fully met. People who use the home have access to health care services. EVIDENCE: The care plans looked at during this visit were more organised and much of the old information has been archived which makes them easier for staff to use. Also some of the information had been updated more regularly and this is an improvement. However, issues still remain and these were discussed with the manager at the time of inspection. Some of the information was not detailed enough. For example in one care plan it stated that the residents blood glucose was ‘to be monitored and Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 12 maintained within normal limits.’ It did not specify clearly what those limits should be. This information needs to be more specific to ensure that the residents’ health care needs can be met. Although some of the recording in relation to wound care had improved there was no evidence of wound mapping or photographs to show the progress of the wound. This is good practice and should be put in place. Some continence assessments had not been fully completed and did not specify action taken or whether a continence advisor had been involved in their assessment or care. There was evidence of input from the GP, psychiatrist and district nurses. However there was insufficient evidence of input and advice from other specialist health professionals such as the continence advisor, dietician and diabetes specialist nurse. In one care plan it stated that referrals should be made to the dietician but there was no evidence of this and no clear nutritional plan in place. A nursing member of staff reported that they have not attended any recent training updates in the areas of wound care, continence or diabetes care. Training must be arranged for all staff who have input in these areas. Staff must remain up-to-date with current knowledge in these areas to ensure that residents receive care that is guided by best practice. A family member wrote that they had been told to buy a piece of medical equipment for their relative that should have been free on the NHS as it was meeting a medical need. One resident who had been assessed as ‘immobile’ had a history of injuries to their legs and it was unclear how this was occurring. This was raised with the manager at the time of inspection who said she would look into this immediately. There were no resident agreements in the care plans seen at this visit. They are very task orientated and are not person centred. For example the daily notes contained statements such as: ‘ate well, drank well. PC given.’ There was also a lack of input from family or advocates. This is an area that needs to be addressed to ensure that residents wishes are taken into consideration and that they are involved in drawing up their care plans. There was also conflicting information in different documents for example the wrong date of birth for one resident and there were no follow up assessments in place. In one instance there was the wrong information in the care plan for the residents next of kin. More care need to be taken to ensure that the information contained within the care plans is correct. Some information was unclear and not detailed enough, for example the key workers diary is poorly used and entries are not detailed enough. Statements include: ‘washed hair’ and ‘had a bath.’ Although some information on social needs had improved many were poorly addressed. There was no evidence that residents are Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 13 supported to pursue interests recorded in assessments. More information is needed in this area and this was discussed with the manager who reported that this would be addressed. It was discussed with the manager that the actual care plan is positioned behind lots of assessments and other information so it is harder for staff – particularly new staff - to find. A risk assessment was not in place for a resident who smokes nor a resident who had been assessed as being at risk of ‘being hit by other residents.’ Risk assessments must be in place for these individuals and clear protection and action plans must be in place for vulnerable residents at risk of ‘being hit’. These issues were discussed with the manager at the time of inspection. One resident said that they had been told they were not allowed to leave the house without support. They had asked if they could walk to the local shops alone as they knew the area well and had good road sense. The person said they were well aware of any consequences of walking out when alone. There was no risk assessment in place regarding this in their care plan. They reported that they had been told it was too dangerous for them to go out alone. They said that they found this patronising and restrictive. They reported they have been told that staff would accompany them if they wanted to go out. However, they have asked staff on several occasions if they could go to the shops and they have always told them that they are all too busy and no one can accompany them. No member of staff has ever offered them the opportunity to go out with them. Risk assessments must be in place for this individual and an action plan should be drawn up in consultation with this resident about how their needs can be met. Residents choice and wishes must be respected. Domestic staff were observed to enter residents’ bedrooms without knocking on the door. This does not respect their privacy and dignity and this must be addressed. A relative wrote that ‘people are being cared for.’ They also said that the home has done a brilliant job in understanding and caring’ for their relative. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Activity provision is limited and only some activities meet the needs of the people who live here. Residents are able to maintain contact with family and friends. However they are not helped to exercise choice or control over their lives. EVIDENCE: A new activities co-ordinator has been employed. However they only work two days a week. The manager reported that they were going to appoint another co-ordinator to cover two more days in the week and a member of care staff would cover the remaining day. The home must ensure that a full-time activities co-ordinator is in place. Several residents said that there were never any trips outside of the home. They said that in the past a very small number of outings for two to three people had been organised (to a local shop and Richmond Park) but that no one had been out for about 2 years. The day centre has now closed and residents said that nothing had been set up to replace the activities which they Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 15 participated in at the day centre. These included Bingo and other group activities. Residents said that an activity person visited the home twice a week. But that they were not informed about organised activities, were not invited to these and did not know what was going on. They said that the Activities Officer had never met with them and asked them what their interests were nor had any one organised anything which would appeal to their interests. Residents also commented that there was never anything to do from day to day except activities they organised themselves, such as knitting, reading, watching TV and talking with others. They said that this could be very boring and this area had not improved but had got worse in the time they had lived at the home. One relative wrote that the home could improve by providing ‘better activities during the day for those who are wheelchair bound – take them out into the garden and so on…’ They also wrote that the home needs to ‘increase the stimulation given to’ the residents. Another relative said ‘I know funding is low but (my relative) loves playing cards and scrabble which cost nothing.’ They reported that their relative only undertakes these activities when they visit them. The ground floor communal areas have changed so that all residents share a lounge and a dining room. The staff said that this had some advantages and some disadvantages. Residents said they were not consulted about the change. They like to sit in small groups and this is no longer possible because all the chairs are placed around the walls of the room. The look of the room is institutionalised. However, the dining room is more pleasant and the desk and TV have been removed. Residents prefer this and like the set up. However, the dining room would benefit from new table cloths, crockery, cruets, place mats so that these matched and looked smarter and more attractive. This was discussed with the manager at the time of inspection who reported that she was going to address this. There is currently only one option for each meal with alternatives of salad, omelette or jacket potato if residents do not want this. The menu for the next day was spaghetti bolognaise with boiled potatoes for lunch and ravioli for supper. The home should review the amount of carbohydrates in each meal and look at the fact that both meals of the day were pasta based. Residents said that they ‘did not always trust the menu’ as the food they got was not always the same as the menu had said. They gave examples of requesting boiled potatoes and being served mashed potatoes. Fruit in bowls in the dining rooms consisted of apples and oranges. The oranges were old and the skin marked. There were no easy to eat fruits Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 16 available and during the visit no staff offered cut up fruit for any one. The home must look at ways of ensuring that residents have access to a range of fresh fruit that is easy for them to eat. A relative wrote ‘the meals could do with some improvements. Especially the evening tea.’ They said ‘its always sandwiches/chicken nuggets and spaghetti.’ They commented that these were hard for their relative to eat. They also wrote ‘portion sizes are very small at times.’ A residents meeting was held in April by the interim manager and fifteen residents attended. The chef attended the meeting and menus and food choices were discussed with the residents. They were informed that new menus are to be introduced at the home. Copies of the new menus were given to the inspection team and show more choice on these than is currently on offer. The menus will be rotated on a four weekly basis. The manager reported that menus will be placed on the tables for the residents to read. Staff on the third floor was observed discussing the menu for the next day with residents so that they could make their choice of meals. One resident said that they were able to lay the tables in the dining room and that they liked that responsibility. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Individuals do not feel able to voice concerns. Staff are unaware of important safety information concerning medical alerts, this could affect the safety of the residents. Staff are confused about important safety procedures. EVIDENCE: One relative wrote that they have ‘always been listened to, taken seriously and action has followed.’ An up-to-date copy of the London Borough of Wandsworth’s Adult protection Procedures was not available at the home. The manager reported that she was aware of this and has requested a copy. These must be kept at the home to ensure that staff are aware of the correct procedures to follow when allegations are made. Allegations are being investigated using the protection of vulnerable adults procedures. The correct procedures were seen to be followed promptly in this case. Not all staff are aware of important information concerning health and safety such as medical device alerts. When discussing blood glucose finger pricking Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 18 devices and recent alerts in relation to these, staff were unaware of recent guidance. The organisation must ensure that all staff are informed of these alerts promptly and are aware of the appropriate guidance. This is to make sure that residents are not placed at risk. A fire drill took place during the inspection visit (see management section of this report) and there was a lot of confusion amongst staff regarding the correct procedure. This could have an impact on the safety of the residents. The inspection staff were concerned to be told during the inspection visit that staff are ‘afraid to whistle blow’ to highlight poor practice. This is discussed in the ‘Staffing’ section of this report. All staff must feel that they can use the whistleblowing procedures to highlight poor practice or concerns. Staff must not be made to feel intimidated. Two staff recruitment files could not be found on the day of inspection and important recruitment information was missing from another file. (See Staffing section of this report). Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There are still many areas that require improvement. Most of the décor needs upgrading. Also furniture is broken and chipped and many chairs are old and stained. The environment is not clean and tidy and does not present as homely. There is a strong smell of urine throughout the home. EVIDENCE: Some issues have been addressed since the previous inspection. The broken windows have been repaired since the last inspection. The organisation have informed the Commission for Social care Inspection that carpets have been ordered and a government grant of £20.000 has been given to the home to refurbish all bathrooms. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 20 However, many issues remain outstanding which must be addressed. As found at previous inspections: The flooring in the bathrooms, toilets and laundry areas throughout the home is marked, stained and peeling in places, this looks unsightly. It is also an infection risk and they must be replaced. One of the lounge areas in the nursing unit does not present as homely and requires redecoration, the walls were observed to be covered in dirty marks. The chairs in this area were marked, dirty and torn in places. Some of the furniture requires replacing, a wooden cabinet was chipped and broken in places and should be replaced. Throughout the home the ornaments and pictures are old and worn and this does not present a homely or pleasant atmosphere. The furniture throughout the home is ill matched and many carpets are stained. Many areas throughout the home including the bathrooms, toilets and communal areas were dirty and dusty. Bins were observed to be overflowing with rubbish. This is not only unsightly but is not good hygiene practice. The home must be kept clean to ensure the safety and comfort of the residents. There was an overpowering smell of urine throughout the home and many staff remarked upon this and agreed it smelt ‘dreadful.’ The home must be kept free from unpleasant odours. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staff morale is low. Staffing levels may not meet the needs of the people using this service which could affect the health and welfare of the residents. There is a high reliance on staff working long shifts. Lack of adequate information in the staff files could place residents at risk. Records of staff training are not up-to-date. EVIDENCE: Staff spoken to at this visit included the manager, administrator, care staff and maintenance staff. It is clear that staff feel demoralised about the changes to management that have taken place. Many staff reported feeling tired and stressed. Staff who had worked at the home for many years said that they had experienced lots of changes and that these were not always for the benefit of the residents. Although the shifts at the home are being covered. Many staff said that recent changes to the rota and their working arrangements were detrimental. They said that they now had to work eight days in a row including four long (12 hour) days. They said that towards the end of this eight day period they were Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 22 tired and unable to perform well. They also said that working late shifts and then early shifts back to back and two consecutive long days in a row meant that they felt they had very limited time at home. The inspection team were concerned to find many staff working long shifts as this could have an impact on the care of the residents. It was also bought to our attention that six to seven residents need to be reassessed as their needs have changed and they may need nursing care. The Manager has requested that they be reassessed. However, this obviously has implications for staffing levels