Inspection on 22/05/06 for Park Lodge Care Home

This inspection was carried out on 22nd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Park 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 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 22nd and 24th May 2006 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.V293869.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 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 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.V293869.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2005 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.V293869.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three days. Two regulation inspectors visited the home on the 22nd and 24th May 2006 and the pharmacy inspector visited on 31st May 2006. The Registered Manager was present throughout the inspection. The Inspection Team spoke to service users and staff on duty. Surveys were left with the manager at the time of the inspection to give out to relatives, health and social professionals connected to the home. Prior to completion of this report five surveys were returned from relatives, three from health and social care professionals and two from service users. Due to the high number of requirements made at the previous statutory inspection on the 5th October 2005 the inspection team have visited the home twice to perform compliance visits on the 7th December 2005 and 22nd March 2006. As found at the last inspection the inspection team noted that limited improvements have taken place in many areas and there is no evidence of progress in some areas. 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. Many requirements have again been carried over from previous statutory inspections. Failure to comply with the Requirements contained within this report may result in the Commission for Social Care Inspection taking enforcement action against the Registered Provider. Feedback from service users was mixed. A service user spoken to at the time of inspection said ‘It’s alright here.’ Another reported that they were ‘very happy’ living at the home. One said that they were ‘unhappy’. A relative reported that ‘this home provides a good care service.’ One health/social care professional commented ‘In my opinion this is not a harmonious home. It appears that staff have little support from management.’ What the service does well: The surveys returned from the health and social care professionals all indicated the home has a good relationship with them. They stated that the home works well and communicates clearly with them. Feedback from relatives suggest that staff are caring and polite. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 6 Some staff members have a good rapport with the service users. What has improved since the last inspection? What they could do better: As reported in the previous inspection report there are many areas in which the home needs to improve and these are documented in the main body of the report. There needs to be an improvement in the quality of the assessments of the service users and care planning documentation at this home to ensure the needs of the service users are met. Care plans need to be more person centred to ensure service users are respected as individuals. Risk assessment documentation must be in place for all service users and must contain sufficient detail to ensure that all individual risks have been considered. As reported in the previous inspection report the home must improve upon the choice of activities offered to service users as there is a lack of both internal and external activities. Suitable activities must be offered to meet the needs of the service users. The home must ensure that one-to-one staff supervision is taking place at least six times a year and that staff are adequately supported and directed in their roles. Staff files need to be reorganised and must contain all the necessary recruitment information to ensure service users are not put at risk. The home must also ensure that there are sufficient numbers of trained and competent staff on duty at all times to ensure the needs of the service users are met. As stated in previous inspection reports all staff must receive up-to-date abuse awareness training, in addition to mandatory training including first aid and food hygiene. Staff must also receive training in areas such as wound care and mental health to ensure they can meet the needs of the service users. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 7 As stated in previous inspection reports all radiators and pipe work in the communal areas must be guarded to prevent harm to the service users. 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 DS0000019112.V293869.R01.S.doc Version 5.1 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.V293869.R01.S.doc Version 5.1 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 the following standard(s): 2. 3. 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Assessments do not contain sufficient detail to ensure detailed care plans can be drawn up and service users’ needs met. This service does not provide intermediate care. EVIDENCE: Those service users who returned survey forms indicated that they had not been given enough information about the home prior to their admission. Five service users files were examined on the nursing unit and although assessments were in place many did not contain sufficient detail. Assessments seen on the residential units were also basic and did not contain detailed information. There was little or no information on social needs or hobbies and many of the entries were meaningless with no information on how needs were to be met. One entry stated ‘widow with daughter who enjoys going to the pub.’ Another assessment said ‘likes most things’ under the social needs Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 10 category. Assessments must be in-depth enough to ensure that detailed care plans can be drawn up that meet the needs of the service users. One service user’s assessment documented their main diagnosis as being a mental health need. This home does not have a category for mental health. When discussing this with the manager she stated that she thought that as the home may admit up to ten service users with dementia a diagnosis of mental health came into this category. The home must apply for a variation of registration for this service user and must demonstrate how it can meet the needs of service users with a mental health diagnosis. Appropriate staff training must also be put in place. There was evidence to suggest that terms and conditions are now in place for service users. Although two service users had not signed their contracts they had only recently been admitted and it was seen that their contracts had been prepared. One service user said it was ‘ok’ at the home, another reported that they were ‘very happy, staff were kind and you couldn’t ask for better’ whilst another said they were ‘unhappy.’ One resident reported that they had lived at the home for many years and said the ‘fees have increased, staffing reduced and there are no activities’ on offer. Another service user reported that ‘staff are kind and caring but if you can’t do stuff for yourself you are just left.’ A relative commented that staff had quickly got to know the needs, likes and dislikes of their family member. One health/social care professional stated that the home provides excellent care in relation to hygiene needs, terminal care and general day-to-day care. However they commented that the home could improve with regard to looking after people with mental health problems and the prevention of falls at the home. Another health/social care professional said the home was excellent at meeting daily care needs and spoke highly of the manager. They felt the home could improve by ensuring that it was prepared for the review of service users placements at the home and produce a written summary for this purpose. Intermediate care is not offered at this home. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7. 8. 9. 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service user’s care plans do not contain sufficient information to ensure the needs of the service users are fully met. Privacy and dignity is not seen to be respected. Minor omissions in record keeping and inadequate supply of medication to be taken out of the home were found. These did not put the health or welfare of residents at immediate risk. EVIDENCE: Five care plans were looked at on the nursing unit and were found to vary in content. It was noted that in some of them there had been improvement as more detail was seen to be recorded. Most of the plans had been updated monthly, however there were still instances where they had not been regularly updated. The care plans were not person-centred and did not contain life history’s or much detail about individuals likes or dislikes. Some of the information contained meaningless phrases about the care of service users Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 12 such as ‘Keep talking to her with action.’ A health/social care professional reported that the home needs to ‘become more resident centred than organisation centred.’ They also commented that in their opinion ‘patient care is compromised’ as when service users ‘are transferred from residential to nursing beds’ staff ‘become confused about who will be taking over their care.’ Much information about service users was recorded in different folders, books and sheets such as activities, weights and bathing records. These should all be recorded in one place to prevent confusion. Staff commented on this and said that they sometimes don’t record information due to this confusing system. Much of the documentation in the care plans could be archived as many files were disorganised and some information was hard to find and out-of-date. The home should ensure that files are archived and remove any inappropriate documentation. Information in care plans was not seen to be followed. One care plan stated that as a service user was deaf they should be given a pen and paper and staff should communicate with them in this way. This was not seen to happen. The service user was left in a chair and kept trying to get up. Each time they tried to stand up staff members told them to sit down again. A service user had correspondence in place from the Tissue Viability Nurse to demonstrate that appropriate specialist advice was being sought. However, three different treatment plans were found in the service users file relating to wound care. So it was unclear what plan of care needed to be followed. A staff member on duty agreed that this was confusing and said they would change the care plan to ensure the correct treatment as advised by the Tissue Viability Nurse was administered. All care plans must contain up-to-date information to ensure the service user’s needs are met. A staff member reported they had not received any up-to-date training in wound care. All staff members involved in wound care must receive training in this area to ensure that they are aware of recent research and current knowledge in this area and are providing the most up-to-date care to service users. One health/social care professional commented that provision of more recliner chairs would be useful for those service users with leg ulcers so that ‘they could elevate their legs appropriately and comfortably.’ One health/social care professional reported that their instructions are seldom carried out and that staff need constant support and reminding. They commented that ‘few staff communicate clearly and accurately with me or my colleagues.’ Continence assessments were insufficient in detail and did not state whether specialist advice had been sought or type of incontinence. These must be more detailed to ensure service users’ needs are met. