Care Home: Park Hall Resource Centre

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• Springfield House
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What the care home does well Park Hall continues to provide spacious accessible accommodation with parts of it decorated to a good standard and which provides a homely feel. A relative commented " the environment is gradually improving with some new flooring and pictures they have changed the layout of the furniture to create a more domestic unit done a brilliant job". A bedroom was described as "comfortable and clean". The home has a very busy environment, as it provides external day care services to the community and has a high turnover of admission and discharges due to the nature and number of short term care placement it provides. The home continues to also provide a service to a wide range of resident`s needs, which the home is able to meet. A sample of comments about residents experiences included "I am happy with my care" "I do like staying here I feel very safe" and "happy and enjoy living here". A health care professional fedback "what the home does best is care of the elderly in a supportive way". The home continues to works closely with the Intermediate care team to ensure that residents referred for Promoting Independence Programme (PIP) receive the support they need, in order that they complete the rehabilitation programme and are able to return to independent living. Many individuals have been enabled to return to their independent lifestyle, which is to be commended. A resident who returned home following this programme spoke positively about the care and support they had received from the home`s staff and the specialist rehabilitation team, which encouraged them to remain as independent as possible. The health needs of residents are well met with evidence of regular input from a range of health care professionals. A resident said "if I an not well they call the Dr pretty quickly". Personal support continues to be offered in ways, which promotes and protect resident`s privacy and dignity. A relative fedback "they take the time to ensure her personal appearance is good". The practices of the home helps to ensure that residents are treated as individuals and generally enable residents to exercise some choices and control over their lives. Links with families and friends are highly valued and supported by the home. Resident`s lives are enriched by the excellent provision of various opportunities for occupation and stimulation. Staff make a positive contribution in residents lives as they benefit from a well trained staff team that know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. A sample of comments made about staff included "generally very good" "wonderful nothing is too much trouble" "staff very kind very pleasant and helpful most of them are very good" and "alright some are very kind". The home is openly managed in the best interests of residents by an effective competent manager, who promotes good practices and provides a clear sense of leadership and direction which then enables staff to provide good quality care. Feedback about the manager included "manager very amiable accessible" "she has really started to make improvements very supportive" and "very approachable she has made a real difference". What has improved since the last inspection? All of the previous shortfalls noted at the last inspection have now been fully addressed, which has improved residents safety through clearer guidance for staff on the administration of certain types of medication. New care planning documentation now provides staff with the guidance they need to be able to undertake consistent care based on residents individual needs. Significantly improvements have been made to the care practices, staffing arrangements and environment on the dementia care units which has resulted in an improved quality of life for residents who have dementia. A relative of a resident who has dementia commented "staff are exceptionally friendly and nice. They changed staff about a year ago and the staff now seem better suited to work with the residents on these units". Another relative said "the home is much improved of late they seem to have put in a great deal of effort in the last year and really made a positive effort". Further extensive staff training in dementia care has improved staffs understanding of good practices when caring for people who have dementia. The resource centre is now used as the main focal point of daily activities with a variety of meaningful occupations now being provided based on residents individual needs and preferences Staff members commented "more activities on the dementia units has translated into residents smiling more" and "much better as residents are not always sleeping throughout the day". Parts of the home have undergone some refurbishment which has involved the redecoration by staff of some of the communal areas and the fitting of new flooring. Pictures and orientation prompts have been developed to create a more homely pleasant environment in which to live. The manager has introduced relatives clinics to created further ways of obtaining feedback on the quality of its services and facilities. What the care home could do better: The information about the home could be more specific and in a format more accessible to residents to ensure that they are informed of the wide range of services and facilities offered and of any changes in the homes practices. Some malodours are present in parts of the home, despite good standards of cleaning and hygiene, and which relate to older flooring. Residents comfort, health and safety needs to be improved through the better provision of suitable beds and mattresses. A more robust system is needed to monitor standards of food in order to finally address recurrent feedback regarding the blandness of some meals. The language used by one staff member in their interactions with residents could be considered patronising and the manager agreed to address this immediately.Although there is a system in place to monitor medication errors this was not always being used effectively. Further work is needed to the medication to be returned