and no additional staffing has been provided to meet these changed needs. Also, some care plans indicate that two staff are needed for the transfer of residents. However, this would not leave enough staff on the units to care for the other residents. Staff said that they did not have time to sit and chat to residents or support them with individual activities. The organisation needs to ensure that residents are reassessed promptly and that staffing levels are reassessed to ensure that the correct levels can be calculated. Many of the residents have complex needs and require a lot of care and support. The home must ensure that there are sufficient numbers of trained and competent staff on duty at all times. One relative wrote that they visit daily and have noticed that ‘the staff have recently been doing very long hours and looking very tired, which can’t be good for them or the residents.’ They reported that the ‘staff are always friendly and polite.’ Another relative wrote that ‘the main problem would appear to be shortage of staff at times.’ Another commented that the home ‘could be better, carers do a very good job but seem to be understaffed.’ Residents were very positive about some of the care staff that worked directly with them. They said that some staff were better than others but were very clear to mention some staff by name praising them highly for their care and dedication. Some good interaction was observed between some staff and residents during the time of inspection. It is evident that some staff are caring and try to offer good care. Some staff reported about an incident that before the appointment of either the interim manager or the new manager. They said that they had been shouted at and not allowed to leave the home until they reported who had spoken to the Commission for Social Care Inspection (CSCI) and stated what had been said. It has left them too worried to raise concerns. The manager also said that she has found that staff are reluctant to whistleblow and raise concerns or areas of poor practice. Minutes from a staff meeting show that she has raised this issue with staff. Staff must be free to raise concerns regarding poor practice through the whistle blowing procedures. They must also be aware that they have a duty of care to the residents and must report any concerns immediately. Staff must not be prevented from speaking to CSCI staff if they wish to do so. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 23 The manager reported that some staff had previously left the home due to ‘immigration issues’. Although there was some evidence that staff training is improving there was insufficient documentation to show that all staff are yet up-to-date with training in mandatory areas such as first aid, moving and handling and food hygiene. All staff need to be up-to-date in these areas to help ensure that residents are not placed at risk. The manager reported that she was going to ensure that staff attend up-to-date training in these areas. It is recognised that the interim manager arranged training for staff and that the new manager needs time to implement a full training programme. She reported that she considers training very important and will ensure staff attend both mandatory training and training that is required to meet the needs of the residents. This will include training in areas including: wound care, pressure area care, continence care and diabetes care. The minutes of the recent staff meeting show that the manger has asked staff to approach her regarding undertaking National Vocational Qualifications (NVQ’s). As reported in the previous inspection report although some staff have received training in the area of dementia care since this training need to be ongoing. This is to ensure that all staff are aware of the needs of service users with dementia. Some information was missing in the staff recruitment files looked at. Two staff files were not available on either day of inspection. Following the inspection visit the manager reported that they had been put away by another staff member for ‘safekeeping’. One file did not contain a Criminal Records Bureau check (CRB). Two references were seen which stated ‘to whom it may concern’ and were not specific for the post applied for. Immigration information was unclear in one file. For one staff member changes to their roles had not been documented in their file. The manager reported that she would go through the files and ensure the correct information was in place. She said that together with the administrator she was reorganising all the staff files. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The manager is new but is aware of the need for change and improvement at the home. Staff do not currently have the support they need to carry out their roles due to a lack of one-to-one supervision. Staff need training updates in the Control of Substances Hazardous to Health (COSHH), as there is a lack of awareness of health and safety issues. EVIDENCE: The previous manager has left and initially an interim manager covered her post whilst the organisation. A new manager has now been appointed but had Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 25 only started work at the home two weeks prior to our inspection visit. She gave time to discuss her role. She reported that the organisation is employing a deputy manager to support the manager. Documentation was available to demonstrate that the recruitment process has begun. She reported that she realises that there