Inspection on 01/09/05 for Park Lodge Nursing and Residential Care

This inspection was carried out on 1st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Park Lodge Nursing and... 01/02/07

Park Lodge Nursing and... 16/01/06

Park Lodge Nursing and... 27/01/05

Park Lodge Nursing and... 14/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Park Lodge 10 Park Avenue Roundhay Leeds LS8 2JH Lead Inspector Ann Stoner Announced 10.00am 1st September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Park Lodge Address 10 Park Avenue Roundhay Leeds LS8 2JH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2659353 0113 2650942 Ashbourne Homes Ltd Louise Taylor Care Home with Nursing 51 Category(ies) of Old Age (51) Terminally Ill (6) registration, with number of places Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27th January 2005. Brief Description of the Service: The home provides both nursing and residential care, and although registered for 51 places, some shared rooms are being used as singles, reducing the number of available places to 48. It is located in a residential area of the suburbs of Leeds and is near Roundhay Park, but still within walking distance of local facilities, which include shops, public transport and a post office. It is a large adapted building and accommodation is mainly in single rooms, many with en-suite facilities. There are gardens, with seating areas, to the front and side of the building. Communal areas are somewhat cramped given the potential number of people who may wish to use them, but there are plans to build a conservatory along the front of the building, which would provide an additional seating area. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was unannounced and took place on the 27th January 2005. There have been no further visits until this announced inspection. The people who live in the home prefer the term resident; therefore this will be the term used throughout this report. During the inspection, I looked at records, I saw care staff carrying out their work and spoke with residents, visitors, staff, the managers of both the nursing and residential units and the home’s general manager, who is the registered manager. Comment cards/questionnaires are left for residents, visitors and other professionals at each inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection. Comments received in this way are shared with the provider without revealing the identity of those completing them. Since the last inspection three have been returned. What the service does well: What has improved since the last inspection? What they could do better: A record should be kept on the pre-admission assessment form as to where the assessment was carried out and who provided the information. All care plans should describe exactly how care is to be delivered, and care should be taken when making daily records to make sure that actual descriptions of Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 6 behaviours are recorded. Senior staff should attend training on how to use the Multi Agency Adult Protection Procedures. Bathrooms should be made more attractive and commodes should look less institutionalised. Requirements and recommendations have been made to address these issues. 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 J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 5. Standard 6 does not apply to this home. People are able to make an informed decision before moving into the home, and the home makes sure that it is able to meet the person’s needs before admission is agreed. EVIDENCE: Five care plans were sampled and in each case the home carried out a preadmission assessment. It is recommended that a record be kept as to where the assessment was carried out, and who provided the information. The residential unit manager explained how the general manager of the home carries out an assessment, before she makes contact with future residents to invite them for a pre-admission visit. A visitor said that she had been to look round the home, on behalf of her relative, before making any decision about admission. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10. Care plans do not give detailed instructions on how care is to be delivered, giving the opportunity for needs to be overlooked. Residents’ health care needs are met, their privacy and dignity is respected and medication is handled properly. EVIDENCE: Through discussions with staff and residents it was clear that care is provided based on the precise needs of individuals, but the level of detail described was not reflected within individual care plans. Care plans on the residential unit were more of an assessment of the person rather than a plan of care. Care plans should be ‘person-centred’, giving exact instructions on how care should be delivered to meet assessed need, taking into account the likes and dislikes of the resident. Two residents had core care plans in place because nutritional and pressure area risks had been identified. The nutritional plan stated that the resident should be encouraged to have snacks and drinks between meals, and the pressure area care plan stated that the resident should be re-positioned every 2/3 hours. There was no way of monitoring this, as there was no fluid/food chart or turn chart in place. The general manager said that both instructions were unnecessary for the particular residents. These generic type plans are not ‘person-centred’ and do not reflect the unique and specific needs of individual residents. Terms such as ‘very moody’ and ‘will manipulate Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 10 staff’ were seen in a care plan and a daily record. Care plans are reviewed on a monthly basis, but there was no evidence of resident participation, despite the fact that some are more than able to contribute. A requirement and a recommendation have been made. Evidence within care plans showed visits by GPs, the tissue viability nurse, optician and chiropodist. During the inspection a GP was seen visiting a resident and another person described how she attended an outpatients clinic accompanied by a member of staff. Care plans were in place for residents who hold their own medication. There was good evidence of reviewing compliance and the nurse manager explained how she is monitoring one situation carefully. The Medication Administration Record (MAR) shows the amount received by the home, and although it is clear that the resident is self-medicating, it does not show the exact amount handed to the resident or the date it was handed over. A recommendation has been made to address this. The residential unit manager had a good understanding on the use of homely remedies and of the need to have handwritten entries on the MAR checked and countersigned by a second person. All staff who administer medication have received accredited training. Throughout the day residents were treated with respect and their was privacy acknowledged. When asked, a care worker had a good understanding of choice, privacy and dignity, and was able to give examples of these from her work practice. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, & 14. Leisure activities are provided for residents, and contact with friends and family is encouraged. EVIDENCE: Residents described the choices available to them, such as their preferred times for going to bed and getting up in a morning being respected. The general manager said that although some group activities are provided, emphasis is placed on providing activities on an individual basis for residents. During the inspection one person, accompanied by a care worker, went shopping, and said that this was a regular occurrence. Another person said that the residential unit manager had taken him to see an air show, which was of particular importance to him because it reminded him of his National Service days. Care staff said that they always have time to chat with residents. Whilst speaking to a resident, the residential unit manager interrupted to tell him that his family from Scotland had telephoned and would be visiting the following week. She said that she would make arrangements for them to have a meal with him. She later said that some people regularly visit at meal times and have a meal with their relative. During the inspection visitors were offered refreshments. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18. Complaints are taken seriously, and staff have a good understanding of adult abuse. Resident’s legal rights are respected and protected. EVIDENCE: Residents said that they would have no hesitation in making a complaint if the need arose, and said that any issues are resolved wherever possible. A care worker and the residential unit manager both had an excellent understanding of the different types of abuse and of how to respond to any suspicion of abuse. Senior staff have not received any training on the Multi Agency Adult Protection Procedures. A recommendation has been made to address this. Residents said that they are able to vote in elections, and have privacy to see legal advisors, such as Solicitors. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22 & 26. Some refurbishment work has taken place, but this must continue to provide a well maintained environment with sufficient communal space for residents. Laundry facilities are suited to the needs of the residents. EVIDENCE: The garden areas were attractive with co-ordinating garden furniture. A new call system, which links to the doorbell, is on order, and the general manager said that a small ramp is to be fitted to the entrance. Communal space remains limited, but a small office has been converted into a small lounge and there are plans to build on a conservatory at the front of the building, which if planning permission is agreed, will provide an additional seating area. One bath in the residential unit needs repair, and bathrooms would be less clinical with the addition of some pictures. The position of beds in some rooms does not give access to the call system. A number of commodes in some rooms look unsightly and institutional because room numbers are painted on the front of the commode. Requirements and recommendations have been made to address these issues. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 14 The home was clean and tidy and there were no offensive odours. Policies are in place for dealing with spillages, infection control and hand washing. A care worker was able to describe the measures taken to control the spread of infection; water-soluble bags are used when laundering soiled linen. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28. Staff training is available and staffing levels are appropriate to meet the residents’ needs. EVIDENCE: Two comment cards returned from visitors make reference to insufficient staffing levels, and the absence of staff in the lounge areas, particularly, when staff are taking a break. The general manager agreed to follow this up and look at deployment of staff. The duty rota showed adequate numbers of staff on each shift and the nurse manager said that she had no problems with staffing, and that agency staff were not used. A nurse said that staff have time to spend with residents, and a care worker said there is always time to spend with residents, painting their nails, or just sitting talking to them. Approximately 33 of care staff have achieved a National Vocational Qualification (NVQ) at level 2 or above, and the remaining staff are working toward the award. A care worker said that training such as moving and handling, infection control, food hygiene and fire safety is given as routine with regular updates available. The general manager completed a pre-inspection questionnaire and stated that training during the past 12 months has included wound care, infection control, continence, supra-pubic catheters, bed-rail safety and challenging behaviour. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 & 38. Staff receive supervision. The health, safety and welfare of residents is protected. EVIDENCE: Staff confirmed that they receive supervision, but care must be taken to make sure that the concept of one-to-one supervision is understood by those staff who are supervising, as some care staff described a ‘clinical supervision’ approach. A written record is kept of the supervision session, which is seen and countersigned by the staff member. Information supplied on the pre-inspection questionnaire shows that all the relevant health, safety and maintenance checks have been carried out. Care staff confirmed that they have received the required health & safety training. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 2 2 2 2 x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x x x 3 x 3 Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 (1) Requirement Care plans must set out in detail the action which needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the resident are met. This is outstanding from the inspection on 27.1.05. Refurnishment must continue. The front bath panel in the residential part of the home needs repair or replacing. Additional communal space must be provided. This is outstanding from inspections on. The call system must be accessible to all residents when in bed, unless the reason for not doing so is explained in the care plan. Timescale for action 31.12.05. 2. 19 23 (2) (d) 23 (2) (b) 31.12.05. 3. 20 28 (2) (h) 31.3.06. 4. 22 23 (2) (f) 31.10.05. Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 3 7 Good Practice Recommendations A record should be kept on the pre-assessment form as to where the assessment was carried out, and who provided the information. Wherever possible residents should be encouraged to contribute to the monthly evaluation of the care plan. Terms such as moody and will manipulate should be replaced with descriptions of actual behaviours. Where a resident is self-medicating the Medication Administration Record must show the amount of medication received into the home, and the amount of medication handed over to the resident and the date it was handed over. Senior staff should access training on the use of the Multi Agency Adult Protection Procedures. The painted room numbers on the front of commodes should be removed, or the commodes should be replaced. Bathrooms should be made more attractive. 3. 9 4. 5. 6. 18 19 21 Park Lodge J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Aire House Town street Rodley Leeds LS13 1HP 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 J52 J03 S1365 Park Lodge V217534 140705 Stage 4.doc Version 1.40 Page 21 - 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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