CARE HOMES FOR OLDER PEOPLE
Parkview Lodge 2 Park Avenue Bedford Bedfordshire MK40 2JY Lead Inspector
Katrina Derbyshire Unannounced Inspection 10:50 23 August 2007
rd 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.V343109.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.V343109.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.V343109.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th March 2007 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 manager provided the following information on charges in August 2007. The fees for this home are £425.86 per week. Parkview Lodge DS0000014946.V343109.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 23rd August 2007. The manager Mr. Tramunto was present during the inspection. During the visit the communal areas of the home were seen alongside some of the individual accommodation. The inspector spent time with many of the people who live at the home in the back sitting area. The care of two people was examined. Information from the home had previously been provided and included documents relating to meals, staff training and activities to assist in assessing the outcomes within each standard. In addition the home has submitted an improvement plan to the Commission for Social Care Inspection. Evidence used and judgements made within the main body of the report include information from this visit, feedback from people who live at the home and the management’s submission of documentation. Observations of care practice and communication between the people living at the home 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:
Staff are good at arranging access to Doctors or other healthcare professionals, if someone needs their help and support. When someone becomes unwell for example, staff are quick to contact a Doctor and make arrangements for them to make a visit to the person. This means that people are helped to make a quicker recovery, through receiving medical advice and treatment. Medication at the home continues to be managed in a safe manner. One person has responsibility for ordering any needed prescriptions and makes sure that there is enough stock kept at the home, so people receive their prescribed medication when they should. The kitchen and other areas in the home are kept very clean. Hygiene standards in the kitchen are very good, making the preparation of food safer for the people that live in the home. Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
We said at the previous inspection that the management at the home need to keep copies of the responses that they give to people when they have raised a complaint. They had not done this. Two complaints had been received since that time and only verbal feedback had been given to the complainant. They must show that the person that has raised the concern has been satisfied with the action, and response taken by the home. We also had concerns when we last inspected about the checks carried out when new staff were employed. Someone had started work at the home, but there was no application form in their file and the references in place were not from their most recent employer. This did not safeguard people living at the home, as these checks are made to make sure people are suitable to work at the home. We couldn’t check at this inspection if the manager had changed his practice as no one else had been employed since March 2007, so the requirement that we made will remain.
Parkview Lodge DS0000014946.V343109.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. The summary of this inspection report can be made available in other formats on request. Parkview Lodge DS0000014946.V343109.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.V343109.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use 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. Pre admission information is sufficient to ensure staff have an understanding of the persons needs so that they can plan appropriately on how they will meet them. EVIDENCE: Assessments examined within individual care records showed information had been gathered prior to the person’s admission into the home. The documents seen gave information using both a tick format and summary. The past medical history of the person was detailed alongside information on their preferences and specific needs relating to the physical and emotional support needed. A summary document was also in place that described the background of the person and what they had done in their lives and included information
Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 10 on those people who were important to them. The funding authority had also supplied an assessment of the persons needs and this was kept in the care file. Intermediate care is not offered at this home. Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use 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. Staff are good at supporting people to access health care support so that their health needs are met. EVIDENCE: The manager as reported at the previous inspection, had obtained a specific format earlier in the year for recording information relating to the needs of the people living at the home. Care plans for the two people whose care was case tracked, were noted to be of a good standard. One person who had recently moved into the home had plans in place for each of their assessed needs. Information within them were detailed, providing staff with very clear guidance on how the person should be supported. Examples included the time in which the person liked to get up in the morning to the type of coffee that they had with their breakfast each day.
Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 12 It was observed sufficient equipment was present in the home to maintain pressure area care for the people living there. Care records contained documentary evidence to support that access to external healthcare professionals, for example chiropody, dentist, General Practitioner and optician took place. District nursing notes were also kept at the home and demonstrated that daily visits took place when required. Observation at this visit showed that staff did engage in conversation with the people living there. Their approach at this time was respectful to the person and they were seen to explain what they were doing when providing assistance. Visitors were also seen at this visit, they confirmed that they were satisfied with the level of care at this time. Medication systems in the home continued to be managed by the one nominated person. Records were in order and staff responsible for the administration records had all received training in this area. Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use 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. The meals provided at the home continue to meet the cultural preferences of the people living there. EVIDENCE: Information at the home continues to describe the services available as ‘specialising in care for the Italian community’. Television in the home for example shows Italian-speaking channels. Documentation examined confirmed that the home arranged for people to continue to practice their chosen faith, through arranging for representatives of the local church to visit, there was also evidence throughout the home that showed people were fully supported to practice their chosen faith, one example was the personal religious ornaments within people’s own rooms. Visiting times at the home continued to be set, information on visiting arrangements is provided prior to a decision on any admission to the home. However the management of the home may still wish to reconsider this as
Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 14 there are other areas in the home visitors could wait in, whilst their relative was having their meal. People are able to receive visitors within their bedrooms or in the lounge areas. This information is made available to all prospective people and their families prior to admission to the home. Meals continue to reflect the cultural tastes of the people at the home and the lunch served at the time of the inspection-included protein, carbohydrates and vegetables. Menus showed that a varied and balanced diet including all the main food groups was on offer. Feedback from people living at the home said that the meals at the home were acceptable and they felt that they had a sufficient amount. Information seen within a activity folder showed that activities did take place. Examples included going to the Local Park, exercise and board games. Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Improvements are needed in the way the home responds to complaints to ensure people and their families feel that their concerns are listened to and acted upon. EVIDENCE: The manager had attended a training day in May 2007 with the contracts and compliance team for Bedfordshire County Council. 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 showed that they had attended workshops on this area and they were aware of the varying types of abuse, which included physical and financial. The homes complaints procedure as previously reported gave sufficient guidance to staff on the action that they should take on receiving a complaint. The procedure described the rights of people and that all complaints must be responded to. Written records were seen on complaints that had been received and the investigation undertaken, two had been made since the previous inspection. A requirement was made at the previous inspection that a record
Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 16 must be made on the response given, this had not been carried out. Entries showed that only verbal feedback had been given, this did not follow the policy of the home. This requirement must now be met without exception. Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use 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. The standard of cleanliness in the home is of a good standard and provides a pleasant environment for the people to live in. EVIDENCE: The premise is a converted three-storey house. Accommodation available is across the three floors at this time. The furnishings, fittings and décor in these areas is of an acceptable standard. The assessment of these standards was noted to be as stated at the previous inspection. People living at the home and relatives commented that the environment was pleasant and felt that the home catered sufficiently for their needs in this area. The rear garden area provides space to sit out in the warmer months. Individual rooms contained
Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 18 personal items of the person to assist in creating a homely atmosphere. The flooring in the home is mainly tiled. All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain 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.V343109.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Systems in place for the recruitment of staff are not sufficient to protect people and places them at risk. EVIDENCE: At the inspection in August 2006 a requirement was made for all staff to have two references in place prior to their commencement at the home. At the inspection in March 2007 files examined were seen to contain two. However it was noted that the most recently employed member of staff did not have an application form in place. Therefore it was not possible to evidence if the references in place were those entered on their application or to show if the home had investigated any gaps in their employment history. This is unsafe and a requirement was made. No staff had been employed since that time so it was not possible to check if this had been met and will be carried forward until the next visit. Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 20 Training information examined that was supplied by the home show that staff had undertaken statutory training, including moving and handling, fire safety and food hygiene. In addition staff confirmed that they had attended a variety of courses including training in abuse. People living at the home who were spoken with felt that the staff had a satisfactory level of knowledge and felt confident in their abilities to meet their needs. Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The manager provides an encouraging and supportive style of leadership to staff so they feel valued in their work. EVIDENCE: The manager had made a submission of an improvement plan to the Commission for Social Care Inspection earlier in the year. We reported in March 2007 that his son was undertaking an NVQ level 4 and was planning on submitting an application to become the Registered Manager later in the year. There has been an outstanding requirement for the manager to complete a
Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 22 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. It is acknowledged that the managers son would have completed this course by the time of this visit, however due to changes made by the training company beyond his control this would not be completed until the end of September 2007. This person had also started to make contributions to changes in the home for example the care planning improvements. The manager had sent out questionnaires to relatives and people who live at the home to gain their views of the standard of care. 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 people living at the 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.V343109.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 24 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 OP31 Regulation 9,18 Requirement The registered person must achieve the minimum qualification to manage a care home at NVQ 4 in Care and Management. (Previous requirement timescale of 31/12/05, 30/06/06, 31/12/06 and 30/06/07 not met) The home must have an application form in place to demonstrate that any gaps in employment have been explored and the references on file are those of the most recent employer, to protect the residents. (Previous requirement not assessed at this inspection) The manager must maintain evidence of his response to complaints to show that he has listened to and acted upon the concerns raised. He must also demonstrate that he acts upon any similar themes that emerge. (Previous requirement timescale of 31/05/07 not met).
DS0000014946.V343109.R01.S.doc Timescale for action 30/11/07 2. OP29 12(1)(a) & 19 30/09/07 5. OP16 12, 13 7 18 31/10/07 Parkview Lodge Version 5.2 Page 25 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. Refer to Standard OP13 Good Practice Recommendations A review of visiting times should be undertaken to stop the restrictions that are in place. Parkview Lodge DS0000014946.V343109.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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