practices to ensure to a clear audit trail of medication is possible at all times. Key inspection report Care homes for older people Name: Address: Park Hall Resource Centre 1 Park Hall Reigate Surrey RH2 9LH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Jewell     Date: 1 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 35 Information about the care home Name of care home: Address: Park Hall Resource Centre 1 Park Hall Reigate Surrey RH2 9LH 01737224420 01737223755 Rachel.Burns@Surreycc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): SCC Adult Social Care Name of registered manager (if applicable) Mrs Rachel Burns Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 50 The registered person may provide the following categories of service only: Care home only- (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Park Hall is located in a quiet residential area on the outskirts of Reigate. The home is registered to provide personal care and accommodation for up to fifty older people, some of whom have dementia. The home is owned and operated by Surrey County Council, who also operate a further six registered care establishments in the Surrey area. Care Homes for Older People Page 4 of 35 Over 65 0 50 50 0 2 8 1 0 2 0 0 8 Brief description of the care home The premises are purpose built and of modern design. Accommodation is arranged across five units all of which are at ground floor level. Each unit has its own placement arrangements and aims and objectives. Two units are mainly used to accommodate elderly frail residents on respite care, one unit for the Promotion of Independence Programme (PIP) and two units are for people who have various levels of dementia care needs. Each unit has its own bathroom and toilet facilities and a communal lounge and dining area. All bedrooms are for single occupancy and have a wash hand basin. There is also a large day centre which is accessed by the local community as well as the residents at the home. The home provides a variety of placement arrangements including Intermediate care, respite care, rolling short term care and long term placements. The homes literature states that it aims to provide a range of residential and day care services for vulnerable frail older people who meet the county council eligibility criteria. The provider confirmed that the fees for residential care are currently £1,620. per month, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, toiletries are additional costs. Refer to the homes literature for the actual amounts charged for any additional costs Care Homes for Older People Page 5 of 35 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: two star good 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 information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home before and after the inspection. The manager had completed an Annual Quality Assurance Assessment (AQAA) form within the date requested, which provided comprehensive information about the home that was used to inform the inspection process. The inspection was facilitated by the Rachel Burns (registered manager) and in part by the deputy manager. This is the homes second Key inspection within twelve months. The focus of the inspection was to look at the progress made towards addressing the shortfalls noted at the previous inspection and to look at the experiences of life at the home for people living there. Care Homes for Older People Page 6 of 35 The inspection consisted of being shown the communal areas, and being invited to view some residents bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff during lunch time and over the morning and afternoon periods. Ten residents, nine staff and four relatives were interviewed as part of the inspection process. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Seventeen were returned in total, nine from residents, three from staff and five from health care professionals. Their feedback is included in this report. There were thirty-eight residents living at the home at the time of the inspection. An (expert by experience) accompanied the inspector for three hours as part of the inspection process. An (expert by experience) is a person who, because of their shared experience of using care services, supports the inspector to look at the quality of the outcomes for the people who use the service. They did this by focusing on specific outcomes for residents including activities and occupation, privacy and dignity and the environment. They obtained this information by observation, discussion with residents, staff and a tour of the premises. Their outcomes are included in this report. Care Homes for Older People Page 7 of 35 What the care home does well: Park Hall continues to provide spacious accessible accommodation with parts of it decorated to a good standard and which provides a homely feel. A relative commented the environment is gradually improving with some new flooring and pictures they have changed the layout of the furniture to create a more domestic unit done a brilliant job. A bedroom was described as comfortable and clean. The home has a very busy environment, as it provides external day care services to the community and has a high turnover of admission and discharges due to the nature and number of short term care placement it provides. The home continues to also provide a service to a wide range of residents needs, which the home is able to meet. A sample of comments about residents experiences included I am happy with my care I do like staying here I feel very safe and happy and enjoy living here. A health care professional fedback what the home does best is care of the elderly in a supportive way. The home continues to works closely with the Intermediate care team to ensure that residents referred for Promoting Independence Programme (PIP) receive the support they need, in order that they complete the rehabilitation programme and are able to return to independent living. Many individuals have been enabled to return to their independent lifestyle, which is to be commended. A resident who returned home following this programme spoke positively about the care and support they had received from the homes staff and the specialist