Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Parkhouse Grange 47 Park Road Earl Shilton Leicestershire LE9 7EP The quality rating for this care home is:
three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Cowley
Date: 1 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Parkhouse Grange 47 Park Road Earl Shilton Leicestershire LE9 7EP 01455851333 01455851333 parkhouse@ala-care.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): A.L.A. Care Limited Name of registered manager (if applicable) Mrs Regina Summerfield Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: No-one under the age of 55 years may be admitted into the home in categories MD or PD. Service Users Numbers No person falling within the category of DE(E) may be admitted to the home when there are 40 persons of that category already accommodated in the home. Service user numbers. No person falling within categories MD/MD(E) may be admitted to the home when there are 10 persons in total in these categories/combined categories already accommodated in the home. Service user numbers. No person falling within categories PD, PD(E) may be admitted to the home when there are 5 persons of these categories/combined categories already Care Homes for Older People
Page 4 of 27 care home 40 Over 65 40 10 40 5 40 10 0 5 accommodated in the home. Date of last inspection Brief description of the care home Parkhouse Grange is a 40-bedded purpose built residential care home. It opened in 1996 and is situated in Earl Shilton, close to a range of local amenities. The home caters for older people, some of whom have mental health needs and/or physical disabilities. All bedrooms are single and 10 have ensuite facilities. There are three lounges, a dining room, and a conservatory downstairs, and a lounge with an adjoining roof garden upstairs. The home is set in 1.5 acres of landscaped gardens. Fees range from #323 to #420 per week. Inspection reports are available at the home, or can be accessed via the CSCI website: www.csci.org.uk. Further information about the home is available from the Owner or Manager. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of we indicates the Commission for Social Care Inspection) spent half a day reviewing information relating to the home. During the course of the inspection, which lasted five hours, we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three residents living at the home by meeting them, talking with the staff who support Care Homes for Older People
Page 6 of 27 their care, checking records relating to their health and welfare, and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also talked to four other residents, two relatives, the Manager, a senior carer and a carer. What the care home does well: What has improved since the last inspection? A change has been made to the way medication is administered. Previously it was given at mealtimes, but staff now give it out just before or after meals (unless it must be given with food). This helps to maintain residents dignity and allows them to have an interrupted meal. A Memory Lane has been created for residents in one of the corridors. This is a Care Homes for Older People Page 8 of 27 pictorial display of old photographs of Earl Shilton which residents and visitors can look at. There is also a Poets Corner where copies of poems, some written by residents and staff, are pinned up. Both these displays can be used by staff and visitors to engage residents and provide a focus for discussion. All residents have had a nutritional assessment to identify their particular needs at mealtimes. The home worked with a dietitian to carry this out. The assessment includes their preferred diet, where they like to sit in the dining room, and any special utensils and particular assistance they might require when eating. These assessments are kept in the dining room so they are easily accessible to staff. They help to ensure that residents have a balanced diet and enjoy their mealtimes. The premises have been improved to make them more suitable for residents with dementia. Pictorial signs have been put on the doors of communal rooms such as toilets and the dining room. Some residents have their photos on their bedroom doors to help them identify their rooms. These signs and pictures make it easier for residents to find their way around the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. Residents needs are assessed prior to admission to ensure the home is suitable for them. Information about the home is readily available to residents and their representatives. This judgement has been made using available evidence including a visit to this service. Standard 3 was inspected. Evidence: The home takes both private and social services funded residents. The Manager assesses new referrals using a standard checklist to determine their needs. The home admits older people, some of whom have mental health needs and/or physical disabilities. Social and health service assessments are taken into account when a decision is made about whether the home is suitable for a particular resident.
Care Homes for Older People Page 11 of 27 Evidence: We looked at the assessments belonging to the three case tracked residents. We saw that staff had all the information they needed before each resident was admitted. This helps to ensure their needs can be met as soon as they move into the home. There is an information station in the homes reception area. This consists of a rack of printed information, including recent inspection reports, menus, the service user guide, and policies and procedures. Also on view is a photo album, documenting life in the home over the last ten years. This information helps potential residents and their representatives make an informed decision as to whether the home is suitable for them. Standard 6: This home does not provide intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Staff in the home, and in the wider community, meet residents health and personal care needs. This judgement has been made using available evidence including a visit to this service. Standards 7, 8, 9, and 10 were inspected. Evidence: All residents have care plans, which set out how their health, personal and social needs are to be met. Residents and their relatives, where appropriate, are consulted when care plans are written and sign to say they are in agreement with them. The care plans we inspected were well written and gave clear instructions to staff about how best to meet residents needs. Case tracked residents talked to us about their preferences with regard to personal care, likes and dislikes, and interests, and it was positive to note that this information was in their care plans.