is much work that needs to be carried out to raise standards at the home. She said that she is prioritising the work she needs to do and she said that she will make changes to improve this home. She said the next six months will be a very challenging time but hoped to implement the changes that are needed and meet the requirements set. She reported that she was aware that staff have been through a difficult time recently and were feeling anxious about the changes of management at the home. The manager has already held a staff meeting to introduce herself and encourage staff to work as a team. The minutes of this meeting were made available to the inspection team. The manager provided documentation to show some changes that she plans to implement. These include full staff training logs and staff supervision logs, which will help to demonstrate what training staff, have attended. This will allow her to ensure that staff receive training updates when needed. The manager reported that she was aware of the need to apply for registration to the Commission for Social Care Inspection. The organisation has quality assurance systems in place. A fire safety audit was observed to be carried out on the first day of inspection. The care plans are audited monthly to help assess if they are completed adequately and that the residents needs can be met from the information in this document. The manager reported that a team audit process and remedial action plan are carried out. The remedial action plan contains information about areas that need addressing including: the environment of the home, activities, domestic issues and laundry. A residents meeting was held by the interim manager. These need to continue as they help the organisation to gain the views of the residents about the running of the home. There was no evidence of residents surveys being given out to gain the views of the residents and the manager reported that this will be addressed. The administrator was spoken to and was very helpful. She reported that she felt there was a good system for the management of resident’s finances and she keeps full records of these. Statements can be produced for residents or relatives. Receipts are kept and filed with the details of the items purchased. Extra items that are not included in the fees include: daily papers, toiletries, clothes and hairdressing expenses. Pensions are paid directly to the organisation who then send a personal allowance to the home. If residents do not have a next of kin/family then the home approaches the London Borough of Wandsworth to become appointees. The organisation are corporate appointees for nine residents. The resident’s money is kept together in one Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 26 account. This needs to be addressed as it is good practice for them to have separate bank accounts. Although some one-to-one staff supervision is taking place this needs to occur more regularly to ensure that all staff have the support and direction they need to carry out their roles. Also, any training and development needs can be identified. A fire drill was held on the day of inspection and there appeared to be a lot of confusion amongst staff. Many staff did not leave their units and those that did gather at the designated point did not seem aware that they should complete the attendance log. Residents did not what was happening and some fire doors did not close. This is a serious issue and all staff must be aware of the correct procedures to follow in the event of a fire. It is noted from the recent Health and Safety meeting held at the home that the manager has reported that she will review the training programme in relation to health and safety (mandatory) training for staff. This is in relation to protection of vulnerable adults training, moving and handling and food hygiene as not all staff are up-to-date with this training as previously stated in this report. The manager recognises that many staff need up-to-date training in food hygiene. She also discussed the importance of staff putting into practice what they have learnt during their training. An up-to-date legionella certificate could not be found on the day of inspection and this needs to be addressed. However, other checks relating to safety including: gas safety, electrical installations and portable appliance testing were up-to-date. A bottle of toilet cleaner was found in an unlocked toilet. Bottles of cleaning substances must not be left unattended and must be locked away securely when not in use to help to ensure the safety of the residents. All staff must follow COSHH (Control of Substances Hazardous to Health) procedures. Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X x 2 X X 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 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 2 X 1 Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 28 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 (1) (2) Requirement Full assessments of need must be completed and reviews of care must take place promptly to ensure that residents ongoing health and social care needs can be met. 1) Resident’s plans must include information on social, health and personal care and all identified needs. 