rehabilitation team, which encouraged them to remain as independent as possible. The health needs of residents are well met with evidence of regular input from a range of health care professionals. A resident said if I an not well they call the Dr pretty quickly. Personal support continues to be offered in ways, which promotes and protect residents privacy and dignity. A relative fedback they take the time to ensure her personal appearance is good. The practices of the home helps to ensure that residents are treated as individuals and generally enable residents to exercise some choices and control over their lives. Links with families and friends are highly valued and supported by the home. Residents lives are enriched by the excellent provision of various opportunities for occupation and stimulation. Staff make a positive contribution in residents lives as they benefit from a well trained staff team that know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. A sample of comments made about staff included generally very good wonderful nothing is too much trouble staff very kind very pleasant and helpful most of them are very good and alright some are very kind. The home is openly managed in the best interests of residents by an effective competent manager, who promotes good practices and provides a clear sense of Care Homes for Older People Page 8 of 35 leadership and direction which then enables staff to provide good quality care. Feedback about the manager included manager very amiable accessible she has really started to make improvements very supportive and very approachable she has made a real difference. What has improved since the last inspection? What they could do better: The information about the home could be more specific and in a format more accessible to residents to ensure that they are informed of the wide range of services and facilities offered and of any changes in the homes practices. Some malodours are present in parts of the home, despite good standards of cleaning and hygiene, and which relate to older flooring. Residents comfort, health and safety needs to be improved through the better provision of suitable beds and mattresses. A more robust system is needed to monitor standards of food in order to finally address recurrent feedback regarding the blandness of some meals. The language used by one staff member in their interactions with residents could be considered patronising and the manager agreed to address this immediately. Care Homes for Older People Page 9 of 35 Although there is a system in place to monitor medication errors this was not always being used effectively. Further work is needed to the medication to be returned practices to ensure to a clear audit trail of medication is possible at all times. 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 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 10 of 35 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 11 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides both prospective and existing residents, with a range of information about the home and what to expect when living there, this does need minor additions to help ensure residents have all the information they need to make informed choices. The way in which prospective residents are assessed ensures that the home admits only those residents whos needs it can meet. The home continues to provide a range of placements types to a wide range of residents needs which the home demonstrates that it is able to meet. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home. These documents are made Care Homes for Older People Page 12 of 35 Evidence: available at the home in a client information pack and given to prospective residents, representatives and other interested parties. These documents were largely generic and did not fully reflect the wide range of local services and good practises provided at the home. This would help to inform prospective residents of what to expect when living there and could be presented in a more accessible format. The manager agreed to review these documents. In response to feedback received from a resident, the manager agreed to update the homes literature to provide details of the homes policy of not now providing a television in short term care bedrooms. This is in light of the changes to the TV licensing guidance. The manager confirmed that all residents are provided with a service user agreement which is used with residents and their families to make explicit the placement arrangements and their rights and responsibilities while residing at the home. A signed copy of the contract is usually retained in residents files. Pre admission documentation was viewed for recent admissions and it is evident that these documents are used effectively to ensure the home is able to meet the needs of prospective residents. The manager or senior staff undertake assessments of prospective residents needs. Where possible copies of social care needs assessments were also obtained from the placement authority. This helped to ensure that a comprehensive picture of needs is established. As part of the assessment process the home also speaks to health care professionals and others who know and understand the perspective resident to help inform their assessment. The manager spoke of having to decline referrals where the assessment highlighted that the home was unable to safely meet a persons needs. In the case of Promoting Independence Programme (PIP) needs assessments are undertaken by the PIP team of rehabilitation nurses who determine who is admitted onto this programme. However the home works closely with the PIP team and it was clear that they had an understanding of the range of needs the home was able to manage. . The home provides a range of placements, this includes the PIP programme which is provided over a course of approx six weeks, rolling short term care and some long term placements. There also continues to be a wide range of residents needs accommodated, this includes residents who require minimum support and residents who have complex dementia and physical needs. The home balances well this range of needs, through the use of specialised units where residents of similar