Care Homes for Older People Page 13 of 27 Evidence: We saw that where they needed them, residents had risk assessments in place. For example, some residents with dementia tend to wander. To reduce risks associated with this, a designated member of staff checks them every 30 minutes and a record is kept of this. This helps to ensure they are safe in the home. Residents are registered with GPs at a local practice. District Nurses visit the home when necessary to provide treatment. Records showed that residents have access to a full range of health care treatment including input from CPNs, chiropodists, dentists (NHS and private), and opticians. Where possible, residents are encouraged to take care of their own medication with staff support as necessary. Staff who administer medication are appropriately trained. Medication storage facilities are being reorganised and a new treatment room is being created where medication will be kept. It is recommended that when this is complete the homes pharmacist is consulted to ensure the new facilities are secure and meet current legal requirements, particularly with regard to the keeping of controlled drugs. Since the last inspection a change has been made to the way medication is administered. Previously it was given at mealtimes, but staff now give it out just before or after meals (unless it must be given with food). This helps to maintain residents dignity and allows them to have an interrupted meal. It was observed during the inspection that staff treat residents with respect and provide care discreetly and sensitively. One resident said, The staff help with anything we want. Care Homes for Older People Page 14 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents social and cultural needs are mostly identified and met. This judgement has been made using available evidence including a visit to this service. (Standards 12, 13, 14, and 15 were inspected.) Evidence: Activities provided include arts and crafts, parties, armchair exercise, hair and beauty, board games, and music. During the inspection staff and residnets were taking part in a sing-a-long in one of the lounges. One residnet told us If theres activities going on I take part. Residents who prefer not to take part in group activites have one to one sessions with staff, for example we saw one resindet having a manicure from a member of staff. Since the last insectpion a Memory Lane has been created for residnets in one of the corridors. This is a pictorial display of old photographs of Earl Shilton whihc residnets and visitors can look at. There is also a Poets Corner where copies of poems, some
Care Homes for Older People Page 15 of 27 Evidence: written by residnets and staff, are pinned up. Both these displays can be used by staff and visotrs to engage residnets and provide a focus for discussion. Shops, the library, and Age Concern are close to the home. Mobile hairdressing is available with dates advertised on the residents notice board. A mobile library visits the home once a month and changes the supply of books. Church services for various denominations are provided once a month. The home has an open house policy for visiting. Visitors can stay for meals if they wish and can see residents in their bedrooms or in one of the lounges. Two visotrs told us they are always offered drinks when they visit. There is a friends and families noticeboard in the homes main corridor. The infomration displayed there helps keep friends and realtives up to date with what is happening in the home. Since the last inspection all residnets have had a nutritional assessment to identify their particular needs at mealtimes. The home worked with a dietician to carry this out. This includes their preffered diet, where they like to sit in the dining room, and any special utensils and particular assistance they might require when eating. These assessments are kept in the dining room so they are easily accessible to staff. They help to ensure that residnts have a balanced diet and enjoy their mealtimes. All residents interviewed made many positive comments about the meals provided. One told us, I like the bread and butter pudding, and another said, The food is very good. Menu records showed healthy and varied meals being served with plenty of choice including vegetarian and diabetic options. Care Homes for Older People Page 16 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents and their relatives are encouraged to talk to staff about any concerns they might have. This judgement has been made using available evidence including a visit to this service. (Standards 16 and 18 were inspected.) Evidence: The home has a written complaints procedure, which is given to all residents (or their representatives) on admission, and also displayed in the home. All residents interviewed said they knew what to do if they had a complaint. One said, If I was unhappy about anything about anything Id tell whoever I saw first out of the staff.A relative said, Id go to the front desk if I had a concern and tell the staff there. There have been no formal complaints since the last inspection. Informal, minor complaints are recorded on residents case files. It is suggested that these are also recorded in the homes complaints book. This would show that staff take all concerns seriously and provide information for management about any areas of the service that have generated concerns. The home has a safeguarding procedure in place which explains what staff should do if they have concerns about the way a resident is being treated. Staff are trained in
