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Care Home: Park House, Little Knowle

  • 11 Park Lane Little Knowle Budleigh Salterton Devon EX9 6QT
  • Tel: 01395443303
  • Fax: 01395443303
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0 0 0 0Park House provides personal care for up to 27 older people who may have physical disabilities or dementia. It does not offer nursing care or intermediate care. The home is a detached property, with large garden areas, approximately half a mile from Budleigh Salterton town centre. Bedroom accommodation is on the ground and first floors, with a stair lift between floors. A comprehensive statement of purpose and Service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is made available to all potential residents before they make a decision about living at Park House. A copy of our most recent inspection report is also available. Information on current fees is available from the home. Services not included in the weekly fee are chiropody, hairdressing and newspapers.

  • Latitude: 50.631999969482
    Longitude: -3.335000038147
  • Manager: Mrs Mabel Eileen Lily Perry
  • Price p/w: ~
  • UK
  • Total Capacity: 27
  • Type: Care home only
  • Provider: Mrs Mabel Eileen Lily Perry,Mrs Suzanne Lily Mary Pilkington
  • Ownership: Private
  • Care Home ID: 11974
Residents Needs:
Dementia, Physical disability, Old age, not falling within any other category, mental health, excluding learning disability or dementia

Latest Inspection

This is the latest available inspection report for this service, carried out on 2nd June 2010. CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Park House, Little Knowle.

What the care home does well There is a homely environment and friendly atmosphere at Park House, with group activities provided that people enjoy, benefit from or which are meaningful to them. People are offered choices in their daily lives. Staff look after their belongings, and keep their bedrooms tidy. Staff ensure that people have enough to drink. They are proactive in trying to help people prone to certain health problems, to help them avoid infections, etc. Current formal staff supervision includes an annual observation of their practise. What the care home could do better: Additional information in some individuals` care plans is necessary to ensure that people`s current needs are clearly identified and there is clear guidance for staff on how they are to meet those needs, so people receive appropriate, consistent support and care.It is recommended that suitable privacy locks are provided on all bathroom and toilet doors. And there should be better systems are in place to maintain a clean, fresh environment, especially with regard to continence-related problems. This is to ensure people`s dignity is protected. Staff must assist people to move in more appropriate and safer ways, so that people are not at risk of being injured whilst being assisted and their comfort is maximised. Staff should ensure that individuals are encouraged and assisted to change position at timely intervals, to ensure their health and general comfort. The home should also ensure that cross-infection risks are minimised at the home where certain handling equipment is shared between people. All staff must know what to do if they have concerns that people are being abused or if there are signs of possible abuse, to protect people living at the home from harm or abuse. And any such action is to be in line with the local authority`s safeguarding procedures. Care staff should receive formal supervision more regularly, with this supervision covering all aspects of practise, development needs, and the philosophy of care in the home. The home`s written policies should be fit for purpose and up to date, reviewed in the light of changing legislation and advice from specialist/professional organisations. This is so as to provide staff with appropriate, clear and current guidance on good practise and the standards expected by the home. Staff rotas should be kept up to date and reflect which staff are on duty at any time, including the manager, and in what capacity they are working that shift. Random inspection report Care homes for older people Name: Address: Park House, Little Knowle 11 Park Lane Little Knowle Budleigh Salterton Devon EX9 6QT two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Rachel Fleet Date: 0 2 0 6 2 0 1 0 Information about the care home Name of care home: Address: Park House, Little Knowle 11 Park Lane Little Knowle Budleigh Salterton Devon EX9 6QT 01395443303 01395443303 perry_pilkingtonparkhouse@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mabel Eileen Lily Perry Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Mabel Eileen Lily Perry,Mrs Suzanne Lily Mary Pilkington care home 27 Number of places (if applicable): Under 65 Over 65 27 27 27 27 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 0 0 0 Park House provides personal care for up to 27 older people who may have physical disabilities or dementia. It does not offer nursing care or intermediate care. Care Homes for Older People Page 2 of 14 Brief description of the care home The home is a detached property, with large garden areas, approximately half a mile from Budleigh Salterton town centre. Bedroom accommodation is on the ground and first floors, with a stair lift between floors. A comprehensive statement of purpose and