level of needs are accommodated. Significant improvement has been made on the dementia care units to ensure that the Care Homes for Older People Page 13 of 35 Evidence: needs of residents who have dementia are now being met, through changes to the environment, staffing and occupation. A relative said the home is much improved of late they seem to have put in a great deal of effort in the last year and really made a positive effort. A staff member said Dementia units have changed feels more like a home more active and they seem to really enjoy mixing with other residents and staff. With the exception of one resident all persons consulted spoke positively about their experiences at the home. A sample of their comments included I am happy with my care I do like staying here I feel very safe and happy and enjoy living here. A health care professional fedback what the home does best is care of the elderly in a supportive way. A resident who was in receipt of short term care placement spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. However in most cases due to the emergency nature or admission onto the PIP programme residents did not have the opportunity to visit due to practical reasons. The home continues to works closely with the Intermediate care team to ensure that residents referred for PIP receive the support they need, in order that they complete the rehabilitation programme and are able to return to independent living. Many individuals have been enabled to return to their independent lifestyle, which is to be commended. The manager and local authority were aware that the placement of one resident was unsuitable to continue to live at the home and this person is unhappy to remain there. Further positive steps must now be undertaken to find a more appropriate place for this individual. The home has a very busy environment, as it also provides external day care services and has a high turnover of admission and discharges due to the short term nature of the majority of placements. A health care professional fedback that what the home does well is to make new residents feel very welcome. Staff continue to show a clear understanding of the aims and objectives of the PIP programme and spoke of the training they receive and the equipment provided to enable them to provide the appropriate support and rehabilitation to residents. A resident who returned home following this programme spoke positively about the care and support they had received from the homes staff and the specialist rehabilitation team, which encouraged them to remain as independent as possible. A health care professional fedback good working relationship with promoting Independence team Care Homes for Older People Page 14 of 35 Evidence: which facilities individuals return to the community. Care Homes for Older People Page 15 of 35 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. Much improvement has been undertaken to the care planning process which now ensures that staff have the guidance they need to be able to meet the individual needs of residents in a consistent way. Residents receive a good standard of health care support from a range of health care professionals. Medication practices are generally well managed, however a more robust system for monitoring medication errors and medication in need of return to ensure that all medication is accounted for. Personal support continues to be offered in ways, which promotes and protect residents privacy and dignity. Evidence: In line with the previous requirement improvements have been made to the care planning process which includes identifying the range of residents needs and their individual preferences for occupation. Five care plans were looked at, which are now more relevant to the type of placement a resident is admitted for and person centred. Care Homes for Older People Page 16 of 35 Evidence: Care plans now provide staff with clearer guidance on how to meet residents individual needs. The standard of daily recording was noted to be good with an account of actions and events that had occurred. A system for regularly reviewing care plans demonstrated that changes in the assessed needs and preferences of residents was highlighted on the care plan. The risks faced and posed by residents are assessed and any actions needed to reduce or manage risks are recorded. It was identified that the risk assessments for residents in receipt of rolling short term care should be reviewed upon each admission. This is to ensure that any changes in risks since their previous stay are identified and the appropriate measures put in place to manager or reduce the risk. The manager agreed to ensure that this was undertaken. The home works closely with health care professionals including physiotherapist and occupational therapists, GPs, district and specialist nurses, chiropodists, opticians and dentists to ensure residents receive the necessary health care intervention. Health and social care professionals consulted all felt that the home responded appropriately to the health and welfare needs of residents, consulting with them regularly. Prompt action is sought if medical advice or intervention is needed with a resident saying if I an not well they call the Dr pretty quickly. Few residents accommodated are assessed as safe to administer their own medication. The medicine administration practice observed was seen to be generally safe and the records demonstrated that systems have been established to ensure staff are appropriately trained. In line with the previous shortfall good practices were now noted in the management of As prescribed medication which provided staff with guidance on when they should be administered. It is recommended that a more robust system be undertaken for managing and recording medication which is to be returned to the pharmacy. This is to ensure that at all times a clear audit trail of medication is possible to reduce any risk of misappropriation. Several gaps in Medication Administration Records (MAR) were noted and it was not clear what had been undertaken to establish the reason for these gaps. The manager reported that there is an errors monitoring system in place and agreed to look into why this had not been