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 13 Some service users were seen to have been assessed as high risk in the Waterlow assessments for pressure areas. However no written plans were in place to indicate what action needed to be taken to ensure that service users were not placed at risk. One service user had a chart in place recording their aggressive behaviour. However, there was no risk assessment, action plan or signed agreement in their files from relatives to indicate that this issue had been fully assessed. These must all be in place to ensure the needs of the service user are met. Another service user was seen to have a bedrail attached to their bed however there was no risk assessment or agreement in their care plan concerning this issue. The inspector was informed that the service user did not require bedrails. These bedrails must be removed immediately if they are not needed. Some risk assessments in service users files were seen to require updating. Risk assessments must be kept under regular review. All records relating to receipt, storage, administration and disposal of current medication were examined. The manager, and two staff members were interviewed. A sample of the current medication in stock was compared to the current records and medication not supplied in the monitored dosage system was counted and compared to the records. This was to check that medication was being given as directed. One resident was self-medicating. Risk assessments and appropriate monitoring were in place. All the medication in stock agreed with the list of medications on the administration records. Most medication is given from a monitored dosage container. Staff are able to check if medication has been given or not. The allergy section on the administration record had not been completed for any residents. The allergies were recorded on the care plan and staff showed that they were aware of specific allergies. Three missing entries were seen on the administration record. Absence of the medication from the monitored dosage system indicated that the medication had been given. One resident did not have the amount of medication given recorded for one item. The running total of medication in stock indicated that the correct amount had been given. All other current administration records had all been completed. Staff were all aware of the procedure for checking and handling medication. When medication is not supplied in the MDS there is a clear audit trail to check whether medication has been given correctly. The amount of medication currently in stock agreed with the records. This indicated that medication had been given to the resident as prescribed unless otherwise recorded. One resident is given medication to take home with them when they are on leave from the home. The medication is supplied in unlabelled envelopes. This Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 14 is not in accordance with the policy. Medication for this service user is administered by staff when they are in the home. No risk assessment has been done to see whether it is safe to give the medication directly to the resident when they leave the home. All medication was stored securely and in the correct conditions. The controlled drug cupboard was not attached to the wall in accordance with the Misuse of Drug (Safe custody) Regulations. This has no impact on the health or welfare of residents. Bathing records for service users were seen to be irregular, with large gaps of over fourteen days in some cases. One service user reported that they were not able to have baths as often as they want as only one a week was allowed. Service users must be allowed to exercise choice about when and how often they would like to have a bath. It was noted that laminated bathing sheets are in place containing set temperatures at which individual service users are to be bathed. Many of the temperatures recorded for service users were low such as 28 or 32 degrees centigrade. This is not good practice as service users may wish to exercise choice and vary the temperature of their bath depending upon many factors such as time of day or the weather. There were no locks on any bedroom doors which does not protect service users’ privacy and dignity. This is discussed in the ‘Premises’ section of this report. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 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 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 the service. Activity provision remains limited and only some activities meet the needs of the service users. Service users are able to maintain contact with family and friends. Service users are not helped to exercise choice or control over their lives. EVIDENCE: Many service users were observed to be sitting in lounges with the television turned on. Most were not watching it and as found at the previous inspection visit were either asleep or staring into space. One service user said ‘There’s not a lot to do’ and ‘The TV is company for us here.’ Throughout the morning in one of the lounge areas service users were left unattended for periods. Staff were not seen to initiate conversations and the TV was left on all the time. No activities or conversation took place. When service users tried to get up from their chairs they were told to ‘sit down’. One health/social care professional commented that they ‘rarely see anyone having morning tea and aside from television there seems to be little stimulation.’ Records kept of service users activities demonstrated that TV watching, singalongs and garden therapy were the choices on offer. Limited and Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 16 inappropriate resources were seen to be available such as old books and a 500 piece jigsaw set. No arts and crafts were observed to be available for the service users. An activities officer works at the home three days a week and was very enthusiastic but they have not been provided with training and have limited resources. She was knowledgeable about the service users she works with and spent time chatting to them and encouraging them to join in. A family member stated that their relative is encouraged to mix socially with other service users but is given the choice and not forced to do so. One family member reported that it ‘would benefit’ their relative to have short spells in the garden in fine weather but said this may be difficult ‘with the normal staffing levels.’ A service user reported that they liked to go out alone shopping or to bingo and this was something that they enjoyed doing, they said that they were happy that their choice was respected. Risk assessments and an agreement signed by a relative were seen to be in their care plan regarding this issue. Another service user said that they were ‘never able to go out’ and that their last trip outside the home was before Christmas for one and half hours to go shopping. Another service user said they would like to go out for a walk on their own but have been told they are ‘not allowed.’ They reported that no one had explained why or had offered to take them out. Some service users reported feeling frustrated that they do not go out and said they are told it is due to a lack of funds and drivers. Service users reported that Christmas day was ‘boring’ and that there were no activities available apart from watching the TV. When the inspection team discussed the lack of external activities available for service users the manager said ‘I would love to take them out but there is no one to drive the bus.’ Up to three service users were observed to be slumped in wheelchairs in one of the lounge areas during the inspection visit. Also, at lunchtime on the nursing unit at least five service users were seen to be left seated in wheelchairs at their dining tables. When this was discussed with a member of staff they stated that at least two service users were kept in wheelchairs as ‘it was safer, otherwise they would fall out of the chairs.’ As stated in the last inspection report wheelchairs must not be used as a form of restraint. A staff member spoken to was unaware that agreement must be gained from the service users, their relatives and other professionals involved in their care. This must be recorded in the care plan and signed by the service user and/or their relatives. A staff member reported that risk assessments had not been completed for this issue as they had not realised they should be. Full risk assessments must put in place to demonstrate that all risks have been considered and also what action has been agreed. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 17 In one service users file, an assessment indicated that when at home this service user was usually supplied with a diet to suit their cultural preferences. However, staff spoken to were unaware of this and reported that they were not offered a specific diet that may meet their cultural needs. Another care plan highlighted that a service user had a particular dietary requirement. On talking to three staff members all of them were aware of this and stated how they ensured this need was met. Food to meet this particular requirement was seen to be available in a fridge in one of the kitchenette areas. At lunch time service users were taken to the dining room with no conversation taking place and they were not asked if they wanted to go. No explanations took place. No one told the service users what they are having for lunch. Staff put aprons on service users without speaking to them or telling them what they are doing. This behaviour does not respect the service users as individuals and allow them to make choices. Staff were observed to be lifting service users under their armpits when transferring them from chairs at lunchtime. This is unacceptable and staff must receive training in moving and handling. Some staff were observed to stand over service users to assist them to eat instead of sitting down with them. One staff member was seen to walk up to service users and feed them forkfuls of food without talking to them. A service user with a poor appetite was given a large plate of food when a smaller portion may have looked more appetising. Comments about the food at the home were mixed. One service user commented that the food was ‘insipid with no flavour.’ They reported that there was a choice of food but that it was not tasty. Another reported ‘the food is ok.’ Three further service users said that the food was ‘nice.’ One family member said ‘the food is good’ and commented that this was important to their relative. Family member commented that the home had given their relative ‘a new lease of life’ and that they were ‘well looked after.’ There was not enough evidence in the staff files that all staff are up-to-date with food hygiene training. All staff assisting with the preparation or handling of food must be up-to-date with this training. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Policies and procedures regarding abuse and whistleblowing are in place. Appropriate recruitment checks have not been made on all staff and not all staff have received information or training on recognising and reporting abuse. This could place some service users at risk of harm. The lack of risk assessments may place service users at risk of harm. EVIDENCE: Family members who responded to the survey all reported that they were aware of the complaints procedure. This home follows the London Borough of Wandsworth’s Protection of Vulnerable Adults (POVA) procedures. The Commission for Social Care Inspection were notified of a POVA issue concerning staff members that occurred since the last inspection visit. The home followed POVA guidelines and referred this issue to Wandsworth Social Services. During the course of the inspection a service user made an allegation about their care to a member of the inspection team. They said they were unhappy at the home. This issue was immediately reported to the manager who instigated the POVA procedures. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 19 The Pharmacy Inspector also came across a concerning issue during his visit. The CSCI had not been informed of this incident and should have been notified. The manager showed the inspection team evidence that many of the staff have attended training in abuse awareness. However, not all staff have attended this training and all must attend to ensure the safety of the service users. However three staff members spoken to on the nursing unit had a good knowledge about whistleblowing and its’ importance in protecting service users. As reported in previous sections risk assessments for many issues including bedrails, aggressive behaviour and wheelchair use are either not in place or are insufficient in content. These must all be put in place to ensure the safety of the service users. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There are still areas that require improvement. The lack of radiator guards and inadequate lagging to pipe work may place service users at risk of harm. The broken windows present a security risk. EVIDENCE: A ground floor window was found to be broken as it cannot be closed and it was secured only by tape, the manager reported that a further window in the home was also broken. This is not only unsightly but also a security risk and they must be repaired immediately. An electrical socket in one of the communal hallways and another in a service users bedroom were found to be covered by tape these must be repaired. Although bedroom radiators are covered as reported in the previous inspection report many radiators in the hallways and communal areas still remain Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 21 uncovered. This presents a risk to the service users. Much of the pipe work throughout the home still needs to be boxed in. At present it is covered in a foam lagging but this looks unsightly and can be pulled away quite easily which could present a risk to the service users. Wooden furniture was seen to be stored under a stairwell and this presents a fire hazard. An Immediate Requirement was issued at the time of inspection to ensure the furniture was removed immediately. There are no locks on any of the bedroom doors. The inspection team were informed by the manager that they had all been removed and that this was for safety reasons as there had been an incident concerning a service user. However alternative locks must be fitted to all bedroom doors to ensure the privacy and dignity of the service users. One health/social care professional stated that the home ‘could do with some decoration, it feels quite dark and yet clinical, everything looks a bit worn.’ A family member commented that ‘the general look outside could definitely improve. There is often litter in the front. The garden is uncared for and it generally appears a bit run down. First impressions are important, an uncared for exterior perhaps reflects sloppiness on the more important interior.’ Another family member said that ‘the home is a little bit dated and perhaps needs a makeover.’ Another said they felt the home was ‘clean and tidy.’ Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. 28. 29. 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The staffing structure and number of senior staff does not sufficiently support the management of the home. Inadequate recruitment practice could place service users at risk. EVIDENCE: Two relatives commented that the staff were ‘very friendly.’ One service user reported that their regular carer was ‘very good’ but said that on other shifts there is no continuity as they have different carers who ‘don’t have time’ for them. The manager reported that staffing levels had been low at the home and that this was improving. She said in the early part of this year ‘I have been desperate for staff.’ She said that more staff were ‘starting now.’ A health/social care professional commented that ‘a lack of resources prevents staff from following their instructions.’ Another professional questioned whether there was enough nursing input at the home. The organisation must ensure that there are sufficient numbers of trained and competent staff on duty at all times. Some staff members were spoken to during the visit and reported that some issues at the home were improving since the last inspection. One reported that they felt more supported by the manager and that they were receiving more Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 23 regular one-to-one supervision. They also reported that they were going to attend a course about the care of people with dementia and the manager showed the inspection team documentation confirming that seven staff members were due to attend this training. Whilst it is positive that some members of staff are to attend this training, all staff involved in the care of service users with dementia must have training in this area to ensure that they can meet their needs. Whilst there was evidence that staff training is gradually improving not all staff are up-to-date in mandatory areas such as food hygiene, first aid and moving and handling. All staff must be up-to-date with this training to ensure the needs of the service users are met. One staff member reported there was a lack of communication between staff, which they felt could affect the care of the service users, particularly when information about service users is not passed on. Staff recruitment files were looked at and issues remain outstanding. They still require re-organising as many are disorganised and information is hard to find. A Protection of Vulnerable Adults check was not in place for one staff member and this must be obtained as a lack of appropriate pre-employment checks could place the service users at risk. One staff member only had one reference in place and immigration status information was missing for another staff member. This information must be obtained. A verbal warning was found in one file dated 25th May 2005, it stated that it would be removed from their file six months from the issue date. This had not been done and it must be removed. One relative reported ‘this home is not the most modern in facilities but it is well run and the staff turnover seems low. The staff take a pride in their work.’ Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31. 33. 35. 36. 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. This home still has many areas which need to be addressed to ensure the well being of the service users. EVIDENCE: Positive comments were received about the manager. One health/social care professional said the manager was ‘good and gave the staff lots of encouragement.’ They also reported that she was ‘flexible and good with the residents care.’ Three staff members reported that they felt supported by the manager. One said that the manager was ‘very approachable.’ Another remarked that if they had an issue or a problem they would ‘go straight to the manager.’ One staff member said that the manager was supporting them with their NVQ training. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 25 However, many requirements that were made at previous inspections have still not been met and serious issues remain outstanding. It was discussed with the manager at the time of inspection that she would benefit from the assistance of a deputy manager as the manager reported that many of the requirements could not be met due to a lack of time on her part or a lack of resources. She reported that she would like to have more time to spend with the service users but said that at present ‘I don’t have time to go and talk to the residents – I wish I did.’ She also said that the lack of external activities was due to a lack of staff and time. One health/social care professional commented that the home should ‘improve communications all round.’ They reported that they had tried to improve communication by using a book to help staff pass on information but ‘found that insignificant notes and unsubstantiated instructions’ were left for them. The inspection team found evidence of an incident that had occurred where the manager had not informed the Commission for Social Care Inspection (CSCI). The CSCI must be informed of all incidents that affect the welfare of the service users. This requirement remains outstanding from the last inspection report. The manager reported that since an incident concerning service users’ monies at the end of last year, procedures have been tightened up and all staff have received information regarding the acceptance of gifts. This issue was followed up in a separate compliance visit by the inspection team on 22nd March 2006. Staff one-to-one supervision has improved in frequency, but evidence in the staff files showed that not all staff are receiving supervision at least six times a year. This must be put in place to ensure staff are receiving the support and direction they need to carry out their roles. In the staff files seen, supervision notes identified problems but there was no evidence of follow up or training and this must be put in place. Evidence was seen of up-to-date fire safety checks and electrical installation checks. An up-to-date legionella certificate and portable appliance schedule have now been obtained. Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 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 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) Requirement Timescale for action 01/08/06 2. OP7 15 (1) (2) The Registered Person must ensure that all service users have been assessed by a suitable qualified or trained person. All service users must have an assessment in place 01/08/06 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 01/06/05 and 01/12/05 not met). The Registered Person must ensure that assessments of risk are sufficiently detailed and identify action to be taken to DS0000019112.V293869.R01.S.doc 3. OP7 13(4&6),1 5 01/08/06 Park Lodge Care Home Version 5.1 Page 28 minimise risks. Risk Assessments must be kept under regular review. (Previous timescale of 01/05/05 and 01/11/05 not met) 4. OP8 18 (1) The Registered Person must ensure that all staff involved in wound care receive up-to-date training. The Registered Person must ensure that accurate records of all administration/nonadministration of medication are retained in the home. (Previous timescale of 06/10/05 not met.) The registered person must ensure that the allergies or absence of allergies is recorded appropriately with the administration records (Previous timescale of 01/11/05 not met.) The Registered Person must ensure that: Service users are offered regular baths and that these are fully recorded. Bathing temperatures remain within acceptable limits for service users. (Previous timescale of 24/06/05 and 01/11/05 not met). The Registered Person must ensure: That a full activity programme is in place to meet the needs of the service users. (Previous timescale of 01/12/05 not met) 9. OP14 12(1-4), The Registered Person must DS0000019112.V293869.R01.S.doc 01/08/06 5. OP9 13(2) 01/07/06 6. OP9 13(2) 01/07/06 7. OP10 121-3 & 4a 01/07/06 8. OP12 16(2)m & n 01/08/06 01/07/06 Version 5.1 Page 29 Park Lodge Care Home 13(7) 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 their wishes and should be subject to advice from relevant health care professionals. (Previous timescale of 01/05/05 and 01/12/05 not met) The Registered Person must ensure that all service users are offered choice at mealtimes. (Previous timescale of 01/10/05 not met) The Registered Person must ensure that any person preparing food has completed a food hygiene course. (Previous timescale of 01/06/05 and 01/11/05 not met) 01/08/06 10. OP14 16m12(24) 11. OP15 134&6 181c,i, 191a 01/07/06 12. OP18 13(4&6)1 8(1)c The Registered Person must 01/08/06 ensure that all staff are trained in recognising and reporting abuse. (Previous timescales of 01/06/05 and 01/11/05 not met) The Registered Person must 01/08/06 ensure radiators and pipe work are guarded throughout the home (Previous timescales of 01/09/05and 01/01/05 not met). 1) The Registered Persons must ensure that all maintenance issues outlined in Standard 19 of this report are addressed. This includes ensuring all bedroom doors are fitted with locks. All broken windows and broken electrical sockets must be repaired. DS0000019112.V293869.R01.S.doc 13. OP19 13 (4) 14. OP19 23(2)b & d 01/08/06 Park Lodge Care Home Version 5.1 Page 30 2) The Registered Person must ensure that regular checks are made on the environment. (Timescale of 01/09/05 and 01/02/06 not met). 3) The Registered Person must ensure that furniture is not stored in the stairwells. (Immediate Requirement.) 15. OP27 181a, 121a,125 a The Registered Person must ensure that adequate numbers of appropriately trained staff are on duty at all times. (Timescale of 01/09/05 and 01/11/05 not met). The Registered Person must ensure that staff files contain all the information specified in the Care Homes Regulations 2001. (Previous timescale of 01/11/05 not met). The Registered Person must ensure that there is clear evidence that mandatory staff training is up-to-date. Refresher training must be provided for staff as required with regard to training including moving and handling, and first aid. The Registered Person must ensure that the Commission for Social Care Inspection is notified of all events that affect the well being and safety of the service users. The Registered Person must ensure that all staff receive oneto-one supervision at least six times a year (pro-rata for part time staff) and that this is fully recorded. (Timescale of 01/12/05 not DS0000019112.V293869.R01.S.doc 01/07/06 16. OP29 Sch 2 01/08/06 17. OP30 18 (1) 01/09/06 18. OP33 37 01/07/06 19. OP36 18(2)a 01/08/06 Park Lodge Care Home Version 5.1 Page 31 met.) 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 recommended that the controlled drug cupboard be attached to the wall in accordance with the appropriate legislation Park Lodge Care Home DS0000019112.V293869.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection SW London Area Office 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 DS0000019112.V293869.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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