Service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is made available to all potential residents before they make a decision about living at Park House. A copy of our most recent inspection report is also available. Information on current fees is available from the home. Services not included in the weekly fee are chiropody, hairdressing and newspapers. Care Homes for Older People Page 3 of 14 What we found: This Random Inspection was carried out as a result of information we were given following a safeguarding alert, which was being dealt with through the local authoritys multi-agency safeguarding processes. As part of these processes, we made an unannounced visit to the home to find out more about how people were treated, how people were handled or moved and the equipment available for this, management of continence, aspects of medication management, how safeguarding concerns are dealt with at the home, and we looked at certain staffing arrangements. The inspection was carried out by Rachel Doyle and Rachel Fleet, Compliance Inspectors. We visited the home for 5.5 hours, on a week day. Mrs Perry (owner and manager) was in charge when we arrived at 9.15am. She and her staff assisted us fully. We met with people living at the home and their visitors, we looked at certain peoples care records, and we observed care and support that people received. We also looked at other records that helped to show us how the home was run, as well as speaking with care and ancillary staff. To get more information relating to the safeguarding concerns raised, we followed up or case-tracked people with relevant needs or problems. So we case-tracked individuals with mobility problems that required staff to move them using equipment such as hoists or assist them in other ways. We also case-tracked someone with mental health or behavioural needs, people with needs relating to continence, and someone who we noted during our visit had a bruise. There were 22 people living at the home that day, with 5 care staff looking after them (in addition to Mrs Perry) when we arrived. A 6th carer was in the role of cook for the day, although the rota still needed updating to show this. The care team were also being supported by an administrator and 3 cleaners. We were informed that no-one was ill or confined to bed, as we were able to confirm when we looked around the home. There was a calm, friendly atmosphere, with staff, although occupied throughout, taking time to engage with people. Some people in the lounge did spend some time dozing. But people who were awake were settled, they did not look distressed, and had had a shave or their hair was brushed, etc. We were told when we arrived that a musical entertainment and a foot massage session for 2-3 people were to take place later in the day. A communion service also took place in the lounge. We looked at how people were moved and handled. Although staff had all recently had manual handling training, we observed at least 4 staff to be using inappropriate ways of assisting people. This included walking backwards holding peoples hands with their arms outstretched in front of them, and pulling someone up out of a chair using their hands. One visitor told us that staff semi drag their relative to the toilet. One person was in a very low chair which seemed to make it difficult to get themselves up to their walking frame. Although they had communication difficulties, they were able Care Homes for Older People Page 4 of 14 to say that they wouldnt call staff gentle when handling them, when we asked the person about this. We observed a staff member tried to get them up from the chair, before fetching a second person, who went to get a handling belt when they still had difficulty in standing the person from their chair. Another staff member helped someone by using a standaid. They encouraged the person to stretch up to the standaid (rather than push up from the chair first), with under arm lifting used to assist them - which is not good practise. A handling belt used to get one person up from their chair slipped up their chest from their waist, resulting in awkward, unsafe assistance from staff. There were two lifting hoists, which staff reported were used a fair amount. However, we saw the layout of the home made it difficult to manoeuvre the hoist between areas. One person who was moved in the hoist was banged against a corridor door as staff tried to keep it open. Staff spoken with said the hoist was being used more and more, as peoples needs were increasing. We were told by Mrs Perry that the home cannot afford separate slings for individuals, which is a cross-infection concern. Wheelchairs we saw used to transfer people had 2 footplates but were without the seat cushions, which can be uncomfortable. Care notes for someone reflected that their ability to weight-bear varied. Risk assessments about falling had been completed for them, with relevant care planning in relation to the outcome of the assessments. Staff had taken action to try to find out why their mobility had worsened, checking for infection for example, with an improvement occurring on occasions once the person had been treated for such infections. The home generally uses appropriate pressure-relieving aids, and we were told no-one had pressure ulcers. But some people who had mobility difficulties did not change position for a period of at least 4 hours - which could put them at risk of developing pressure