Inspection on 05/10/05 for Park Lodge Care Home

This inspection was carried out on 5th October 2005.

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

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

Other inspections for this house

Park Lodge Care Home 01/07/10

Park Lodge Care Home 14/04/10

Park Lodge Care Home 20/10/08

Park Lodge Care Home 22/10/07

Park Lodge Care Home 15/05/07

Park Lodge Care Home 04/10/06

Park Lodge Care Home 22/05/06

Park Lodge Care Home 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 5th October 2005 10:00 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.V254943.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 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.V254943.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th May 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. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Inspection Team: Sharon Newman Sandy Patrick Jeremy Howe Regulation Inspector Regulation Inspector Pharmacy inspector This unannounced inspection took place on the 5th October 2005, and was the second statutory inspection visit. The Registered Manager was present throughout the inspection. The Inspection Team met with service users and staff on duty. Due to the high number of requirements made at the previous statutory inspection on the 11th and 12th May 2005 the inspection team have visited the home twice to perform compliance visits on the 16th June 2005 and 24th August 2005. Further Requirements were made following the compliance visit on the 16th June 2005. The inspection team noted that limited improvements have taken place in many areas and there is no evidence of progress in some areas. There has been some improvement with regard to the cleanliness of the home and a programme of refurbishment of the kitchenette areas is in place following previous requirements made by the inspection team. However, the inspection team noted 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 been carried over from the previous statutory inspection and subsequent compliance visits to the home. Four Immediate Requirements were made in relation to medication issues by the pharmacy inspector at the time of inspection. A service user spoken to at the time of inspection said ‘it’s alright here’ and the food is ‘not bad.’ Another service user commented ‘it’s ok here’ and the food is ‘alright.’ One stated ‘everybody is very nice’ and ‘I like it here.’ This service user also commented ‘the staff are excellent.’ What the service does well: Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 6 Some staff were noted to have a good rapport with the service users and an understanding of their needs, likes and dislikes. What has improved since the last inspection? What they could do better: 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. 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. The Pharmacy Inspector was very concerned regarding medication issues during this inspection visit. Attention must be paid to rectifying this situation as service users could be put at risk. The home must improve upon the choice of activities offered to service users and ensure accurate records are kept of participation. 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 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 all mandatory training. As stated in previous inspection reports radiators and pipework must be guarded to prevent harm to the service users. Please contact the provider for advice of actions taken in response to this Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 7 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.V254943.R01.S.doc Version 5.0 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.V254943.R01.S.doc Version 5.0 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. Terms and conditions of residency are not in place for all service users. Assessments do not contain sufficient detail to ensure service users needs are met. EVIDENCE: Two service user files were sampled on the nursing unit. Assessment details were in place but they were seen to be incomplete and contained insufficient information about the needs of the service users. A social assessment for one service user contained only limited details such as name, room number and age. Preadmission assessments were seen in five files from two residential units and all were found to be inadequate. They all contained sections that had not been completed. In all the assessments there were no recorded dietary needs, preferences or food dislikes. Additionally information on behaviour, emotions, social needs and medical history was either absent or very limited. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 10 Social histories were absent and information on hobbies and interests included statements like ‘loves people’ and ‘no hobbies.’ No detailed information about any of the service users’ individual needs was provided. These assessments do not provide enough information to draw up detailed care plans. There was no record of consultation with the service user in any of this documentation. The Manager stated that terms and conditions were still not in place for all residents but that the home was addressing this issue. Terms and conditions must be in place for all service users. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 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 Service users care plans do not contain sufficient information to ensure the health needs of the service users are fully met. Although the home has arrangements for the ordering, storage, recording and auditing of medication and has access to a pharmacist for advice serious errors in administration of medication and errors and omissions in recording were found that question whether these arrangements protect the health and welfare of service users. EVIDENCE: Three care plans were examined on one residential unit and two on another. Two care plans were sampled on the nursing units. Care plans on the residential units were found to be often unclear with poor and often illegible handwriting. In some instances words were squashed together making it still harder to read. In addition some of the entries written did not make sense and did not give clear guidance to staff. For example regarding what a care plan referred to as ‘mood swings’ the following was written: – ‘To ensure good attention to him by the staff. To reassure him always. To avoid him getting angry as much as possible. Good orientation to others.’ ‘Goes into a temper sometimes.’ ‘Staff to calm him down with apathy.’ Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 12 Another care plan entry stated: ‘Tidy, nice gentleman.’ Also care plans were not in place where service users had specific needs such as catheter care, soft diets and mental health needs. Information on social care needs was either very limited or absent. Care plans must be legible and must contain sufficient information to ensure service users needs are met. Much of the documentation on the nursing unit had been reviewed regularly. However, similar shortfalls to those found in the residential unit plans were identified in two care plans sampled in the nursing units. In one service users’ file a community nurse had identified ‘nausea and vomiting’ and ‘pain’ as problems. However these issues were not highlighted in the homes’ care plan. One entry stated ‘to monitor blood sugar regularly.’ However it did not specify what it meant by regularly, did not give examples of this service users usual blood glucose limits or what would be regarded as acceptable limits and did not specify whether was any input from a specialist healthcare team/individual. Another care plan identified continence as a problem but did not specify the type of incontinence diagnosed or whether there was any specialist input. There was evidence of input from healthcare professionals in the care plans including dieticians, GP’s and specialist nurses. One member of staff reported that the GP and District Nurses were very supportive and that they had a positive relationship with them. The majority of risk assessments often failed to identify any action to minimise risk or even to identify the risk. For example one service user leaves the house on their own. Their file contained a statement written by the home and to be signed by the next of kin to say they recognised there were risks to going out alone. Neither the next of kin nor the service user had signed this statement and there was no indication that either had seen this document. There was no risk assessment in place regarding the service user going out alone and no action plan in their file to indicate how risks could be minimised whilst supporting them to go out alone if they wished. One risk assessment identified risks of falling, choking, sharp cutlery and chipped glasses. There was no other information regarding the risks or how to minimise these. A bed rail (cot side) agreement was seen to be signed by a service user but there was no evidence of any involvement from health and social care professionals on this document. No risk assessment was seen to be in place either. One entry was noted in their file which stated ‘risk of falling from bed to prevent falling use cot sides.’ detailed risk assessments must be in place and must contain sufficient detail to indicate that the risks have been fully considered with the involvement of service users and next of kin. Where necessary additional advice should be sought from health and social care professionals. The written medication policies and procedures were found to be adequate on a last inspection and were not reviewed on this visit. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 13 All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The person in charge and three staff members were interviewed, and ten residents’ medications counted and compared to the records of receipt and administration to check that residents received their medication as prescribed to ensure their health and welfare is protected. From these discussions and observations the allergy section on the administration record was completed for only two residents. Two residents had been given medication for the last three days after the GP had stopped the medication the previous month. Two residents had not received one of their medications for the last three days. In one instance the receipt of the medication had not been recorded and staff did not know the medication was in stock. Four residents had not been administered their medication as directed by the prescriber. These errors in administration could have had a serious impact in the health of the residents involved. It was not possible to see whether medication had been administered correctly in twenty two instances as twelve residents had missing entries on the administration record, one resident had no record of receipt of the medication and nine residents did not have the actual quantity of medication given recorded in the administration record. One other resident did not have the receipt of medication recorded and three residents had been signed as being given their medication when it was clear the medication had not been given. Staff were not aware of these issues until highlighted during the inspection. Two items were found that were no longer prescribed for residents in the home. One of these had expired in March 2005. Two items were not used in correct rotation running the risk of medication that is out of date being used. In one instance the quantity of medication carried over had not been recorded making it difficult to audit the use of this item. Records of baths in two residential units were examined. They indicated that some service users were having regular weekly baths. However, other service users had considerably long gaps between baths – many of which were over two weeks. One gap was for 46 days and several others were for over three weeks. In the nursing unit 21 baths were seen to be recorded for July 2005 one bath recorded in August 2005 and 7 baths were documented for September 2005. All service users should be offered regular baths. Also records of temperatures still indicate that service users are given baths at between 33 degrees centigrade and 38 degrees centigrade and this issue was raised at a previous compliance inspection visit. Throughout the inspection visit a radio playing loud pop music was turned on in the foyer. This was so loud it could be heard in one of the units whilst service users were having their lunch. