CARE HOMES FOR OLDER PEOPLE
Parkland House Barley Lane Exeter Devon EX4 1TA Lead Inspector
Rachel Fleet Announced 15 July 2005 10:10hrs 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. Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Parkland House Address Barley Lane Exeter Devon EX4 1TA 01392 251144 01392 252774 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) Peninsula Care Homes Limited John Surel Bayliss Care Home 49 Category(ies) of DE(E) Dementia -over 65 (49) registration, with number LD(E) Learning dis - over 65 (2) of places MD(E) Mental Disorder - over 65 (49) OP Old age (49) PD(E) Physical dis - over 65 (49) Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 That the category of Learning disability applies for two named service users only 2 On the termination of the placement of the two named service users, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 16th December 2003 3 The maximum number of placements including that of the two named service users, will remain at 49 Date of last inspection 12 January 2005 Brief Description of the Service: Parkland House is a care home for 49 older people who may also have dementia, mental disorder or physical disability. The Home also offers day care, but only cares for a maximum of 49 people including residents. It is a detached and extended period house, standing in large gardens, on the western outskirts of the city. In a residential area of Exeter, it is not too far from some local shops and a bus route to the city centre, with St Thomas shopping centre less than a mile away. The property has been extensively refurbished, including ‘The Coach House’ (- providing accommodation for more independent service users). There is one passenger lift between the ground and first floors. Residents have the use of three lounges, a sun lounge and a spacious hallway. The Home also has a large dining room, a lounge/dining room, and a kitchenette / dining area which is used for activities and where residents can make themselves drinks or snacks.The gardens are well kept, with good wheelchair access to sitting areas, and with a walkway around the building. A courtyard garden has been created which gives an improved view from rooms overlooking it.There is a car parking area at the front of the Home. Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. There were 47 residents at the Home on the day of the inspection, with two other residents away elsewhere. Three inspectors visited the Home on this occasion, including the Pharmacist Inspector who looked at medication systems. Fourteen people living at the home contributed to the inspections by sharing their views on the service provided. Six visitors and four members of staff also took part in the inspection. CSCI comment cards were returned by four residents and five relatives/visitors, which were positive apart from one reply indicating the respondent felt there wasn’t always enough staff on duty. Throughout the day the atmosphere was relaxed and friendly. Residents made use of the various communal spaces, their own rooms and the gardens. Visitors commented on the quality of information provided by the manager when they first visited the home, and felt it was the welcome that they had received that had made them feel confident about the home. What the service does well: What has improved since the last inspection?
The hall was in the process of being decorated during the inspection. Residents commented favourably on the difference, which makes the hall area brighter and more welcoming. Work has also taken place on the porch with new lighting and attractive plants. All radiators are now guarded. There are no current concerns about the suitability of individuals’ bedrooms regarding their individual needs. A new care planning system is being introduced to the home, with additional detail. Records are now kept of residents’ ‘last wishes’ i.e. regarding their care in the event of deteriorating health or terminal illness.
Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 6 Care plans are reviewed more regularly, with the resident’s involvement (or that of their representative). Aspects of medication systems have been improved, as well as certain matters relating to health and safety of residents. Required recruitment information and evidence is obtained about staff. The Registered Manager has undertaken training and updating relevant to the service offered by the Home. Training for all staff has included protection of vulnerable adults, staff meetings are held at intervals, and a system of formal supervision has begun. 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. Parkland House D54 D06_s55233_parklandhouse_v222850_150705 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 Parkland House D54 D06_s55233_parklandhouse_v222850_150705 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) None of these standards was inspected. EVIDENCE: Parkland House D54 D06_s55233_parklandhouse_v222850_150705 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) 7,8,9,10,11 The quality of information contained in care plans is improving and has begun to reflect the good practice of staff in promoting the individuality, privacy and dignity of residents throughout their stay at the Home. Health care needs are well met, with evidence of good interdisciplinary working with community health professionals. Medicines were well managed, with only minor shortfalls in some of the systems in the home. EVIDENCE: Care plans are reviewed monthly. These include psychological and mental health needs, as well as physical care needs. Moving and handling guidance is up to date and reviewed. The resident or their representative now signs care plans. Daily records are improving, with less use of generic expressions such as ‘usual care’. Records were particularly detailed for a new resident, indicating how they were settling in, and reflecting views of staff and the person’s relatives gained during the inspection. ‘Last wishes’ of residents are now recorded. There is improved focus on hobbies and interests, with information sources noted. Activities co-ordinators have been encouraged to record their interventions in care plans and there was some evidence of this.
Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 10 Evidence from residents and care plans showed there is access to a range of health care services, including district nurse, chiropodist, optician and GP. Description of skin care procedures i.e. equipment used, reviewing pressure areas, and treatments was recorded in care plans, with the outcome of this care. Nutritional needs, assessments, and ways of helping frailer residents with meals were recorded in care plans, with the assistance observed during the inspection. The manager explained how different communication techniques are being considered for one resident, to enable them to put across their wishes to staff. Residents spoke positively about the staff and their relationship with them, and the caring attitude of staff was seen during the inspection. One resident became disorientated during the day and a member of staff was seen sensitively reassuring them and maintaining their dignity. Visitors said their relatives always looked well cared for. Residents felt that their dignity was respected. Several residents said their clothes were well looked after and washed regularly. Two other residents spoke about their ‘houses’ when referring to their rooms and displayed a real sense of pride and privacy about their own space. Discussion with staff about people living at the home highlighted how they are treated as individuals i.e. recognising their sense of humour and reactions to loss. This reflected discussions with residents and visitors. Receipt of medicines is normally recorded on the Medication Administration Record chart, but was forgotten this month. Most hand-written entries have two signatures and are dated, as is good practice. The cupboard containing creams and lotions was not lockable. Some variable doses were not recorded for aperients and antacids. All staff administering medicines have undertaken “Safe handling of medicines” training. Their daily administration practices should be monitored to ensure they maintain good standards based on this training. Staff were seen explaining to residents what their medication was for (‘Helps with your bad legs’, for example). Parkland House D54 D06_s55233_parklandhouse_v222850_150705 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 &15 The Home encourages a stimulating environment, in ways that focus on individual interests and independence of the residents, and that satisfy social, spiritual and recreational needs. Residents’ lives are enriched by good links with the community it is part of. Skilled staff promote residents’ independence and dignity through appropriate encouragement and promotion of choice. This included mealtimes, ensuring dietary needs and preferences of residents are met as fully as possible. EVIDENCE: Residents said they felt the routine of the home was flexible. One person said how much they enjoyed being able to choose what they did, and that they couldn’t fault the care. This included when they got up and their bedtime, where they eat breakfast and other meals. One resident told the inspector how they preferred to spend time in their room reading, but liked to meet other residents during meals. Residents were observed walking in the garden, choosing where they sat and spending time in their bedrooms. The atmosphere of the home was relaxed. The gardens are accessible, a path guiding the walker around the different seating areas and providing a sense of purpose. Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 12 One resident enjoys helping with domestic tasks, and was seen setting the table. Staff were creative regarding ways of getting residents involved in activities. For example, during the morning quiz, questions varied in topics and ability to suit the individual needs of those participating. Eleven people took part and appeared relaxed, with plenty of banter being exchanged. Others said they chose not to be actively involved but liked to listen. Later, there was an exotic fruit tasting session, which again was lively and drew on the life experiences of residents. The two activities co-ordinators demonstrated a clear understanding of the individual needs of service users based on their interests and level of cognitive impairment. One-to-one company is offered by the activities co-ordinators for less able residents, and they also provide a valuable escort service by accompanying residents to the bank, shops and health appointments. Residents and visitors said that staff were welcoming and that communication was good between staff, residents and visitors. Residents confirmed that they could see visitors wherever they chose. Daily records and the visitors’ book show that many people visit the home. A multi-denominational service is held regularly at the Home. Residents spoke positively about the food provided, describing it as ‘good’ and ‘excellent’. Written menus offer a balanced diet. The mealtime observed in the upper lounge was unhurried. Some residents sat up at a table, and others sat in easy chairs with lap tables. Staff offered gentle prompting and encouragement to help people initiate feeding themselves. Meals that were liquidised still had the ingredients separated, to help promote individual flavours. Choice was seen being offered for drinks and pudding, and staff topped up drinks, and encouraged a good fluid intake. Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 13 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 & 18 The Home has a satisfactory complaints system, with evidence that residents and their representatives feel their views are listened to and acted upon. Appropriate action has been taken to try to ensure residents are protected from abuse. EVIDENCE: Three residents’ comment cards said they knew who to speak to if they were unhappy with their care; one said ‘sometimes’. Visitors said that the manager was approachable, which made them feel that if they had a problem they could go to him or to other staff. They felt that good communication was a strength of the home. CSCI has not received any complaints about the Home since the last inspection, and the Home has not received any complaints. Comment cards from residents included that they liked living at the Home and felt safe there. Staff had had training on protection of vulnerable adults, and described appropriate procedures. There have been no allegations of abuse made against the Home. Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 14 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) 19,23,24 & 25 Maintenance of the environment - internally and externally - is generally very good, providing residents with an attractive, clean, safe and homely place to live. EVIDENCE: The Home is well maintained and attractively decorated, with a rolling programme to maintain this standard – for example, bedrooms are redecorated and re-carpeted if they become vacant, as seen during a tour of the building. The upper floor of the main building is looking tired in appearance. This area is included on the current maintenance plan to be addressed later this year. The home was clean and odour free, which residents and visitors confirmed was always the case. The grounds are attractive and well managed, with a range of seating areas to choose from. One person who uses a wheelchair has been moved to a larger room and a stand-aid has been bought for another person with mobility needs, to maximise the limited space in their bedroom, which staff said was an
Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 15 improvement. They felt there were no other issues with bedrooms, in relation to the needs of current residents. Three radiators have now been guarded in the upper lounge and landing, to promote the safety of residents. Staff confirmed that some residents had requested bedroom doorlocks that they used when they left their rooms. One room has a safe storage facility. Mr Bayliss confirmed this can be provided for anyone else wanting it, as well as there being central safe storage. Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 16 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, 29 & 30 There are sufficient staff with an appropriate variety of skills to meet residents’ needs. Residents benefit from and are protected by the Home’s recruitment practices and a proactive approach to training and supervision. However, induction and foundation training of new staff would be improved if linked to Skills for Care (previously ‘TOPSS’) specifications. EVIDENCE: Comment cards from four residents said they felt well cared for. Four of five relatives/visitors’ comment cards indicated the respondent felt there were always sufficient staff on duty. Two members of staff said that the staff team is more stable, reliable and happier. Generally, they felt staff meetings were helping. They both showed a good knowledge of the residents’ needs, including recent changes and both felt that communication was good within the home. Staff files that were seen contained required recruitment information and documents. They also included induction and training records, showing a range of subjects - health and safety/mandatory topics, and those more specific to the care offered by the Home (mental health and challenging behaviour, for example). One staff said the training they had undertaken had been useful. And confirmed they had had formal supervision or an appraisal with senior staff. The induction and foundation programme does not yet met Skills for Care (previously ‘TOPSS’) specifications.
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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) 31, 33, 35, 37 & 38 The Home benefits from the management style of the Registered Manager, John Bayliss. Good systems are in place to include residents in the running of the Home. Sharing action plans based on results of care surveys would show further how the Home is run in residents’ best interests. Their personal finances, rights and best interests are protected by the Home’s record-keeping, policies and procedures. There are satisfactory systems to ensure good working practices to promote the safety and health of residents and staff. These systems would be even more robust if advice was sought from relevant authorities about managing cross-infection risks in the absence of sluice facilities, health risks from low beds are assessed, and checks on window restrictors were recorded, to evidence all is being done to protect residents’ wellbeing. EVIDENCE: Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 18 Since the last inspection, the Registered Manager has undertaken a range of training relating to the care the Home offers, besides already holding the registered Managers Award (including NVQ4 in Care). There was positive feedback from residents, visitors and staff regarding his approach in the management of the Home. A Quality assurance survey had recently been carried out by the Home, with 15 responses returned to the Home. An action plan was not included with results, though Mr Bayliss said the cook had taken steps to address one of the findings. There hasn’t been a recent residents’ meeting due to poor health of the chairperson (a resident), but feedback from residents and staff was that Mr Bayliss was available to them, and he acted to deal with issues raised with him. Minutes from the last meeting showed a wide range of subjects was discussed. Staff evidenced resident-centred thinking in their conversations with the inspectors. Records and receipts seen for residents’ personal monies were well kept, and balances held matched the records. Staff are not appointees currently for any resident, this role being undertaken by residents’ relatives or other representative. All records requested were available, and well kept. One staff felt information relating to moving and handling of new residents might be shared better with care staff when residents first moved in. Two staff commented on the lowness of some beds and consequent difficulties for staff caring for people in bed. Fire safety checks had been recorded at recommended intervals. The Home has no sluice facilities; advice has not yet been sought from relevant authorities about systems for managing cross-infection in such circumstances. Staff confirmed there were always sufficient supplies of disposable protective clothing (gloves, aprons, etc.). New water tanks are being installed to minimise risks of Legionella. The pre-inspection questionnaire indicated that maintenance checks are up-todate. The Manager confirmed window restrictors on upper floors are checked regularly. These checks are not recorded at present. Radiators all now have protective covers to eliminate risk of burns. Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 19 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x 3 3 3 x STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 2 x 3 x 3 2 Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 20 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 9 Regulation 13(2) Requirement You must make arrangements to ensure that all prescribed medicines are stored securely, including creams and lotions. Timescale for action 31 08 05 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 9 30 Good Practice Recommendations It is recommended that the competence of staff administering medicines be reviewed regularly. You should ensure the staff training & development programme meets Skills for Care (previously ‘TOPSS’) specifications for induction and foundation training, including the experiences & particular needs of the service user group. You should include an action plan with the findings of Quality of care reports. You should 1) seek advice from relevant authorities about managing cross-infection risks in the absence of sluice facilities, including for the occurence of an infectious illness; 2) assess health risks to staff from low beds; 3) record checks on window restrictors, to promote & protect the health & safety of residents & staff. 3. 4. 33 38 Parkland House D54 D06_s55233_parklandhouse_v222850_150705 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX 4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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