Care Homes for Older People Page 17 of 27 Evidence: safeguarding during their induction, and go on to attend alerters or referrers training provided by the local social services department. This helps to ensure they know what to do should a concern about a residents wellbeing arise. Care Homes for Older People Page 18 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. Residents live in an environment that is safe, accessible, comfortable, and well maintained. This judgement has been made using available evidence including a visit to this service.(Standards 19 and 26 were inspected.) Evidence: Parkhouse Grange was purpose built and provides a high standard of accommodation to residents. Accommodation is spacious and there are six lounges and a large dining room. Corridors are wide and all areas of the home are accessible to those with limited mobility. We looked at five residents bedrooms and saw they were all personalised and homely. One visitor told us, My relative loves her little room here. The home is set in extensive landscaped gardens, which are wheelchair-accessible. There is a secure section of garden at the rear of the home, which is suitable for residents who wander. There is a walkway, a lawn, and a patio area with tables and
Care Homes for Older People Page 19 of 27 Evidence: chairs. Since the last inspection the premises have been improved to make them more suitable for residents with dementia. Pictorial signs have been put on the doors of communal rooms such as toilets and the dining room. Some residents have their photos on their bedroom doors to help them identify their rooms. These signs and pictures make it easier for residents to find their way around the home. All areas inspected were clean, fresh, and tidy. A resident told us, When you go to your bedroom its always clean and the beds made up. Care Homes for Older People Page 20 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. An established staff team meets residents needs. Relationships between staff and residents are warm and caring. This judgement has been made using available evidence including a visit to this service. (Standards 27, 28, 29, and 30 were inspected.) Evidence: The staff team is established and there is a core of experienced staff who have worked at the home for many years. The staff were observed as being warm, caring and professional, and to have excellent relationships with residents. Residents comments about the staff included, I get on well with the staff and theyre always very good, If I want anything I ask the staff, and, Were like a big family here. During the inspection we saw that staff were constantly interacting with residents and taking the time to sit and talk to them. A relative told us, We see the carers chat to the residents all the time. Recruitment procedures were discussed with the Manager. She confirmed that all staff are subject to CRB and POVA checks, and references are obtained. Staff files were
Care Homes for Older People Page 21 of 27 Evidence: sampled and had the appropriate documentation in place. This helps to ensure residents are safeguarded. Staff receive good training opportunities including an induction, NVQs, and short courses including Dementia Care, Infection Control, and Manual Handling. In addition all staff have annual appraisals with the Manager. The training and supervision arrangements in the home help to ensure that staff are competent to do their jobs. We discussed the prevention of choking as this has been identified nationally as a significant risk in care and nursing home. The Manager told us staff are trained in First Aid and residents are risk assessed for choking. However she agreed to discuss this issue at the next staff meeting to ensure staff know what to do if a resident chokes, and to arrange further training where necessary. Care Homes for Older People Page 22 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. The home is well run in the best interests of residents by an experienced Manager. This judgement has been made using available evidence including a visit to this service. (Standards 31, 33, 35, and 38 were inspected.) Evidence: The Manager is well-qualified and has substantial experience in care. Her office is in the reception area and she keeps her door open so residents and relatives know where she is and can approach her when they want to. She is knowledgeable about the needs of all the residents in the home and has good relationships with them and their relatives. She is a Dignity Champion. This is a person who has demonstrated a commitment to adhere to the principles of the Dignity in our Home charter, which is displayed in
Care Homes for Older People Page 23 of 27 Evidence: Parkhouse Granges reception area. Since the last inspection she has begun a dignity audit of the home which has resulted in changes to the way medication is administered (see Health and Personal Care). She told us she is looking at the environment next and will be talking ot residents, visitors and staff about how it can be improved. Relatives meetings are held every few months. At these staff share information about the home, listen to relatives views, and discuss issues like dementia. These meetings provide a forum for relatives to discuss the service and make suggestions about any improvement they would like to see. Quality assurance questionnaires are send out annually to residents, relatives and visiting professionals. The results are analysed and areas in need of improvement are identified where necessary so action can be taken. Residents finances are handled by the residents themselves, or their representatives. However, staff at the home will look after small amounts of cash for residents if they need to pay the chiropodist or hairdresser, for example. Appropriate records are kept. There is a range of policies and procedures in place to maintain health and safety in the home. The Manager is knowledgeable about health and safety in a residential care setting, and has a proactive approach to keeping the environment as safe as possible for residents and staff. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 9 When the homes new medication storage facilities are complete the homes pharmacist should be consulted to ensure they are secure and meet current legal requirements, particularly with regard to the keeping of controlled drugs. All complaints, however minor, should be recorded in the homes complaints book. This would show that staff take all concerns and provide information for management about any areas of the service that have generated concerns. Staff training with regard to choking prevention should be reviewed with extra training provided where necessary. 2 16 3 30 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!
