CARE HOMES FOR OLDER PEOPLE
Parkview Lodge 2 Park Avenue Bedford Bedfordshire MK40 2JY Lead Inspector
Katrina Derbyshire Unannounced Inspection 11th August 2006 11:45 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 Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 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. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Parkview Lodge Address 2 Park Avenue Bedford Bedfordshire MK40 2JY 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) 01234 219620 gaetano.tramunto@btinternet.com Mr Gaetano Tramunto Mrs Antonietta Tramunto Mr Gaetano Tramunto Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Learning registration, with number disability over 65 years of age (14), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (14), Old age, not falling within any other category (14), Physical disability over 65 years of age (14) Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th February 2006 Brief Description of the Service: Park View Lodge was originally registered in 1986 to provide care for people over 65 years of age. The home caters predominantly for Italian speaking older people. The home is located in a pleasant residential area of North Bedford, opposite Bedford Park and within walking distance of small local shops, pubs and places of worship. The building has been converted from a three storey Victorian House and provides communal living space on the ground floor and bedrooms are provided across all three floors. A passenger lift has been installed to access the varying levels in the home. Parking is available at the rear of the home this is located next to a smallenclosed garden that maybe accessed by the residents from the living/dinning area. The fees for this home are £425.86 per week. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit was carried out on 11th August 2006. The manager Mr. Tramunto was present throughout the inspection. During the inspection all areas of the home were visited and the inspector spent time with many of the residents’ in the sitting area of the home. The care of two residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. Information from the home was provided and included documents relating to meals, staff training and activities to assist in assessing the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit, feedback from residents and the homes submission of documentation. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
The home continues to be good at how it orders and manages medication on behalf of the residents. They are organised in the way they order so there is always a stock of medication for each resident that has been prescribed. The medication is also stored correctly making it safer for the residents and the records that the home keeps are of a good standard, to show when a medicine has been given. The standard of cleanliness at the home is also good. The two sitting areas and residents own rooms are kept clean, tidy and there are no unpleasant odours in the home. Staff also make sure that any waste is disposed of safely and this makes sure that the levels of hygiene in the home are to a level that makes it safer for the residents. Safety in the home is also to a good standard. The environmental health department described the kitchen as having very good standards of cleanliness and food hygiene in place. The home also makes sure that contractors visit on a regular basis to make sure that all the equipment is maintained for example fire systems, this makes the home a safer place to live in for the residents. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
The manager at the home still needs to start a course on managing a care home; we made a requirement about this in 2005. This course is about understanding management and care to a level that is needed by anyone who runs a care home. The manager must now look at undertaking more training to help him understand how to improve the way that care is delivered at the home to make it better for the residents. The way staff are trained when they start working at this home also needs to improve. There are national standards that all staff working in a home must follow this is important as it makes sure that they have the basic information needed to look after the residents. This home does not use them and the manager is not aware of them or the reasons why they were introduced, this means new staff will not have an adequate level of knowledge on how to care for the residents at this home. The way the home writes about the individual needs of each resident is called a care plan. The care plans need to be clearer in the guidance they give to staff on exactly how they should be supporting the residents to meet their needs. This is very important and has to be in place so that all residents receive continuity of care. The care plans at this home had started to improve when we visited earlier in the year but changes have been made and now it is not clear what the needs of the residents are and the action to be taken to ensure they receive all the care that they need. Another area that must change at this home is when they recruit new staff. All homes must carryout a number of checks on the people applying for jobs, they must do this to protect the residents from harm by ensuring the homes have sufficient information to know if they will be suitable to work with vulnerable people. The home had allowed a member of staff to start working before they had received any written references therefore allowing them to work with the residents before they had checked that they had a suitable working history and this placed the residents at risk. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 7 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. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 EVIDENCE: Assessments were seen within the care records of the residents, the information and format in use was noted to be at least over 2 years old having been recorded at the time of the residents admission. An assessment of this area was not possible as all assessments seen were inconsistent as they reflected the tool in use at the time of each resident’s admission. The home however is reminded that for all future admissions to the home a comprehensive assessment must be undertaken that makes clear all the assessed needs of the resident, so that an informed decision can be made as to whether the home is able to meet their needs. This home does not provide intermediate care. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The standard of care planning at this home is insufficient to ensure that all information required by staff is in place, to ensure all assessed needs of residents are met EVIDENCE: Care plans examined were of a mixed standard. One plan seen was clear in its guidance and instructions to staff and was of an adequate standard. However one residents’ plan did not make clear how staff should care for a resident who had recently been diagnosed with a medical condition it was not clear on the care that they would need to provide and placed this resident at serious risk. Recent changes made to the care documentation had resulted in inconsistent recording, care plans made statements for example ‘unable to walk’ but did not give instructions on the care that would needed to be provided to meet those needs. In addition the format in use was photocopies of the Primary Care Trust documentation and this practice must cease. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 11 Within the care records risk assessments were in place in relation to pressure area care, moving and handling, nutrition and dependency. These assessments had not been reviewed monthly this is needed to ensure the nutritional needs of the residents are being met and this was discussed with the manager at the time of this visit and a requirement is made. It was observed sufficient equipment was present in the home to maintain pressure area care for the residents. Care records contained documentary evidence to support that access to external healthcare professionals, for example chiropody, dentist, General Practitioner and optician took place. Medication records contained information relating to prescribed medications past and present. Entries on these documents matched the homes medication administration records and medication stocks for the residents. The drug fridge was kept locked, and appropriate checks made on the temperature but these must be recorded. Residents through discussion confirmed that they felt that staff treated them in an acceptable manner. Staff were also seen to knock on doors and wait for consent to be given prior to entering. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems and support to residents in maintaining personal relationships is good, and enhances the resident’s standard of life. EVIDENCE: Information within the homes statement of purpose still describes the services available at the home as ‘specialising in care for the Italian community’. The home was noted to provide a diet that reflected the cultural tastes of the resident’s and television in the home shows Italian-speaking channels. Several residents confirmed that the home arranged for them to continue to practice their chosen faith, through arranging for representatives of the local church to visit. However no care plans were in place to outline the individual social emotional or cultural needs of the residents and this must be addressed by the home. Visiting times at the home are set, information on visiting arrangements is provided prior to a decision on any admission to the home. Residents are able to receive visitors within their bedrooms or in the lounge areas. This information is made available to all prospective residents and their families prior to admission to the home. Information relating to the residents families
Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 13 and friends were seen within the care records and staff confirmed that this was used to support the residents in maintaining their own personal relationships. Meals at the home continue to reflect the cultural tastes of the resident’s and the lunch served at the time of the inspection-included protein, carbohydrates and vegetables. Residents said that the meals at the home were acceptable in their standard and they felt that they had a sufficient amount. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems in place for the management of complaints are sufficient for residents to feel that their concerns are listened to and acted upon by the home. EVIDENCE: The homes policy for the protection of vulnerable adults was examined, the policy was comprehensive and included how any incident of abuse should be reported. Staff training records also showed that they had attended workshops on this area and they were able to describe the varying types of abuse, which included physical and financial. However one staff member had not yet attended this training and had worked at the home for almost a year, a requirement has been made in this area. The homes complaints procedure gave sufficient guidance to staff on the action that they should take on receiving a complaint. The procedure described the rights of residents and that all complaints must be responded to. Within the homes statement of purpose a summary of how to complain had been included for residents and their relatives. Written records were seen on complaints that had been received, the investigation undertaken and the response by the home. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 15 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The standard of cleanliness in this home is of a very good standard and provides a pleasant environment for the residents to live in. EVIDENCE: The premise is a converted three-storey house. Accommodation available to residents is across two floors at this time. The furnishings, fittings and décor in these areas are of an acceptable standard. All residents who were seen commented that the environment was pleasant and felt that the home catered well for their needs in this area. The rear garden area provides spaces to sit out in the warmer months. Individual rooms contained personal items of the resident to assist in creating a homely atmosphere. All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain
Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 16 activities. Cleaning schedules were in place and clinical waste was disposed of in an appropriate manner and clinical waste contracts are in place. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Systems in place for the recruitment of staff are not sufficient to protect residents and places them at risk. EVIDENCE: Staff files were examined all were noted to contain application forms, evidence of identification and Criminal Records Bureau checks. However the most recently employed staff member had commenced their employment prior to the home receiving any references. This places the residents at risk and a requirement has been made relating to this. Staff training records were also examined and showed that staff had attended a variety of courses and workshops including health and safety, food hygiene and management of medication. However the induction of new staff does not follow the national occupational standards in this area and through discussion it was confirmed the manager was not aware of them. This is concerning as they have been in place for several years and a requirement has been made. Staffing rotas submitted by the home showed that the number and skill mix of staff were sufficient to meet the needs of the residents. Residents and staff felt that there were enough staff to care for the residents, it was reported that at
Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 18 times residents would need to wait for assistance if help was being offered to another resident but that this would normally only be for a few minutes. Staff through discussion demonstrated that they were aware of the needs of the residents as recorded within their care records and were able to describe the individual. It was observed that the interaction between the staff and residents was positive and showed that supportive relationships between them had been established. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Management at this home is not sufficient to ensure care delivery follows current best practice guidance and places the residents at risk of not receiving all the care they require and achieving positive outcomes in all aspects of their lives. EVIDENCE: The manager at this home still needs to complete a course on managing a care home; this requirement was made in 2005 for him to achieve a care and management qualification to at least NVQ level 4. The standard and format of the care documentation is not acceptable, requirements relating to these have been made over a long period yet he has not been able to demonstrate sufficient competency in resolving these matters. In addition the recruitment of a staff member prior to the receipt of any references and his limited understanding and knowledge of the national induction standards that have
Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 20 been a requirement for several years validate the need for him to undertake further training. This requirement must now be met. The home had sent out questionnaires to relatives and residents to gain their views of the standard of care at the home, those responses seen showed that this had been undertaken in 2005 and 2006. However the home now needs to use this information and show how they have used the feedback received to change and influence the running of the home. No monies are managed on behalf of the residents at this home. Documents pertaining to the management of Fire, environmental Health and internal safety checks were seen. All were up-to-date and demonstrated that required safety measures were in place to meet the relevant legislation in this area. Staff and their training records confirmed that they had been trained in a variety of Health and Safety areas including moving and handling, food hygiene and infection control. Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 21 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 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 3 Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1)(a), 15(1)(ad) Requirement Care plans must be clear in their content to instruct and guide staff in the care that they are to provide. They must be accurate and up to date. A plan must be in place for all the healthcare needs of the residents to ensure they receive the care and support that they require. Assessment and a plan of care must be undertaken to make clear the individual social and cultural needs of the residents. All staff must receive training in the protection of vulnerable adults following local and national guidance. The home must not commence the employment of staff prior to securing references. The induction of staff must meet the national occupational standards. The registered person must achieve the minimum qualification to manage a care home at NVQ 4 in Care and Management. (Previous
DS0000014946.V307664.R01.S.doc Timescale for action 15/10/06 2. OP8 12(1)(a), 15(1)(ad) 15/10/06 3. OP12 12, 13 & 15 30/10/06 4. OP18 12, 13 7 18 30/10/06 5. OP29 12(1)(a) & 19 12 & 13(4) & 18 9,18 30/09/06 6. 7. OP30 OP31 30/10/06 31/12/06 Parkview Lodge Version 5.2 Page 23 requirement timescale of 31/12/05 and 30/06/06 not met) 8. OP33 24 The home must show how the views of residents influence the running of the home, and report on and supply a copy to all residents. 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Parkview Lodge DS0000014946.V307664.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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