triggered in these instances. During the inspection staff were generally seen to be respectful and considerate to residents and visitors. However some language used by staff in their interactions with residents could be considered patronising and the manager agreed to address this immediately. It had already been identified that a more dignified way of protecting Care Homes for Older People Page 17 of 35 Evidence: residents clothing during meals could be employed rather than the use of bids, and were awaiting the delivery of a different style of protective clothing. Staff consulted with showed an understanding of good practices in preserving residents rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practices. Residents were observed to be dressed in well laundered clothing and residents enjoyed the regular input from the visiting hairdresser. A relative fedback they take the time to ensure her personal appearance is good. Care Homes for Older People Page 18 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practices of the home helps to ensure that residents are treated as individuals and generally enable residents to exercise some choices and control over their lives. Links with families and friends are highly valued and supported by the home. Residents lives are enriched by the excellent provision of various opportunities for occupation and stimulation. Although meals are varied with choices provided variable feedback was received regarding the quality and flavour of meals and a more robust monitoring system needed to monitor standards of food. Evidence: Consistent feedback was received regarding the improved provision of meaningful occupation with employment of two activity coordinators. Their role is to develop, implement and co ordinate a flexible activities programme based on the needs and preferences of residents and resource centre visitors. Staff spoke of how residents are now actively encouraged and supported to attend the daily activities in the resource centre and the positive impact that this has had for many residents. Staff commented much better as residents are not always sleeping throughout the day and more Care Homes for Older People Page 19 of 35 Evidence: activities on the dementia units has translated into residents smiling more. Residents spoke of undertaking a variety of activities including craft sessions, musical entertainers, games and reminiscence sessions. A residents said they help to keep us occupied very well. A resident was proud of their gardening skills and raised beds enabled them to manage their own planting. Another resident spoke of their enjoyment of participating in the recent harvest festival held with local school children. A relative spoke of recently attending a fate at the home and how the staff positively encouraged their relative to join in the activities that their relative is known to enjoy. Outings were also being undertaken enabling residents to visit local venues. On the day of the inspection the resource centre was very busy with a variety of small groups and one to one activities being undertaken. Many positive signs of engagement were observed between staff and residents. Computing equipment including internet access has recently been installed to enable residents, in particular those who plan to return to home, to do their shopping on line and make Dr appointments. All relatives consulted continue to comment upon how welcomed they are made to feel when they visit, this included being offered beverages or meals and staff being friendly and approachable. Relatives spoke of attending individual meetings with the manager to gain their feedback on the quality of the services and facilities and to identify any areas of individual concern. Relatives spoke of being invited to coffee mornings at the home, where they had a chance to meet up with other relatives and residents. Links with the local community are good and support and enrich residents social opportunities. Residents spoke of being able to go out for example to the hairdressers and taxies would be arranged. Observation of the daily routines and discussion with residents and staff confirm that staff accommodate residents personal wishes with regard to meal times, going to bed, rising and bathing. Although there were no menus with pictures available, to help some residents make choices, a visual communication book has been introduced. This includes pictures of different types of food and meals. There was also a similar book with more general daily living pictures to help residents exercise some choice. The main meal time was observed on several units, this showed that some residents individual preferences were respected, for example additional vegetables or larger portions. Residents were provided with modified knives and forks if needed and were being assisted sensitively, discretely and encouraged to eat independently. Care Homes for Older People Page 20 of 35 Evidence: Variable feedback was received regarding the quality of meals with positive comments including food very good and good variation nice and hot and I am vegetarian and they always give me an alternative. Four residents independently described the food as bland with one resident commenting we have curry without the curry powder. This was fedback to the manager who had previously identified this issue through their own food surveys and had previously undertaken steps to address this. The manager agreed to re-address this issue more robustly in order to improve the quality of meals. Two other residents comments about the food included adequate and patchy. Although staff commented that hot drinks and snacks are available at any time day and night, not all residents were aware of this. Care Homes for Older People Page 21 of 35 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. There is an effective complaints system with evidence that residents and relatives feel that their views would be listened to. Staff have the guidance and training necessary to show them what to do if abuse is suspected. Evidence: There continues to be an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. All residents and relatives consulted with felt able to share any concerns they had with management ad staff and that where they have done so their concerns have been addressed promptly and satisfactorily. The manager reported that there is currently one complaint which was made directly to social services and the details of which were not know to them. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with have received formal training in safeguarding adults and prevention of abuse and showed a good understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Older People Page 22 of 35 Evidence: The home is very proactive in ensuring that appropriate safeguarding referrals are made if they have any concerns regarding residents wellbeing. No safeguarding referrals have resulted in recommendations being required to improve practices at the home. Care Homes for Older People Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the environment has been significantly improved through redecoration and re flooring which has helped to create a homely pleasant environment in which to live. However despite current good cleaning and hygiene practices there was some unpleasant malodours in parts of the building and residents comfort and health and safety needs to improve through the provision of suitable beds and mattresses. Evidence: Park Hall is located in a residential road on the outskirts of Reigate. Local facilities are a short journey away. The premises are split into five distinct units each with their own dining lounge areas and kitchen. Some gradual refurbishment of some of the units has been undertaken since the previous inspection. This has involved the redecoration of some of the communal areas by staff, the fitting of new flooring on some units and the development of memory boxes or personalised door pictures to aid orientation. These changes have helped to create a more homely environment in these units. A relative commented the environment is gradually improving with some new flooring and pictures they have changed the layout of the furniture to create a more domestic unit done a brilliant job. While this refurbishment is being undertaken there has been some temporary movement of residents around the building while units are closed. Feedback received was that this has been managed well with minimum disruption to residents. Care Homes for Older People Page 24 of 35 Evidence: Communal space is spacious and accessible and includes a large centrally located resources centre in which the units are then located fro. This configuration makes it very accessible to those living at Park Hall to join in the resource centre activities. There are also small quiet areas throughout and a hairdressing room. There are small patio areas attached to each unit and a larger patio with raised flower beds leading out from the day unit. The whole complex has large windows, is light and easy to move around. Bedrooms were similar in size and each had a washbasin, residents consulted with said that their private space was satisfactory and that they were encouraged to bring any small items into the home to make it more personalised. A relative described the bedroom as comfortable and clean. Consistent feedback was received by residents about the poor standard of beds and mattress which were described as lumpy and uncomfortable. Three staff confirmed that they regularly receive negative comments about the uncomfortable and used state of many beds and mattresses. The home has been required to now address this. A resident who was staying at the home on a short term care placement was frustrated that there was no TV in their bedroom and had requested one several times. However due to changes in TV licensing laws means that the home does not now provide TVs in short term care bedrooms. The manager agreed to update the homes literature with this information in order to inform residents of the changes in services provided. There was a range of individual aids and adaptations to assist residents mobility and independence, including raised toilet seats, walking aids, hoists, ramps and grab rails. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. Residents who said that they have used it confirmed that staff responded as quickly as they could. There is sufficient number of toilets and assisted bathrooms located around the home. However one resident said that they were unable to bath since being at the home, due to the style of assisted baths. The home had recently installed an assisted shower to enable them to bath. All areas inspected were observed to be cleaned to a good standard, with residents confirming that their bedrooms are always kept clean. However there was some malodorous odours in the entrance, some bedrooms and communal areas. Residents, relatives and staff consistently felt that this was due to the age of the carpets in these locations. There were currently no plans to address these areas in the refurbishment. Staff confirmed that they have undertaken training in infection control and were Care Homes for Older People Page 25 of 35 Evidence: observed to be working in ways that minimised the risk of infection through the use of protective clothing. Care Homes for Older People Page 26 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff make a positive contribution in residents lives as they benefit from a well trained staff team that know them and who are robustly recruited and employed in sufficient numbers as is necessary to meet their needs. Evidence: There has been changes in the staffing arrangements on the dementia care units in order to address the shortfalls noted at the last inspection. This has involved an increase in staffing levels, more extensive dementia care training and only permanent staff now work on these units. The practices observed on these units showed that staff had a good understanding of dementia care and the individual needs of residents. Residents displayed many signs of positive body language including smiling, touching and laughing when interacting with staff on these units. A relative of a resident who has dementia commented staff are exceptionally friendly and nice. They changed staff about a year ago and the staff now seem better suited to work with the residents on these units. Staff, relatives and residents felt