Care Home: Park Lodge

What the care home does well Residents requesting respite care at the home have had a full assessment of their care needs prior to their admission to the home. New care plans have been developed by the acting manager; these are a good record of the care needs and care provided for residents. Meal provision at the home is good and individual dietary needs are catered for. Improvements have been made to communal and private accommodation currently in use by residents and staff. These areas are comfortable and clean. Staff from the other care home involved are currently covering the staff rota at Park Lodge. These staff have been recruited safely and have had the training needed to equip them with the skills to carry out their role effectively. The home is being well managed and improvements to various systems have been made by the acting manager, including the initial assessment of care needs, care planning and the administration of medication. What has improved since the last inspection? This is the first inspection of the home since it was purchased by the current registered provider. What the care home could do better: There are no records to indicate that existing residents had a thorough needs assessment prior to their admission to the home, although the current staff group have undertaken an assessment of needs in retrospect. Staff employed by the current registered provider have not been recruited in a safe way and have not had induction or training to equip them to carry out their role effectively and safely. Some records required by regulation are not held, for example, there is no complaints log in place and there was no accident book in place until one was introduced by the acting manager. Staff that have the responsibility for the administration of medication have not received appropriate training; this is needed to ensure that they can carry out this task safely and failure to do so could place residents at risk of harm. The prospective owners have put temporary arrangements in place to protect residents from the risk of harm. The registered person has not informed the Commission for Social Care Inspection of the current management arrangements of the home, as required by regulation. Health and safety arrangements at the home are not robust. For example, the stair lift is not safe to use, there is no gas safety certificate in place and thereis no evidence that bath and mobility hoists have been serviced. This places residents and staff at risk of harm. CARE HOMES FOR OLDER PEOPLE Park Lodge 1 Park Row Hornsea East Yorkshire HU18 1PT Lead Inspector Diane Wilkinson Key Unannounced Inspection 30th September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park Lodge Address 1 Park Row Hornsea East Yorkshire HU18 1PT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01252 678699 Mr Ben Futhee Care Home 11 Category(ies) of Dementia (11) registration, with number of places Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia - Code DE, maximum number of places 11 2. The maximum number of service users who can be accommodated is: 11 First inspection Date of last inspection Brief Description of the Service: Park Lodge is a privately owned care home that is registered to care for and accommodate eleven older people with dementia related conditions. It is a situated close to the sea front in the seaside town of Hornsea, in the East Riding of Yorkshire. Private accommodation is provided in a dining/living room and communal accommodation is provided in a variety of shared and single rooms; none have en-suite facilities. There is a courtyard and garden to the rear of the premises but access to this area is limited. The home is close to the town centre and local amenities are easily accessible for residents. Some bedrooms have a sea view and others look out over the nearby park. On-street parking is available close to the home. Information about the home is provided in a Statement of Purpose and a Service User’s Guide; these inform residents and others about the scope and nature of the care and facilities on offer. The home is in the process of being purchased by the registered providers of a nearby care home and the registered providers of both homes have recently reached a legal agreement that the prospective registered providers will manage Park Lodge on a temporary basis. There are currently only three permanent residents accommodated at the home and care staff employed by the prospective providers at the nearby care home are covering the staff rota. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the current owner became the registered provider on the 3rd April 2008, including information gathered during a site visit to the home on the 30th September 2008. The site visit was undertaken by one inspector over one day; it began at 10.00 am and ended at 2.50 pm. We telephoned the registered manager who is currently overseeing management arrangements at the home on the previous day, as we wanted them to be present at Park Lodge some time during the day of the site visit. On the day of the site visit the inspector spoke on a one to one basis with a resident and a member of care staff as well as the providers of the care home that are in the process of purchasing the home and their registered manager. Following the day of the site visit, we spoke to relatives of the current residents and a social care professional. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The current registered provider did not submit information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Comments from relatives and others were positive; a social care professional told us, ‘The relative I spoke to at a review said that things were marvellous and she just hoped that more people would come in now’ and relatives told us that the food at the home has improved greatly and that the current staff group have a good rapport with the residents. Other anonymised comments are included throughout the report. At the end of this site visit, feedback on our findings was given to the registered providers that are in the process of purchasing the home and their registered manager, including requirements and recommendations that would be made in the key inspection report. What the service does well: Residents requesting respite care at the home have had a full assessment of their care needs prior to their admission to the home. New care plans have been developed by the acting manager; these are a good record of the care needs and care provided for residents. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 6 Meal provision at the home is good and individual dietary needs are catered for. Improvements have been made to communal and private accommodation currently in use by residents and staff. These areas are comfortable and clean. Staff from the other care home involved are currently covering the staff rota at Park Lodge. These staff have been recruited safely and have had the training needed to equip them with the skills to carry out their role effectively. The home is being well managed and improvements to various systems have been made by the acting manager, including the initial assessment of care needs, care planning and the administration of medication. What has improved since the last inspection? What they could do better: There are no records to indicate that existing residents had a thorough needs assessment prior to their admission to the home, although the current staff group have undertaken an assessment of needs in retrospect. Staff employed by the current registered provider have not been recruited in a safe way and have not had induction or training to equip them to carry out their role effectively and safely. Some records required by regulation are not held, for example, there is no complaints log in place and there was no accident book in place until one was introduced by the acting manager. Staff that have the responsibility for the administration of medication have not received appropriate training; this is needed to ensure that they can carry out this task safely and failure to do so could place residents at risk of harm. The prospective owners have put temporary arrangements in place to protect residents from the risk of harm. The registered person has not informed the Commission for Social Care Inspection of the current management arrangements of the home, as required by regulation. Health and safety arrangements at the home are not robust. For example, the stair lift is not safe to use, there is no gas safety certificate in place and there Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 7 is no evidence that bath and mobility hoists have been serviced. This places residents and staff at risk of harm. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 was not assessed, as there is no intermediate care provision at the home. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are now assessed prior to their admission to the home and only admitted if it is considered that their assessed needs can be met. EVIDENCE: There are currently three permanent residents living at the home. We examined their care records and found that there was no care needs assessment in place. However, the current staff group have completed care needs assessments for these people in retrospect. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 10 Since the temporary registered persons have been in place someone has been admitted to the home for respite care. The acting manager has completed a full needs assessment in respect of this person, and a community care assessment and care plan have been obtained from Care Management. This was a comprehensive document and was been used by the home, in conjunction with their care needs assessment, as a care plan. The acting manager was advised that they should develop their own care plan for people having respite care at the home as well as those that are living in the home permanently. Although a new person has been admitted to the home for respite care, the prospective registered providers told us that they are not willing to take referrals for permanent admissions until the future of the home is certain; they feel that this would be unfair to any prospective or new residents. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health care needs are met in a way that respects their privacy and dignity, including the administration of medication. EVIDENCE: We examined the care plans for the three people that live at the home. These have recently been rewritten by the acting manager and are a thorough record of a person’s strengths and needs, and the assistance that each individual needs to be able to live their life to as full a life as possible. In addition to this, care plans include a record of the care that has been provided to each person throughout the day. There are various risk assessments in place, including a continence/pressure care assessment and monitoring form, a physical health assessment, a mental health assessment and a personal risk assessment; the latter includes information on the risk of falls and any assistance needed with bathing. We observed that daily records are detailed and include information Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 12 on food and fluid intake, assistance with personal care tasks, any activities undertaken and the person’s ‘mood’ that day. On the day of the site visit a care plan review had been organised by Social Services; the resident, their relative, a staff member and a Social Services reviewing officer were present. There is a weight chart in each person’s care plan and we noted that all residents had been weighed the previous month; in future months this will assist staff to