2) Residents 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. (Previous timescales of 01/06/05, 01/12/05, 01/08/06, 01/12/06, 31/01/07 and 01/04/07 not met). Timescale for action 01/06/07 2 OP7 15 (1) (2) 01/07/07 3 OP7 13(4&6),1 5 Assessments of risk must be in 01/06/07 place and be sufficiently detailed and identify action to be taken to minimise risks. Risk DS0000019112.V335816.R01.S.doc Version 5.2 Page 29 Park Lodge Care Home 4 OP8 18 (1) 5 OP8 18 (1) 6 OP8 13 (1) (b) 7 OP8 18 (1) 8 OP8 13 (1) (b) Assessments must be kept under regular review. Previous timescales of 01/05/05, 01/11/05, 01/08/06 and 01/11/06 not met. All staff involved in wound care must receive up-to-date training. To ensure that residents needs are met in this area and they receive the most up-to-date care. Previous timescale of 01/08/06 and 01/12/06 not met. All staff involved in the continence care and assessment of residents must receive training in this area. To ensure that residents needs are met in this area and they receive the most up-to-date care. Advice about continence issues must be sought from a suitably trained individual such as a continence nurse specialist. Individual residents must be referred for assessment when needed. This is to make sure that residents needs in this area are properly assessed and they receive the most suitable treatment or intervention. All staff involved in the care and assessment of residents with diabetes must receive training in this area. To ensure that residents needs are met in this area and they receive the most up-to-date care. Advice about diabetes issues and care must be sought from a suitably trained individual such as a diabetes nurse specialist. Individual residents must be referred for assessment when needed. This is to make sure that residents needs in this area are properly assessed and they receive the most suitable DS0000019112.V335816.R01.S.doc 01/09/07 01/09/07 01/06/07 01/09/07 01/06/07 Park Lodge Care Home Version 5.2 Page 30 9 OP10 12 (4) (a) 10 OP12 16(2)m & n 11 OP14 12 (2) (3) 12 OP15 16m12(24) 13 (6) 21 13 OP18 14 OP18 13(4&6)1 8(1)c 15 OP18 13 (4) 16 OP19 23(2)b & d treatment or intervention. All staff must knock on the door before entering a residents bedroom. This is to protect their privacy and dignity. 1. A full activity programme must be in place to meet the needs of the service users. Previous timescales of 01/12/05 and 01/08/06 not met 2. An appropriately trained full-time activity coordinator must be employed. Previous timescale of 01/12/06 not met. Residents must be allowed to exercise choice and control in their daily lives in relation to all their health and social care needs. All service users must be offered choice at mealtimes. Previous timescales of 01/10/05, 01/08/06 and 01/12/06 not met All staff must use the whistleblowing procedure to highlight any areas of poor practice or anything which may affect the health or well being of residents. This is to ensure the safety of the residents. All staff must be trained in recognising and reporting abuse. Previous timescales of 01/06/05, 01/11/05, 01/08/06 and 01/12/06 not met Staff must be aware of the information in the Medical Device Alerts. Copies must be shared with all staff to ensure that they are aware of issues which may affect the health and safety of the residents. All maintenance issues outlined in Standard 19 of this report DS0000019112.V335816.R01.S.doc 01/06/07 01/08/07 01/06/07 01/06/07 01/06/07 01/07/07 01/06/07 01/09/07 Page 31 Park Lodge Care Home Version 5.2 17 OP26 23 (d) 18 OP27 181a, 121a,125 a 18 (1) (c) 19 OP28 20 OP29 19 (4) (a) (b) Schedule 2 18 (1) 13 (4) (5) 21 OP30 22 23 OP31 OP33 8 24 (3) 24 OP35 16 (2) (l) 25 OP36 18(2)a must be addressed. Previous timescale of 01/08/06 not met. 01/12/06 The home must be maintained in a clean and hygienic condition. Previous timescale of 01/11/06 not met. Staffing levels need to be reviewed to ensure that there are sufficient numbers of trained staff to meet the needs of the residents. Staff involved in the care of people with dementia must receive up-to-date training in this area. This is to help make sure that they can meet their needs. Staff recruitment files must be available for inspection and all files must contain the necessary pre-recruitment information. This is to help ensure the safety of the residents. There must be clear evidence that mandatory staff training is up-to-date. Refresher training must be provided for staff as required including moving and handling, and first aid. Previous timescales of 01/09/06, 01/12/06 and 01/04/07 not met. The manager must register with the Commission for Social Care Inspection. The organisation must look at ways of involving residents and relatives more directly in the quality assurance process. This could be by use of surveys. Resident’s finances must not be pooled and the home must look at organising separate accounts for them. All staff must receive one-to-one supervision at least six times a year (pro-rata for part time DS0000019112.V335816.R01.S.doc 01/06/07 15/05/07 01/08/07 01/06/07 01/07/07 01/07/07 01/09/07 01/08/07 01/08/07 Park Lodge Care Home Version 5.2 Page 32 26 OP38 13 (4) 27 OP38 23 (4) staff) and this must be fully recorded. 01/12/06 All materials hazardous to health 15/05/07 under COSHH guidelines must be locked securely away. Previous timescale of 04/10/06 not met. All staff must be aware of what 15/05/07 action to take in case of a fire this is to ensure the safety of residents, visitors and staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Park Lodge Care Home DS0000019112.V335816.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000019112.V335816.R01.S.doc Version 5.2 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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