sores as well as causing general discomfort. Following our visit, Mrs Perry has informed us that the home has obtained training on safe handling from a different training provider to the one they previously used. We were told that 4 staff currently administered medication, and they had had training from a pharmacist or other external trainer. Mrs Perry confirmed that staff currently undertaking a care qualification (NVQ3 in Care) would be undertaking a module in medication. However, from what we were told by staff it appeared that some staff might, in the near future, be administering medication after given a booklet on medication and having been observed before they administered medication on their own, but without necessarily having had external training. Mrs Perry said she would ensure everyone had training by a pharmacist or other suitable person first. Whilst changes to peoples medications were noted in their care records, we did not see evidence of recent full medication reviews, and staff did not always link peoples medication to the effect on them for care planning purposes. For example, diuretics (water tablets) in relation to continence promotion. Staff were seen to promote privacy and dignity for people living at the home during our visit by knocking on the door before entering peoples rooms, folding peoples clothes neatly, and keeping rooms tidy. Some people had facilities so that they could lock their Care Homes for Older People Page 5 of 14 bedroom door when not in the room. We noted one bathroom being used during our visit did not have a locking device. One person, when we asked if staff were polite, indicated there were one or two that werent, but then went on to describe staff who they found particularly helpful or kind. We heard staff chatting pleasantly to people as they assisted them with personal care in their rooms, enabling them to choose their clothes for the day, with individuals responding to the conversation. Care plans included meeting personal care needs, faith needs, and social needs, for example, in an individualised way. We did not find any disrespectful language in care records. We observed a lovely rapport between staff and people living at the home, in general. People in the lounge, with staff helping them to dance or join in, were seen to enjoy a dance and a sing song with the visiting music man. The environment was homely, and bedrooms were nicely kept and personalised. Generally there were no malodours except in a few bedrooms where we identified furniture to be the source of the odour. Some people with continence problems did not have a bed or chair that was of a clean standard. We asked that a chair and a bed which was damaged, which both smelt strongly of urine, be replaced immediately. The manager agreed to do this on the same day, and she has since confirmed that this was done as agreed. We discussed that there was no system for auditing the furnishings and the condition of the room to assist the home to address problem areas. Mrs Perry and other staff reported delays in assessment processes that establish if individuals are eligible for incontinence pads through the NHS. This meant that Mrs Perry herself purchased pads for people. Staff confirmed they had access to pads although they were not necessarily NHS-provided ones. We were also told that the home had been asked to toilet some people hourly, as part of the continence assessment, which certain people objected to or were distressed by when attempted. These points have been brought to the attention of other relevant agencies since our visit. We asked someone in the lounge how they would summon staff if they needed them. They said they would use the call bell, but we saw it was on the wall difficult to reach behind a chair. They confirmed that staff popped in regularly when we asked them about this. And there was a good staff presence in the lounge for much of our visit. However, we noted there could be more focus on promotion of peoples continence. Staff spoken with said that they realised when someone was wet. But they had not considered action plans or altering planned care to promote continence - such as toileting someone more regularly than others or establishing a pattern for an individual - rather than just accepting, as a staff member told us, that they are like that, wet all the time. Staff do pay attention to preventative measures in relation to people who are prone to urine infections, which will help prevent incontinence. They assisted people to drink more, appropriately, and had urine tested for infection, ensuring for prompt treatment. We saw there was a system for providing fresh juice in peoples rooms, and people we met had fresh drinks within reach. Although one relative felt that it was a lottery as to who was offered a hot drink when people were first brought to the lounge in the morning, we heard staff offer people a choice of drinks when they served the hot drinks. Care Homes for Older People Page 6 of 14 Some people were on fluid charts, with staff recording what they were drinking. Although these were not totalled at the end of the day or had a recommended amount detailed (as would be good practise), those seen showed that the individuals were having a good amount of fluid. The home uses a Behaviour Book for some individuals, to record behaviour which staff may find challenging. Whilst these records could be useful, the manager and staff do not