monitor a person’s well being. We observed that pressure care and continence care equipment is provided as necessary. Very specific information is recorded for one person on the need for staff to use ‘barrier nursing’ due to the risk of cross infection and we observed good hygiene practices being used by staff on the day of the site visit. Any visits by health care professionals are recorded – this includes the reason for the visit and the outcome. There are appropriate policies and procedures in place on the administration of medication, although the prospective providers intend to introduce new policies and procedures (as per those used at their current home) when they are registered with the CSCI. Medication records include a photograph of the resident concerned and a record of their current prescribed medication; this includes any changes as a result of GP visits, current illnesses etc. Medication administration records were examined and we noted that there were no gaps in recording. We did recommend, however, that any written medication administration records or any entries added to medication administration records should be signed by two members of staff to ensure accuracy. Medication is stored in two cabinets that are fixed to the wall just outside the manager’s office. These are specially designed medication cabinets that lock securely. One of these has another cabinet fixed to the inside for the storage of controlled drugs. The acting manager informed us that the prospective providers intend to have these enclosed within a cupboard as soon as they are registered so that they are not visible to residents and others; this would increase safety and security. None of the current residents have been prescribed controlled drugs but the acting manager was able to tell us about the specific storage and recording requirements for these should residents be prescribed them in the future. The staff that are employed by Park Lodge have not had any medications training. In view of this, staff from the other home are working at Park Lodge on a temporary basis. The acting manager and senior staff have undertaken medications training and the remaining care worker has had in-house training from the acting manager (who has observed this person undertaking the administration of medication and has deemed that they are competent) and has been booked on to a medication training course. Although staff should have medications training before they start to administer medication, the Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 13 prospective providers have taken appropriate precautions to protect residents from the risk of harm. There should be a sample signature in place for staff that are responsible for the administration of medication so that records can be checked for authenticity. All residents are currently accommodated in single rooms so they are able to see visitors in private. There is currently only one communal area that serves as both a lounge and dining room. The prospective providers intend to refurbish the premises and this would include the creation of additional seating space; this would provide another area where people can sit quietly or meet with family and friends privately. One resident has recently had a lock fitted to their bedroom door as they expressed concerns about other residents going into their bedroom uninvited – we saw that they had been given a key. We observed that staff knock on doors before entering and speak to people sensitively regarding personal care issues. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported to take part in their chosen activities, to live their chosen lifestyle and to remain in touch with family and friends. Meal provision at the home is good. EVIDENCE: Care plans include a person’s life history and personal profile; some of these are currently quite brief as the current staff group are just getting to know individual residents and their families; this information was not recorded on the care plans previously in place. Each care plan includes a visitor’s log and every visitor or person who makes contact with the resident is recorded, including family/friends and health and social care professionals. Entries include information such as, ‘district nurse visited – foot much better’, ‘brother and niece visited and took x out’ and ‘daughter visited’. There is an activities book in place and this records regular activities, both one to one activities and those that some or all residents have participated in. This evidences that residents go out into the town, to the local Freeport shopping outlet, listen to Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 15 ‘Golden Oldies’, play cards and have a monthly church service. One person has been encouraged to attend an activity afternoon at the care home operated by the new staff group and we were told that they thoroughly enjoyed this new opportunity. Key workers complete a ‘key worker and client time’ log – this records all of the one to one time a key worker spends with a resident; we noted that entries are almost daily. Time spent with residents includes nail care, chatting and shopping trips. Staff told us that they are able to spend more time with residents, as there are usually two staff on duty to support three or four residents. We observed that visitors are made welcome at the home and the people we contacted following the site visit told us they were kept informed of events regarding their relative. One resident expressed concern about their financial affairs and we were told that an appointment had been made for them to see their bank manager, and that the acting manager had arranged to accompany this resident to offer them support. Although the prospective providers have appropriate information about advocacy services, this should be made available in the home so that it can be