that there was usually sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed. A sample of comments made about staff included generally very good wonderful nothing is too much trouble staff very kind very pleasant and Care Homes for Older People Page 27 of 35 Evidence: helpful most of them are very good and alright some are very kind. One career was particularly singled out by several residents and relatives for their supportive patient nature and understanding of the needs of older people, which was fedback to the manager. Staff spoke of the reduction in the use of agency staff which has helped to improve continuity of care for some residents. The manager confirmed that the use of agency still has to remain as a large number of temporary posts require covering but where possible the same agency staff are used. An incident was observed which highlighted that a good standard of support is provided to agency staff by experienced senior staff. This involved agency staff being unable to deal with a situation who called the deputy manager who then effectively managed the incident. The personal files of three staff were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. This helps to ensure that only staff who are suitable to work with vulnerable people are employed. The home has been proactive in ensuring that the majority of staff have completed a National Vocational Qualification in care. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with older people. Staff consulted with confirmed that they have undertaken all of the areas of mandatory training needed for them to work safely with residents. Specialist training undertaken included death, dying and bereavement and a four day intensive dementia care course. A member of staff spoke of how useful she found the dementia care training and how it had improved her own care practices. New staff undertake the industry recommended minimum inductions standards. This is designed to help ensure that all new staff entering into the care industry have a minimum level of initial training. Care Homes for Older People Page 28 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is openly managed in the best interests of residents by an effective competent manager who has made significant improvements to practices at the home by promoting good practices and providing a clear sense of leadership and direction which enables staff to provide good quality care. The home regularly reviews aspects of its performance through an excellent program of self review and feedback which shows that views are both sought and acted upon. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: Since the previous inspection the manager has now become registered with the Commission. They reported that they have undertaken all the recommended management qualifications and undertake regular training to keep up to date with changes in good practices and legislation. They demonstrated an excellent Care Homes for Older People Page 29 of 35 Evidence: understanding of the running of a care home for older people and have been instrumental in the significant improvements made at the home since the previous inspection. Feedback about the manager included manager very amiable accessible she has really started to make improvements very supportive and very approachable has made a real difference. There are many mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. This includes annual fedback surveys, yearly placement reviews, internal audits, relative clinics and regular meetings with direct residents and staff. It was evident that there is a good standard of communication between the manager, staff and stakeholders with residents consistently saying that they could tell the manager of anything they wanted to improve. A staff member commented about staff meetings you can say what you like and they do tend to listen if they can. Changes to the homes practices, staffing roles and menus has been undertaken in response to various types of feedback received. The area manager undertakes the providers required monthly audit of the services and facilities and completes a comprehensive written report on their visit. This helps the provider to monitor practices at the home. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or other responsible persons external to the home. Small amounts of monies are held on behalf of some residents, for daily living expenses, which is managed by the administrative staff and audited by an external person. Care staff spoke of receiving appraisals, formal supervision and direct supervision through working alongside the senior staff and the deputy manager and felt well supported to undertake their role. Written guidance is available on issues related to health and safety. Records submitted by the home prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. The cook reported that all recommendations made from the last visit by Environmental Health have been addressed. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment had been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. Care Homes for Older People Page 30 of 35 Evidence: Care Homes for Older People Page 31 of 35 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 32 of 35 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 1 24 16 That service users bedrooms 11/12/2009 are provided with suitable beds which includes appropriate mattresses. To ensure the comfort and health and safety of service users. 2 26 16 That robust procedures are put into place to ensure the effective management and eradication of offensive odours throughout the home, in order to provide a pleasant dignified environment in which to live To ensure a pleasant dignified environment in which to live work and visit. 11/01/2010 Care Homes for Older People Page 33 of 35 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 That medication to be returned to the pharmacist is recorded at the point of it being placed into the returns box, to ensure a clear audit trail of medication and to reduce the risk of any misappropriation. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - 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. 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