use them to ascertain behaviour patterns or for further action regarding entries. Therefore triggers which may be causing challenging behaviour are not being identified in care plans, and staff are not looking at what a behaviour might be communicating. This could mean that some peoples needs are not being met appropriately. For example, an entry included that when going to bed, one person did not want to go to bed or have a bath. The action recorded was Got help from another carer to give them a bath. And another entry said that the person was alright if staff talked to them to distract them. We noted there was sometimes a pattern of challenging behaviour from the person with certain staff, but this was not followed up, and tasks simply continued regardless of the presenting behaviour. There was no evidence that staff questioned why the behaviour was happening. Other entries were not always worded appropriately, such as the person was not co-operating. Some staff were aware of behaviour triggers in practise, and in one case were heard to say If they (the service user) dont want to get up now, then we can do it later. In general, staff and the manager were knowledgeable about peoples needs, and paid attention to personal details and likes and dislikes. Some people had a personal story book with their current care records, detailing their personal social history. Such information can assist with minimising individuals behaviour that may be challenging to others, or aid communication with them, to ensure that their needs are met in a more effective way. Care plans did not detail how staff are to manage individuals challenging behaviour in a person centred way. We looked at some of the guidance for staff in relation to behaviours that challenge, and about safeguarding people from harm or abuse. We noted that the homes policy on restraint made no reference to deprivation of liberty safeguards, and that the policy on aggression toward staff was very brief (offering little guidance to staff on how they should act). The Protection & prevention of abuse policy included appropriately, among other actions, degrading treatment as a form of abuse. We noted that staff were supposed to sign the homes policies to show they had read them, but not all had done so. Mrs Perry has since told us that new documentation is being put in place, which will enable better monitoring of this through supervision sessions with new staff. One person told us staff were All nice, with some ups & downs. We spoke to three staff and the manager about the process of safeguarding people, and reporting alleged abuse. All staff spoken to were able to outline what they saw as abuse - such as We dont make people do what they dont want to do - but we found this was not always related to actual practise. In relation to the management of challenging behaviour, for example. None of the staff members were aware of the need to report concerns to an outside agency, or that it is good practise to follow the Alerters Guide and not to investigate before seeking advice from the local authority safeguarding team. There was evidence in the past that some concerns had not been promptly followed Care Homes for Older People Page 7 of 14 through and reported to appropriate agencies. It was noted during our visit that someone sustained a skin tear on one occasion without further follow-up as to the cause. And there was no record of someones bruise in care notes we read relating to the month prior to our visit, and staff did not know how it occurred. Staff spoken to felt that the atmosphere in the home had improved recently, following the safeguarding alert. We spoke with 3 staff in detail and all agreed that there was a good staff morale now. All staff felt that they could talk to the manager and that it was an open door office, but evidence showed that sometimes actions could be taken more promptly to ensure that people living at the home are fully protected. The manager says that they have learnt from the incident. We looked at supervision of staff, as this is an important way that the home can ensure good practise and address poor or inappropriate practise promptly. We saw senior carers working with other staff, organising the other staff and getting feedback from them. Staff spoke about annual appraisals when we asked about formal, recorded supervision, and indicated they felt they were supervised and supported regarding their daily work. Mrs Perry has told us that staff practise is observed annually as part of formal supervision also, which is good practise. However, the National Minimum Standards for such a service recommends more frequent formal supervision than this. Concerns had been raised that some staff were working many hours, and we knew some staff had left since the safeguarding alert was made. We looked at rosters for the last month to see how the home was being staffed. We noted time spent by Mrs Perry at the home was not shown on rotas. And some staff had regularly worked in excess of the standard 48-hour week. Mrs Perry told us that some of the overseas staff have to attend college regularly, but this was not reflected on the rosters we were given. She admitted some staff have recently worked long hours, but told us she is currently recruiting to replace those who have left. Rosters showed very occasional use of agency staff. Since our visit to the home, Mrs Perry has informed us of action she has