accessed independently by residents and others. There is a menu on display and this evidences that there is a variety of meals on offer and that there is always a choice of meal at teatime. We discussed the lunchtime menu with the acting manager and acknowledged that there is currently no need to offer a true choice of meal at lunchtime, as there are only three or four residents living at the home. We were told that some of the residents have dislikes and that they are provided with an alternative meal whenever these foods are on the menu. One of the residents requires a diabetic diet and staff have ensured that there is always plenty of choice available so that this person’s dietary needs can be met. We observed the preparation of lunch and were told that the home now uses fresh meat and vegetables on a daily basis. People told us that the meals are much improved; a social care professional told us that they were told by a relative at a review that, ‘the food is now excellent’ and a relative told us that they were pleased that their parent was now getting fresh fruit on a regular basis. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The prospective providers have taken action to strengthen the complaints and safeguarding policies, procedures and practices at the home. These need to be more robust to fully protect residents from the risk of harm. EVIDENCE: There is a complaints procedure in place and this is displayed on the notice board in the entrance hall. The prospective providers told us that an updated complaints procedure would be included in the new Statement of Purpose and Service User’s Guide when they become the registered persons. There is currently no complaints log in place so it is not possible to check whether any complaints have been made to the current registered provider. No complaints from residents, relatives or others have been made to the CSCI since the current registered provider took over the home. Relatives told us that they would speak to the acting manager if they had any concerns and that their experience so far was that any queries were responded to promptly. There is a complaints book in place at the home – the most recent entry was in September 2006; this book was used by staff to complain or express concern about other staff so it serves a different purpose to a complaints log that is Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 17 available to residents and others. It is not clear if residents and others have been supported to use the complaints procedure. A ‘comments and requests’ book has been introduced by the acting manager – this records such things as ‘x asked for some chocolate and we gave her some’, ‘x asked if we would ring her GP – done’ and ‘x said that she found her meal enjoyable’. There is a policy on abuse at Park Lodge and staff employed by Park Lodge have been given a copy of a whistle blowing policy and a Code of Conduct by the prospective providers. One of these care workers has undertaken training on safeguarding adults whilst working at another care home; this information was seen in their recruitment file. We believe that the other two care workers have had no training on this topic, but as there is no training and development plan or other training record in place, it is not possible to verify this. The staff that are employed by the other care home have had training on safeguarding adults and they are currently covering the staff rota at the home, so the prospective providers have put safety measures in place to protect the residents from the risk of harm. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The areas of the home currently used by residents are comfortable and clean; some equipment is unsafe and has been taken out of use by the prospective providers. EVIDENCE: There is a maintenance plan in place that has been introduced by the acting manager; this includes details of the day to day maintenance undertaken by the handyman, such as renewing old light bulbs with energy saving ones, lawn and garden care and minor repairs. The prospective registered providers told us that they intend to make extensive alterations to the home, but until they become the owners of the property they have made some low cost improvements, for example, carpets have been cleaned and furniture has been Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 19 moved around and repaired by their own handyman so that the current residents have the best available furniture in their bedrooms. The home was warm and comfortable on the day of the site visit. The living/dining room, kitchen, bathroom and toilet facilities and bedrooms currently in use were clean, pleasantly decorated and free from unpleasant odours. However, some areas of the home that are currently not in use had unpleasant odours and furniture that was in need of repair. The acting manager noted that the stair lift in use by the home had been declared unfit for use some time previously, but continued to be in use. She disconnected the electricity supply to prevent it from being used again. The only residents currently accommodated on the first floor are able to use the stairs with little difficulty and have chosen to remain in their upstairs accommodation. There is a shower room on the ground floor but most residents have chosen to have a bath rather than a shower. They are currently being assisted up the stairs by staff so that they can have a bath. The laundry facilities are adequate and the washing machine has a sluicing facility. However, the laundry room is only accessible via the manager’s office, which could lead to poor infection control and inconvenience if a private meeting was taking place in the office. Apart from this, we observed good hygiene practices being used by staff on the day of the site visit and noted that protective clothing and disinfectant gel is readily available. The general layout of the home is poor and restricts access to certain areas of the home and garden; the prospective registered providers are going to take advice from the CSCI regional registration team about the implications of making alterations to the premises. The kitchen has recently been refurbished and although small, includes all of the necessary equipment and is kept clean and hygienic by staff. The kitchen is no longer used as a thoroughfare to access other areas of the home. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is currently being staffed by appropriately trained workers who have the skills and experience to carry out their role. Staff appointed by the current registered provider have not been recruited in a safe way but they have been temporarily replaced by staff from the other home that have been recruited in accordance with robust policies and procedures; this offers residents protection from harm. EVIDENCE: There is no staff rota in place at Park Lodge as the staff are currently being provided by the other care home; staff told us that the rota is being covered by a regular group of staff so that the residents get used to the new members of staff. A member of staff from the other care home is preparing meals for residents and the handyman is providing day-to-day maintenance work. There are two staff available at most times of the day, with only one member of staff being on duty from 5.00 to 10.00 pm – there is someone ‘on call’ from the other nearby care home should assistance be required; the prospective registered providers were asked to undertake a risk assessment to evidence that this cover is adequate. There is one member of staff on duty overnight, Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 21 with an additional carer ‘sleeping in’. There is a bedroom available for the staff member who is on call during the night. We looked at the recruitment records for the three staff employed by the current registered provider. There was a completed application form for all three employees but none of the records included a start date, a Protection of Vulnerable Adults (POVA) first check or a Criminal Records Bureau (CRB) check. We also found no evidence of any references being obtained from former employers for two of these care workers, and only one reference for the other one. The prospective registered persons recognised that these lapses in recruitment procedure left the residents at risk of harm and, as an interim measure, arranged for the staff from Park Lodge to work under supervision at their own care home and for staff from their care home to work at Park Lodge; all of these staff have appropriate recruitment checks in place. The prospective registered persons have sent the current registered provider all of the information needed to apply for CRB checks and they have been told that this has been actioned. There is no training and development plan in place and the only training information held for staff is what was provided by them when they completed their application form. There is evidence that the three staff employed by Park Lodge have had no training since they were employed at the home, although one care worker had undertaken various training courses at their previous place of employment, i.e. pressure care, the protection of vulnerable adults from abuse, food hygiene and diabetes awareness. This same member of staff has achieved NVQ Level 2 in Care but there is no information about NVQ training held for the other two staff members. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is currently being well managed and monies held on behalf of residents are held securely. Health and safety systems are not robust and the systems in place to enable people to influence the way in which the home is managed are not being used. EVIDENCE: The home is currently being managed by the registered manager of the other care home, who has the skills and experience to run the home. There is evidence that a number of improvements have been introduced by the acting manager, such as the development of new care plans, the assessment of Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 23 prospective residents, the cleaning regime at the home, meal provision and the deployment of staff from the other care home. Relatives told us that the new staff group are pleasant and polite and that there is a good rapport between the manager, staff, residents and visitors. One relative said that residents seemed to be afraid of some of the previous members of staff and that residents now seem to be less agitated and spend more time together as a group. There are quality assurance systems in place at the home but there is little evidence of how these have been used. A resident survey was undertaken in October 2007 and the responses have been collated. We saw that a survey had taken place with relatives and visitors but this information was not dated and had not been collated. There are policies and procedures in place but some of these have not been updated for some time; the prospective registered persons told us that they would review all policies and procedures to bring them in line with their own policies and procedures as soon as the purchase of the home goes ahead. There is evidence that staff meetings and resident meetings have been held but because records are not dated, it is not possible to see how often these have taken place and when the most recent meetings were held. The acting manager has introduced a system to record monies held on behalf of residents. This was checked at the time of the site visit and we found that monies held and associated records were accurate, and that money is held securely. There are environmental risk assessments in place for health and safety areas such as fire doors, bathrooms and toilets, lighting, laundry and the kitchen. An