Inspection on 16/01/06 for Park Lodge Nursing and Residential Care

This inspection was carried out on 16th January 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 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... 01/09/05

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

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

Similar services:

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Snydale Care Home

Abbey The

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

CARE HOMES FOR OLDER PEOPLE Park Lodge Nursing and Residential Care 10 Park Avenue Roundhay Leeds Yorkshire LS8 2JH Lead Inspector Ann Stoner Unannounced Inspection 16th January 2006 10:30 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 Nursing and Residential Care DS0000001365.V271621.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 Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Park Lodge Nursing and Residential Care Address 10 Park Avenue Roundhay Leeds Yorkshire LS8 2JH 0113 2659353 0113 2650942 park.lodge@ashbourne-homes.co.uk 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) Ashbourne Homes Limited Louise Taylor Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51), Terminally ill (6) of places Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of service users aged between 55 and 65 years of age should not exceed 3. 1st September 2005 Date of last inspection 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 planning permission is being sought to build a conservatory along the front of the building, which would provide an additional seating area. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 announced and took place on the 1st September 2005. There have been no further visits until this unannounced inspection. The purpose of this inspection was to monitor the home’s progress in meeting the requirements and recommendations made at the last inspection and to look at the standard of care for people living in the home. This inspection was carried out by one inspector between 10.30am – 5.30pm. 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 staff carrying out their work and spoke with residents, visitors, staff, and the home’s general manager, who is the registered manager. Feedback at the end of the inspection was given to 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 none have been returned. What the service does well: What has improved since the last inspection? The home has once again applied for planning permission to build a conservatory, which if approved, will provide additional seating areas for residents. The call system has been refurbished, and now incorporates the doorbell so that staff are aware of callers when the door is locked at dusk. The manager said that work on improving care plans had come to a halt because of organisational changes within the company and as a result, all of the systems, documentation, policies and procedures of the home are being changed. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 6 What they could do better: 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 Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 the following standard(s): These standards were not assessed at this visit. EVIDENCE: Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 the following standard(s): 7 & 9. Care plans do not give detailed instructions for staff, this provides the opportunity for needs to be overlooked. The medication records for service users who handle their own medication are not clear and fail to give staff detailed instructions. This could lead to inconsistent practice. EVIDENCE: The care records of four residents were sampled, and in each case they lacked specific detail. One person was a diabetic, before lunch staff were seen taking a blood sample, and although they recorded this person’s blood sugar levels, there was no information in the care plan about acceptable levels. Some information about this person was recorded in the district nurse’s notes, held within the home, such as a risk assessment for the use of bed rails, but there was no record in the care plan of this risk assessment being carried out. There was also information within the district nursing notes about pressure relieving equipment again this information was not in the care plan. One resident said that she enjoyed watching snooker on television, and liked to watch television in bed. In order to do this she needs the remote control within easy reach, which she said doesn’t always happen. This information was not in her care plan. Bed rails were in use for another resident, but the rationale for the use of the bed rails was not recorded. Risk assessments are undertaken and if a risk is identified this triggers a ‘core care plan’. These are generic pre-printed Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 10 plans, they do not identify the specific needs of individual residents and fail to demonstrate a ‘person centred approach’. Abbreviations such as ‘NAD’ (no abnormalities detected) and ‘OPA’ (out-patients appointment) were seen in daily records. The medication records of a resident who administers some of her own medication was sampled. The medication administration record (MAR) did not clearly indicate the amount of medication handed over to the resident and the date on which it was handed over. The MAR did not indicate that she was selfmedicating. An assessment of ability to self medicate was completed, but there were no instructions for staff about how to monitor compliance, although staff explained that this person’s medication is counted on a weekly basis. During the inspection the manager said that work on improving care plans had not taken place because all of the home’s documentation, policies and procedures are to change. Requirements and recommendations have been made to address the above issues. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 the following standard(s): 15 Residents have a well balanced diet. EVIDENCE: The menus showed a choice at both lunch and dinner, and there was evidence of specialist dietary input from the speech and language therapist for one resident. The lunch time meal on the day of this visit was home made lentil soup, assorted sandwiches or cauliflower cheese with potato croquettes, followed by yoghurt, ice cream or sponge pudding and custard. The dinner menu, served at 5pm, was braised gammon or chicken and vegetable pie with vegetables and potatoes, followed by chocolate éclairs. Service users said that they enjoyed their meals. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 the following standard(s): 18 The registered manager has made efforts to access training for senior staff on adult abuse. EVIDENCE: This standard was not assessed in detail, but the manager was able to provide written evidence that she has contacted the multi-agency adult protection trainer, with a view to accessing training for her senior staff. This was a recommendation made at the last inspection. The manager has a good understanding of the requirements of POVA (Protection of Vulnerable Adults) and was able to provide evidence of contacting POVA for advice. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 22, 24, 25 & 26 Communal space remains limited. Some areas of the home require attention to make sure that residents live in good standard accommodation. Some practices increase the risk of the spread of infection. EVIDENCE: Communal space remains limited, but once again the home has applied for planning permission to build a conservatory at the front of the building, which would provide an additional seating area. Some bedrooms are more spacious than others, and the overhead lighting in some bedrooms is dim. There are some divan beds that do not have a valance and the counterpanes did not cover the bed base, this along with the fact that commode chairs have the bedroom number painted on the front in white paint, gives some rooms an institutional look. Bedding should be reviewed, particularly the blankets that are currently in use. The position of some beds means that the call bell cannot be accessed and not all divan beds have a headboard fitted. Staff use water soluble bags for laundering soiled linen, which is good practice, but they were seen carrying these bags to the laundry wearing only one glove and no protective apron. One member of staff was seen assisting a resident to Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 14 and from the toilet. When assisting the resident back to the lounge, the member of staff was still wearing latex gloves, and came into contact with wheelchairs, tables and lounge chairs. One member of the domestic team found it difficult to communicate in English because it was not her first language. This person had no cleaning trolley and was carrying her cleaning equipment in a bucket marked ‘garden only’. Some products were left on the floor. She had two cloths, one red and one blue. She indicated that she cleaned all of the toilets with the red cloth and was carrying one toilet brush with her. This practice is unacceptable. Cleaning staff in other parts of the building had a well stocked trolley and an ample stock of different coloured cloths. The domestic supervisor had a good understanding of infection control and said that staff used red cloths for cleaning toilets and these were disposed of after cleaning each toilet. Toiletries were seen in one bathroom, and were therefore at risk of becoming contaminated. There were no clinical waste bins in any of the bathrooms and toilets, but there was a supply of plastic bags, which staff use to transfer clinical waste to the sluice area. Requirements have been made to address the above issues. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 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): 29 & 30. Overall residents are protected by the home’s recruitment practices, and new staff receive an induction programme based on national standards. EVIDENCE: The recruitment records of three people were sampled. There were detailed application forms, 2 written references, work permits where necessary, and in all cases a successful CRB/POVA (Criminal Record Bureau/Protection of Vulnerable Adults) check had been returned prior to employment. There were no interview records held on file and the photograph, which was a photocopy taken from either a passport or driving licence, was in the case of one person difficult to distinguish. Two recommendations have been made to address these issues. Evidence that all three people had completed the home’s induction programme was seen in the staff files. The induction programme was cross referenced to the TOPSS (Training Organisation for Personal Social Services) induction standards. The manager was aware of the introduction of the Common Induction Standards. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 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 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 & 38. The home is well managed, and quality assurance systems are currently in place. Overall resident’s finances are safeguarded. Health and safety is monitored but some infection control practices promote the spread of infection. EVIDENCE: The manager, who has many years of experience in the care of older people, is a first level nurse and is currently studying for a BSc in Nursing Studies. She is also completing some units of the Registered Manager’s Award. Despite the large amount of paper work that needs to be undertaken by a registered manager, she spends a large amount of time supervising staff in the home and is known and recognised by residents, visitors and other professionals. The manager completes a quality audit that feeds into an annual development plan. Regular meetings are held with staff and residents and satisfaction questionnaires are available in the reception area. However, along with all other systems in the home, this is to change in line with organisational changes. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 17 The administrator said that all residents savings are held in individual named interest bearing accounts. Evidence was seen of record keeping. During the inspection one relative handed over a small sum of money for ‘sundry items’ for a resident. A record of this transaction was made and the person was given a receipt. However, the person handing over the money was not asked to sign the record sheet, which is considered good practice. One resident had handed over a cheque book and a debit card for safekeeping. Although both of these were in the safe, there was no written record of this. Recommendations have been made to address these issues. Records were seen of maintenance checks, risk assessments and fire alarm tests and drills. There are wall-mounted heaters in some bedrooms, although the manager said that these are not used very often. There were no risk assessments for the use of these heaters in place. As previously stated in Standard 26 some practices increase the risk of the spread of infection in the home. The manager explained how she reviews all accident records on a monthly basis, but there was no written detailed analysis or breakdown of accidents to show how trends or patterns are identified. Requirements and recommendations have been made to address these issues. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 2 X 2 X 2 2 2 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 19 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 OP7 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 and 1st September 2005. There must be recorded evidence within the care plan about the rationale to use bed rails. Where a resident is selfmedicating the Medication Administration Record (MAR) 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. This is outstanding from 1.9.05. The MAR must clearly show that the resident is self medicating all or part of his/her medication. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 20 Timescale for action 01/05/06 2 OP7 13 (4) 01/02/06 3 OP9 13 (2) 01/02/06 4. OP20 28(2)(h) There must be detailed instructions for staff on how to monitor compliance of medication. Additional communal space must be provided. This is outstanding from inspections on 27.1.05 & 1.9.05 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. This is outstanding from 1.9.05. All divan beds must be fitted with a headboard, unless the reason for not doing so is explained within the care plan. All bedding must be reviewed. The overhead lighting, particularly in bedroom numbers 24, 25 & 26 must be reviewed. The following measures must be taken to prevent the spread of infection in the home: • Laundry bags containing soiled linen must be transferred to the laundry using a laundry trolley with a suitable red liner. Staff must wear protective aprons and gloves when transferring clinical waste and soiled laundry. After use all toiletries must be returned to the resident’s bedroom. Clinical waste bins must be available in toilets and bathrooms. Cloths used for cleaning 01/06/06 5. OP22 23(2)(f) 28/02/06 6 OP24 16 31/03/06 7 8 OP25 OP26 23 13 (3) 31/03/06 28/02/06 • • • • Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 21 9 OP38 13 toilets must be disposed of after each use. • All staff must demonstrate a clear understanding of infection control. • Protective gloves must be disposed of immediately after leaving the toilet or bathroom area. Risk assessment must be completed to justify the use of wall-mounted heaters that are in some bedrooms. 01/03/06 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. 3. Refer to Standard Good Practice Recommendations Abbreviations such as ‘NAD’ and ‘OPA’ should not be used within daily notes. 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. This is outstanding from 1.9.05. Divan beds should have a valance. There should be a record of the recruitment interview held on staff files. This record should identify that any gaps in employment have been explored. The record should be signed and dated by all parties conducting the interview. Original photographs should be held on staff files, rather than a photocopy from a passport or driving license. Where money is handed over on behalf of a service user, a signature should be obtained from the person handing over the money and the person receiving the money. A written record should be kept of all items handed over for safekeeping. A written detailed analysis of accidents should be kept on a monthly basis to identify and patterns or trends. This should include the number of times individual residents DS0000001365.V271621.R01.S.doc Version 5.0 Page 22 4 5 6 7 8 9 Park Lodge Nursing and Residential Care sustain an accident or injury, the time of the accident and the place of the accident. Park Lodge Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 23 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 Nursing and Residential Care DS0000001365.V271621.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!