taken, or is taking, to address issues raised in this report. What the care home does well: What they could do better: Additional information in some individuals care plans is necessary to ensure that peoples current needs are clearly identified and there is clear guidance for staff on how they are to meet those needs, so people receive appropriate, consistent support and care. Care Homes for Older People Page 8 of 14 It is recommended that suitable privacy locks are provided on all bathroom and toilet doors. And there should be better systems are in place to maintain a clean, fresh environment, especially with regard to continence-related problems. This is to ensure peoples dignity is protected. Staff must assist people to move in more appropriate and safer ways, so that people are not at risk of being injured whilst being assisted and their comfort is maximised. Staff should ensure that individuals are encouraged and assisted to change position at timely intervals, to ensure their health and general comfort. The home should also ensure that cross-infection risks are minimised at the home where certain handling equipment is shared between people. All staff must know what to do if they have concerns that people are being abused or if there are signs of possible abuse, to protect people living at the home from harm or abuse. And any such action is to be in line with the local authoritys safeguarding procedures. Care staff should receive formal supervision more regularly, with this supervision covering all aspects of practise, development needs, and the philosophy of care in the home. The homes written policies should be fit for purpose and up to date, reviewed in the light of changing legislation and advice from specialist/professional organisations. This is so as to provide staff with appropriate, clear and current guidance on good practise and the standards expected by the home. Staff rotas should be kept up to date and reflect which staff are on duty at any time, including the manager, and in what capacity they are working that shift. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 14 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, 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 7 15 You must ensure that each 01/08/2010 person has a care plan that is sufficiently detailed as to include their various needs and how those health & welfare needs are to be met, particularly regarding Behaviour that may challenge staff; Continence promotion; And including their medication with regard to care planning & meeting individuals needs To ensure that there is clear person centred guidance for staff on how they are to meet peoples current needs, so people receive appropriate, consistent support and care. 2 18 13 You must make suitable 01/08/2010 arrangements, through staff training or other measures, to protect people living at the home from harm or abuse, Page 11 of 14 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 including ensuring All staff know & follow the local authoritys safeguarding procedures for reporting concerns about or actual abuse; That all injuries (including skin tears, bruising, etc.) are properly noted & the cause followed up To protect and promote individuals wellbeing & welfare. 3 26 12 You must ensure that 25/07/2010 systems are in place to maintain a clean, fresh environment, especially with regard to continence-related problems To protect the dignity of individuals living at the home. 4 38 13 You must ensure there are 25/07/2010 safe systems for moving and handling people at the home, through training, monitoring of staff practise or by other means. This includes physical assistance by staff & correct use of handling or moving equipment, with advice sought from relevant professionals (such as physiotherapists or occupational therapists) as necessary Care Homes for Older People Page 12 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 So that people are assisted to move appropriately, safely and without risk of injuries, with their comfort maximised. 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 8 Staff should ensure that individuals are encouraged and assisted to change position at timely intervals, to avoid pressure ulcers and ensure their health and general comfort. It is recommended that suitable privacy locks are provided on all bathroom and toilet doors. The home should seek advice from relevant professionals and carry out risk assessments for shared use of handling or lifting slings, to ensure that cross-infection risks are minimised at the home. Staff rotas should be kept up to date and reflect which staff are on duty at any time, including the manager, and in what capacity they are working that shift. The homes written policies should be fit for purpose and up to date, reviewed in the light of changing legislation and advice from specialist/professional organisations, so as to provide staff with appropriate, clear and current guidance on good practise and the standards expected by the home. This is particularly regarding safeguarding, mental capacity, deprivation of liberty, restraint, & aggression toward staff. Care staff should receive formal supervision 6 times a year, with this supervision covering all aspects of practise, development needs, & the philosophy of care in the home. 2 3 10 26 4 27 5 33 6 36 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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