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 14 A service user was seen to remain in their wheelchair whilst they ate their lunch. If this is their choice then this must be recorded in their care plan. Wheelchairs must not be used as form of restraint. One service user spent the morning of the inspection wearing an apron, which was covered, in food stains. A service user commented that they felt some staff did not want to help with a personal care task. They stated that this ‘upset’ them. Staff must ensure that service users are supported and assisted with dignity in their personal care tasks. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 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 Activity provision is 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 offered a choice of wholesome food. EVIDENCE: The manager reported that some service users choose to attend the day centre that is attached to the home. She said that additional activities and day trips are sometimes organised by the day centre and service users can attend these trips. The manager also reported that an activities person visits the home to offer reminiscence and musical entertainment. She also stated that she has arranged for a theatre company to visit the home. The manager said that every unit has an activities programme to follow each day. The inspection team observed service users in one unit sitting in the lounge with the television switched on. A few service users were watching this, some were staring into space, two were chatting periodically while the majority of the service users were not watching the television. On another unit service users were again observed sitting in a lounge area with the television switched on. The majority of service users were not looking at the television. A staff member commented that it was a shame that the service users lives consisted of getting up and being washed and dressed and then sitting in the lounge all Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 16 day and everyday. In another unit music was being played and a member of staff was encouraging service users to clap along to the music. One service user was observed to clap, most of the other service users stared ahead of them. The home must ensure that activities are appropriate for the age of the service users. This staff member was observed to have a very good rapport with the service users. They stated how important it was to always ‘give the best care.’ They reported that they had a birthday party recently for one of the service users and that family members visit and some service users go out with their relatives. A member of staff on one unit reported that they facilitated activities in the afternoon. They reported that they encouraged all service users to participate. Activity records for this unit had been completed regularly and indicated participation. However, the range of activities was limited to sing-alongs, quizzes, reminiscence and watching television. One resident was recorded as having gone for two walks in the garden in September. Although some service users may choose to sit and relax there needs to be sufficient evidence that they are all offered a full range of activities in which to participate. A staff member on one unit said that ‘better activities were arranged when the home was owned by the council.’ Another member of staff on a different unit also made a similar comment. They said that more day trips and holidays used to be arranged for service users when the home was council-run. In one unit a staff member went for a break and was replaced by another who positioned themselves in front of the television and proceeded to watch this for the whole time they were in the unit. They did not speak to the service users with the exception of telling two of the service users who had stood up to sit down again. Lunch was observed to be served on one unit. A staff member was observed to offer each individual choices and encouraged them to eat smaller lunches when they said they did not want any food. She had a kind approach and demonstrated a good knowledge of individual needs and likes. Condiments were seen to be available on the tables for the use of service users. In another unit puddings of apple pie and custard were already plated up with the custard poured on individual dishes prior to serving so that service users could not make choices about portion sizes and whether they wanted custard. No condiments were available on the tables on this unit. Also, on this unit a stack of plates with left over food and cutlery were positioned immediately in front of one service user who was still eating. The member of staff then proceeded to scrape more left over food from other dinner plates onto the pile in front of the service user. Bowls of fresh fruit were not seen to be available for service users. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 17 A staff member on one unit reported that soft meals were presented appropriately. She reported that sandwiches and snacks were available throughout the day and that porridge, eggs, cereal and toast are offered for breakfast. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 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. Policies and procedures regarding abuse and whistle blowing are in place. Appropriate recruitment checks have not been made on all staff and they have not yet received information or training on recognising and reporting abuse. This could place some service users at risk of harm. EVIDENCE: Organisational policies regarding abuse and whistle blowing are in place. The home has also adopted the Local Authority (Wandsworth) Protection of Vulnerable Adults procedures. A staff member spoken to at this inspection visit did not have much knowledge about abuse and said they had never heard of whistle blowing. The manager stated that she has organised for staff to attend abuse awareness training which is run by the London Borough Of Merton. The home will need to ensure that staff undertake the abuse awareness training. One issue the home inspection about this home. regarding the conduct of a staff member towards a service user at has been brought to the attention of the CSCI since the last visit by the home. However, the CSCI has not yet received a report issue or a previous complaint which were both requested from the One staff file examined did not contain sufficient identification. There was no birth certificate, marriage certificate or passport in place. There was only a declaration of age and marriage written by a family member. No work permit Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 19 or visa was in evidence in this file either. No criminal record check was seen in another file examined. Service users may be placed at risk by inadequate checks on staff. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 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. 20. 21 25. 26 Improvements have been made with regard to cleanliness and some refurbishment has taken place. However, further work is required to create a more homely and pleasant environment. EVIDENCE: The inspection team noted that there have been improvements regarding the cleanliness of the home since the previous inspection visit. The manager reported that she has developed a new cleaning schedule however this has not yet been implemented. Carpets are still badly stained and woodwork, flooring and some paintwork remains in need of refurbishment. The manager informed the inspection team that new kitchenettes are in place in most of the kitchen areas and there is only one kitchen left to be replaced. These new kitchens were seen to be in place but are still awaiting decoration. The manager reported that there are plans to decorate some of the communal and staff areas. She also stated that the worn carpets in lounges and some bedrooms are to be replaced. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 21 A bedpan washer on the second floor has been broken since the previous inspection visit and staff are required to carry items requiring washing to another floor. The washer remains broken, however the manager reported it was due to be repaired later that week. Although improvements are noted, the length of time taken to make repairs and respond to requirements is unacceptable and service users are put at risk by these delays. Many radiators in the hallways and communal areas still remain uncovered. The manager reported that there are plans to cover the radiators throughout the home. Much of the pipe work throughout the home will need 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. The manager stated that there were faults with the hot water system and some of the temperature control valves at the outlets. Bathing records indicate that service users are bathing at temperatures between 33 degrees centigrade to 38 degrees centigrade. This situation must be rectified and the home must ensure that the hot water system is repaired. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 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. 29. 30 The staffing structure and number of senior staff does not sufficiently support the management of the home. Staff are given a good range of written information but are not directed or supervised on a daily basis. Staff are not well supported and morale is low, this situation could have a detrimental effect on the care of the service users. Inadequate recruitment practice could place service users at risk. EVIDENCE: The manager stated that staff changes have occurred. She said that one nurse had resigned, another had transferred from night duty to day duty and one nurse had transferred from another Four Seasons Home to work at Park Lodge. She also reported that she recently recruited one permanent and three bank care staff. She informed the inspection team that a proposal had been submitted to the directors to recruit senior carers and a deputy manager. She stated that she did not have any influence over this decision and that no decision would be made until the next budget year. One member of staff reported that they were well supported and had regular supervision. They said that the staff team on that unit worked well together. They reported that they had recently undertaken manual handling training and were due to undertake abuse training and a course in wound care. They also commented that the training delivered to the staff team at the home had been Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 23 the most useful they had received. Another staff member commented that ‘I really enjoy working here.’ A staff member on one unit said they felt unhappy and unsupported. Another staff member stated they were ‘not particularly well supported’ they said they have one-to-one supervision but that it was ‘just a tick box exercise.’ Another member of staff on another unit also stated that they felt when they had supervision it was ‘just ticking boxes.’ Many of the staff who spoke to the inspector about staffing arrangements at the home were anxious that they would face repercussions if they were identified. It is important that staff feel that they can freely talk to the Inspector about any aspect of the home or their work that they feel is important. The inspector is particularly interested in hearing justified concerns, which are relevant to the home’s ability to meet National Minimum Standards. Staff must not be penalised for their honesty and their open and positive approach to the inspection. The Registered Person must ensure that staff feel fully supported in this area. The Commission for Social Care Inspection would consider any failure to support staff in this manner a breach of Regulation. Rotas were hard to follow due to alterations and it was unclear in places who was supposed to be covering a shift. Staffing rotas indicated that night staff had worked a night shift and then an early shift in at least three cases over the two weeks around the date of inspection. One member of staff had worked two night shifts and two early shifts consecutively. The manager was asked to provide copies of the rotas to the CSCI and at the date of completion of this report these have still not arrived. Rotas also indicated that domestic staff work care shifts and in the kitchen. Some staff also raised concerns that staff employed for domestic duties are sometimes allocated to care duties and are providing personal care The inspection team were informed that the night nurse is responsible for administering all the night time medication to service users throughout the house therefore no nurse is left on duty in the nursing units at this time. The home must ensure that these staffing issues are not impacting on the care of the service users. There must be sufficient numbers of trained, competent and appropriately supervised staff on duty at all times. Staff files were found to be disorganised and the paperwork was not in any apparent order. Information was found in staff files indicating that staff may be promoted on an ad hoc basis. A letter in one staff members’ file stated ‘following our discussion today I am pleased to upgrade you to bank care assistant.’ There were no records of this staff member attending an interview, completing an application form, a new contract or of references being taken Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 24 up. Another staff file contained a letter from the manager indicating that this staff member had been promoted. Again, there was no evidence of an application form, interview, references, new contract nor induction into new role. There was also a warning in this file dated 16/06/05. The warning stated that it would be removed and destroyed after three months. However, the warning was still in place on the day of inspection. The manager reported that she has been addressing the issue of staff training. She said that she is looking to arrange dementia training for staff and has arranged for training in abuse awareness. The inspection team were also informed that the new training co-ordinator is arranging for staff to attend training in care planning. The manager also said that staff will be attending training in moving and handling and first aid. Regular staff meetings were seen to take place and issues seen to be discussed include the findings of previous CSCI inspections and the requirements that were made. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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. 36. 38 This service is not managed in a way which promotes the health and well-being of service users. Staff are not appropriately supported to undertake their duties which may impact upon the care of the service users. This home still has many areas which need to be addressed to ensure the well-being of the service users. EVIDENCE: Many requirements made at previous inspections and compliance visits have still not been met and the manager stated this is not her fault. For example, requirements about care planning have been repeatedly made as this documentation is inadequate. This issue was raised with the manager at the time of inspection and she stated that she had sent the staff memos and was arranging care-planning training for them. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 26 Some staff reported that they feel unsupported and that they are too worried to speak out. One spoke of ‘a culture of blame’ at the home. Another staff member said ‘there is not much support, we are told what to do, I don’t feel I can use my initiative.’ They also commented ‘the manager is too busy and not approachable.’ They stated they were happy working with the service users but said ‘it is the management side that is stressful, with no support.’ The manager’s response to poor performance tends to be to take disciplinary action. During the inspection she stated, ‘There will be disciplinary’s for this’ regarding the feedback from the inspection team. Although the disciplinary route is clearly appropriate at times, staff indicate that this is the main way in which they receive instruction about improving poor practice. Three staff members told the inspector they would like more feedback from management and to be told ‘well done’ occasionally. Records of supervision were found to be periodic. In all staff files examined there had been only one or two supervisions recorded in 2005. Supervision records were inadequate and did not indicate discussions held. Where training needs had been identified these had not been met. In one supervision record, training needs identified in 2004 due to a promotion had not been met. In the staff files there was evidence of incidents that had occurred including misadministration of medication where the CSCI had not been notified. The manager informed the inspection team that she wanted to undertake an accredited course in dementia to further her own knowledge. Evidence was seen of up-to-date fire safety checks and electrical installation checks. Gas safety records were also found to be in order. An up-to-date legionella certificate or portable appliance schedule could not be found on the day of inspection and these must be put in place. The manager reported that the Care Director from the organisation has recently completed an audit of the home and this has been compiled into an action plan for the home to follow. Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 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 2 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 2 3 x x x 2 3 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x 2 x 2 Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 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 OP2 Regulation 5(1)b Requirement The Registered Persons must ensure that every service user is issued with terms and conditions of residence which must include details of the rooms to be occupied. (Previous timescale of 01/06/05 not met). 1) The Registered Person must ensure that service user plans include information on social, health and personal care and all identified needs. 2) Service users must be given the opportunity to participate in the development and review of their service user plan. Plans must be signed by the service user (or if necessary their representative) as an indication of their agreement. 3) The Registered Person should ensure that files are archived and remove any inappropriate documentation. (Previous timescale of 01/06/05 not met). The Registered Person must ensure that assessments of risk are sufficiently detailed and identify action to be taken to DS0000019112.V254943.R01.S.doc Timescale for action 01/01/06 2 OP7 1213151-2ad162m&n 01/12/05 3 OP7 13(4&6), 15 01/11/05 Park Lodge Care Home Version 5.0 Page 29 4 OP9 13(2) minimise risks. Risk Assessments must be kept under regular review. (Previous timescale of 01/05/05 not met) The Registered Person must ensure that all medication is administered as prescribed unless otherwise recorded appropriately. Immediate Requirement The Registered Person must ensure incident reports are completed for all the medication administration errors and sent to the CSCI office. Immediate Requirement The Registered Person must ensure that the administration/nonadministration of all medication is recorded appropriately. Immediate Requirement The Registered Person must ensure that the receipt of all medication is recorded accurately. 05/10/05 5 OP9 13(2) 07/10/05 6 OP9 13(2) 06/10/05 7 OP9 13(2) 06/10/05 8 OP9 13(2) 9 OP9 13(2) 10 OP9 121-3 & 4a Immediate Requirement The Registered Person must 01/11/05 ensure that the allergy section on the administration record is completed for all service users. The Registered Person must 01/11/05 ensure that all items of medication that are expired or no longer in use are removed and disposed of appropriately and items of medication are used in correct rotation. The Registered Person must 01/11/05 ensure that: 1. Service users are offered regular baths and that these are fully recorded. 2. Bathing temperatures DS0000019112.V254943.R01.S.doc Version 5.0 Page 30 Park Lodge Care Home 11 OP12 16(2)m & n 12 OP14 12(1-4), 13(7) 13 OP14 16m 12(2-4) 14 OP15 134&6 181c,i, 191a 13(4&6) 18(1)c 15 OP15 16 OP19 13 (4) remain within acceptable limits for service users. (Previous timescale of 24/06.05 not met). The Registered Person must ensure: 1. That accurate records of activity participation and enjoyment are maintained. (Previous timescale of 01/05/05 not met) 2. That a full activity programme is in place to meet the needs of the service users. The Registered Person must ensure that service users are given the opportunity to be seated in chairs rather than wheelchairs. Wheelchairs must not be used as a form of restraint. Any decision for a service user to remain in their wheelchair must be based on their wishes and should be subject to advice from relevant health care professionals. (Previous timescale of 01/05/05 not met) The Registered Person must ensure: 1. That all service users are offered choice at mealtimes. 2. Plates are not scrapped clean in front of service users. The Registered Person must ensure that any person preparing food has completed a food hygiene course. (Previous timescale of 01/06/05 not met) The Registered Person must ensure that all staff are trained in recognising and reporting abuse. (Previous timescale of 01/06/05 not met) The Registered Persons must DS0000019112.V254943.R01.S.doc 01/12/05 01/12/05 01/10/05 01/11/05 01/11/05 01/01/06 Page 31 Park Lodge Care Home Version 5.0 17 OP19 23(2)b & d 18 OP27 181a, 121a, 125a Sch 2 19 OP29 20 OP33 37 21 OP36 18(2)a 22 23 OP38 OP38 13(4) 13(4) ensure radiators and pipework are guarded throughout the home (Timescale of 01/09/05 not met). 1) The Registered Persons must ensure that all maintenance issues outlined in Standard 19 of this report are addressed. 2) The Registered Person must ensure that regular checks are made on the environment. (Timescale of 01/09/05 not met). The Registered Persons must ensure that adequate numbers of appropriately trained staff are on duty at all times. (Timescale of 01/09/05 not met). The Registered Person must ensure that staff files contain all the information specified in the Care Homes Regulations 2001. The Registered Person must ensure that the Commission for Social Care Inspection is notified of all events in accordance with Regulation 37. (Timescale of 01/06/05 not met). 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. The Registered Person must ensure that an up-to-date legionella certificate is obtained. The Registered Person must ensure that an up-to-date portable appliance testing schedule is obtained. 01/02/06 01/11/05 01/11/05 01/11/05 01/12/05 01/11/05 01/11/05 Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is strongly recommended that the quantity of all medication carried over from one month to the next be recorded on the administration record. It is recommended that an alternative closed off smoking area is found to prevent smoke from drifting throughout the communal areas of the home. 2 OP24 Park Lodge Care Home DS0000019112.V254943.R01.S.doc Version 5.0 Page 33 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.V254943.R01.S.doc Version 5.0 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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