annual fire alarm test was undertaken on 28/4/08 and in-house fire tests are taking place consistently. There is also evidence that staff currently working at the home have regular fire safety training. As previously recorded, the stair lift was tested on 18/8/08 and was ‘condemned’ by the contractors. There is evidence that the home had been told this previously but had taken no action. There is no evidence that the bath hoist and mobility hoist have been serviced recently. The mobility hoist does not currently need to be used to assist residents with moving and handling but the bath hoist is used on occasions. No evidence that the gas safety systems have been serviced in the last year could be found on the day of the site visit; this places residents at risk of harm. The current registered provider is required to provide us with evidence that these safety checks have been carried out on receipt of this report. The water temperature in bathrooms and at other outlets accessible to residents are tested on a weekly basis by the handyman – these were seen to be consistently between 39 - 40°C. There was no accident book in place at the Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 24 home but the prospective registered persons have obtained one and it is now in use. Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement All prospective/new residents must have a full needs assessment prior to their admission to the home to ensure that their individual care needs can be met. Staff must have appropriate training on the administration of medication before they have responsibility for this task. This is to ensure that residents receive their medication safely. There must be a system in place to record any complaints made to the home, including details of the complaint, the investigation and the outcome. This is to evidence that the home’s complaints procedure is being followed. Timescale for action 30/09/08 2. OP9 13(2) 30/09/08 3. OP16 22(8) 31/10/08 4. OP19 13 (5) 23 Residents must be able to access 31/10/08 all areas of the property in a safe way, including the bathroom on the first floor and the rear courtyard. Equipment in place to facilitate this must be maintained DS0000071524.V372684.R01.S.doc Version 5.2 Page 27 Park Lodge in good working order to protect residents from the risk of harm. 5. OP29 19 There must be a recruitment policy in place that is robustly adhered to. The home must obtain two written references and a satisfactory POVA first check or CRB check prior to staff commencing work at the home. This is needed to ensure that only people who are considered safe to work with vulnerable people are employed. Staff at the home must receive training to ensure that they have the skills to carry out their role. This includes moving and handling, infection control, safeguarding adults, first aid and health and safety. This information should be recorded on a training and development plan. 30/09/08 6. OP30 18 30/11/08 7. OP31 8 The registered provider must 30/10/08 inform the CSCI of the current arrangements in place for the management of the home, as previously requested in our letter of 5.9.08. There must be evidence that health and safety checks are taking place. The registered provider must provide us with evidence on receipt of this report that there is a gas safety certificate in place and that the mobility hoist and bath hoist have been serviced in accordance with the manufacturer’s instructions. 30/10/08 8. OP38 13/16 Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations People having respite care at the home should have a care plan in place that has been developed by the home to ensure that all staff are aware of a person’s care needs. The medication cabinets should be relocated or be located within a cupboard so that they are not visible to residents and others; this would increase their security and safety. Any handwritten additions to medication administration records should be signed by two members of staff to ensure accuracy. Information about available advocacy services should be displayed in the home so that people can access these without asking for advice; this increases privacy and independence. Residents and others should be made aware of the complaints procedure and should be supported to use it. Staff should receive training on safeguarding adults from all types of abuse to ensure that they are aware of good practice and are able to recognise any bad practice. The layout of the home should be improved so that it meets the individual and collective needs of residents. For example, residents’ bedrooms should be private and should not be used as a thoroughfare. The laundry room should be relocated or there should be a different access route, to reduce the risk of cross infection. There should be a staff rota in place that records the role of each member of staff on duty, and to evidence that the home is appropriately staffed. There should be a risk assessment in place to evidence that the prospective registered persons have considered the safety of current staffing levels. DS0000071524.V372684.R01.S.doc Version 5.2 Page 29 2. OP9 3. OP9 4. OP14 5. 6. OP16 OP18 7. OP19 8. 9. OP26 OP27 10. OP27 Park Lodge 11. OP28 There should be a plan in place to ensure that staff are suitably qualified, including the achievement of National Vocational Qualifications. The date that someone starts to work at the home should be recorded to enable recruitment records to be checked thoroughly. The quality assurance systems in place should be operational so that residents and others are able to influence the way in which the home is operated. 12. OP29 13. OP33 Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Park Lodge DS0000071524.V372684.R01.S.doc Version 5.2 Page 31 - 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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