Care Home: Parkview Lodge

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What the care home does well Residents consistently expressed a good level of satisfaction regarding the quality of care and support they received, a view shared by both visiting relatives. The comments from residents, relatives and staff have been reflected throughout the report. The assessment and admission process was good, thus ensuring that the resident`s needs could be met on admission to the home. The implementation of health and personal care needs were being monitored internally through a monthly review system, involving the resident and their family. Relationships between the staff and the residents were positive. Staff were seen to be patient, sensitive and respectful towards residents. Residents who wished to wander around were not restricted unless it was in their best interests. The meals provided at the home were of a good quality and residents liked them. An alternative was offered if something was not liked. Residents were fully involved in menu planning to reflect their tastes, preferences and cultural needs.Parkview Lodge benefited from having a small but well-established core staff team, which meant the home did not have to depend on agency staff; this had ensured consistency and continuity in the overall quality of service delivery. What has improved since the last inspection? The requirements made in the last inspection report dated 23 August 2007 have been addressed; this has resulted in an overall improved quality of service for residents. The manager maintained documentary evidence of his response to complaints to show that he has listened to and acted upon the concerns raised. The home now has an application form in place to demonstrate that any gaps in employment had been explored. The references on file were those of the most recent employer. This ensured the protection of the residents. The assistant manager has completed NVQ level 4 in care and management in July 2008. He was planning on submitting an application shortly, to become the registered manager. A ratio of 55.5% of care staff has also completed their NVQ level 2, which is quite an achievement. What the care home could do better: There are two requirements and two recommendations arising from this report, which need addressing. Recruitment files must include a recent photograph of the individual staff, as specified in schedule 2 of the regulations. This would ensure the protection of staff and residents. Fire drills must be carried out at suitable intervals; this would ensure that staff and residents are aware of the fire procedure to be followed, in case of a fire. The care plan should include the signature of the resident and their representative as appropriate; this would demonstrate their participation in the care planning process. The frequency of staff formal supervision should be increased to two monthly, at minimum. This would ensure monitoring of staff`s work performance and development needs. CARE HOMES FOR OLDER PEOPLE Parkview Lodge 2 Park Avenue Bedford Bedfordshire MK40 2JY Lead Inspector Mr Neil Fernando Unannounced Inspection 10th September 2008 11:00 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 Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkview Lodge Address 2 Park Avenue Bedford Bedfordshire MK40 2JY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 219620 gaetano.tramunto@btinternet.com Mr Gaetano Tramunto Mrs Antonietta Tramunto Mr Gaetano Tramunto Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Learning registration, with number disability over 65 years of age (14), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (14), Old age, not falling within any other category (14), Physical disability over 65 years of age (14) Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2007 Brief Description of the Service: Park View Lodge was registered in 1986 to provide care for people over 65 years of age. The home caters predominantly for people of Italian origin. The accommodation is a three storey Victorian House. It offers communal living space on the ground floor and bedrooms are provided across all three floors. Bathroom and toilet facilities are adequate for the residents accommodated. A passenger lift is available to access all floors. The home is located in a pleasant residential area of North Bedford, opposite Bedford Park. It is within walking distance of local shops, pubs and places of worship. Parking is available at the rear of the home, which is located next to a smallenclosed garden that may be accessed by the residents from the living/dinning area. A copy of the service user’s guide and last inspection report was available for residents and visitors to read. The fees for this service were £457.06 per person, per week. Parkview Lodge DS0000014946.V371760.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 2 stars. This means the people who use this service experience good quality outcomes. We, the Commission for Social Care Inspection, undertook this unannounced key inspection on 10 September 2008. We spoke with 4 residents, 2 visiting relatives, the manager and 4 staff members including the assistant manager. We spent a significant amount of time discretely observing residents and staff care practices. We had a look round the accommodation and viewed a range of records the home must keep. At the time of the visit, there were 13 residents accommodated including 2 in hospital, with 1 vacancy. The “AQAA” (Annual Quality Assurance Assessment - a document, which gives the manager the opportunity to tell us how well outcomes are being met for people living in the home) has been sent to the manager but we have not received this as yet. Any information received would be dealt with as appropriate. To date, we have received surveys from 5 residents. The manager was present throughout the inspection. What the service does well: Residents consistently expressed a good level of satisfaction regarding the quality of care and support they received, a view shared by both visiting relatives. The comments from residents, relatives and staff have been reflected throughout the report. The assessment and admission process was good, thus ensuring that the resident’s needs could be met on admission to the home. The implementation of health and personal care needs were being monitored internally through a monthly review system, involving the resident and their family. Relationships between the staff and the residents were positive. Staff were seen to be patient, sensitive and respectful towards residents. Residents who wished to wander around were not restricted unless it was in their best interests. The meals provided at the home were of a good quality and residents liked them. An alternative was offered if something was not liked. Residents were fully involved in menu planning to reflect their tastes, preferences and cultural needs. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 6 Parkview Lodge benefited from having a small but well-established core staff team, which meant the home did not have to depend on agency staff; this had ensured consistency and continuity in the overall quality of service delivery. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 8 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): Standards 1, 2, 3 and 5. Standard 6 is not applicable. Quality in this outcome area is good. Information to people who may wish to use the service is available. Full preadmission assessment is carried out, thus ensuring the identified needs of the potential resident could be satisfactorily met on admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user’s guide was both available and reflects the service provided. The information provided for prospective residents is presented in a format that is informative and helpful. The file for three residents were examined and they contained initial assessments compiled by the manager, prior to the residents moving into the Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 9 home. Other assessments completed by the referring social services were also available. Following admission, staff continued to review and make adjustments to the assessments available, as they got to know the person concerned. Risk assessments were seen on the files viewed and these had been updated. The manager said that all residents have individual contracts on file, stating the conditions of their stay and the fees payable. Evidence of this was seen in the files for all three residents. Visits to the home to assess its facilities are encouraged and one resident said that she had visited for a day before moving in, and that her son had received an ‘Information pack’ about the home. A visiting relative said that, “It is a service that meets the identified needs of my dad”. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. The care plans ensured that residents’ assessed needs were met. The residents observed during the course of the visit appeared well care for; staff treated them with dignity and respect This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for three residents were examined. The information they contained was detailed and up to date. Residents’ needs including health, personal hygiene, dressing, mobility, communication, food and religion were clearly identified and being addressed. The residents, where appropriate and their representatives should sign the care plans; this would demonstrate that they have contributed and are in agreement with the contents. Staff members spoken with demonstrated a good understanding of equality and diversity Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 11 issues relating to residents they are key workers for, in particular. The care plans were reviewed and updated at least once a month; there was evidence that where care needs had changed between reviewing dates, the plans had been updated accordingly. Risk assessments are completed and updated as and when required. All of the residents are registered with a GP. The home had a good relationship with the community nursing service who visited as necessary. Other professionals residents have access to included chiropodist, optician and dentist. The policy and procedure on medication is available and accessible to staff members. All staff had received training on medication, provided by an external trainer. Medication is stored in a locked cabinet. The medication administration records were examined for six residents and these were in order. Residents spoken with said that they received their medication on time. Privacy and dignity is a subject included in the induction programme for all staff members. Personal care was seen being given in an appropriate and respectful manner; the feedback received from residents about the standard of their care was generally positive. “I love being here, the staff are polite and smashing” said one resident. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards12, 13, 14 & 15 Quality in this outcome area is good. Residents had been supported to achieve a lifestyle that, were practical and safe to do so, which met their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information at the home continues to describe the services available as ‘specialising in care for the Italian community’. Television in the home for example shows Italian-speaking channels. Documentation examined showed that the home arranged for people to continue to practice their chosen faith, through arranging for representatives of the local church to visit; there was also evidence that showed people were fully supported to practice their chosen faith - one example was the personal religious ornaments within people’s own rooms. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 13 Records examined indicated that residents were supported to maintain contact with their families and friends. Staff members spoken with were clear that residents’ bedrooms are their own space and “staff members would normally not enter anyone’s room in their absence”. “We would always knock” before entering a resident’s bedroom”, said a member of staff. Residents were able to exercise choice and control over their lives. Some of their comments included, “I can do what I wish…. I often get up early and staff don’t mind”, “I feel I am able to come and go as I please”. There had been a satisfactory level of social and recreational activities taking place, which had been chosen by the residents. Both visiting relatives confirmed that visiting times were flexible and staff members were always welcoming. The provision for meals had been based on regular consultation with residents to take into account their cultural needs, tastes and preferences. Residents said that they were satisfied with the meals, “The food is nice and there is plenty of it”, “If you don’t like something, they will get you something else” are typical comments from residents spoken with. Menus showed that a varied and balanced diet was available to the residents. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. Policies and procedures are in place to safeguard residents from abuse. Residents and relatives are confident that their complaints will be listened to and investigated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about how to make a complaint was available in the service user’s guide. Although not all residents we spoke to were aware of the complaints procedure, most were able to identify someone in the home they could speak to if they were dissatisfied with any aspect of their care. Two visiting relatives told us that the home would respond appropriately if they had any concerns. “Any queries we have had have always been dealt with satisfactorily”, commented one. There was one complaint recorded since the last inspection in August 2007, concerning the rudeness of a staff member. The manager investigated the matter and provided a written response to the complainant within appropriate timescale. All three staff interviewed showed some knowledge of the complaints procedure but two members said that they would benefit from some training on this subject – an issue the manager was aware Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 15 of. There were no complaints received by the Commission since the last inspection. The home has a copy of the procedure on adult protection. Staff members interviewed showed an understanding of the above procedure; they have all received training on adult protection. This is a subject also included in the induction programme for all new staff members. There were no adult protection matters recorded since the last inspection in August 2007. There were a number of systems in place, which should adequately protect a resident from harm. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 16 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): Standards 19, 20, 23 and 26 Quality in this outcome area is good. The environment is safe and residents live in a comfortable surrounding. A good standard of cleanliness was evident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We undertook a brief tour of the premises. The decoration and furniture and fittings are of a good standard. Bedrooms are personalised to suit the taste and preference of the residents. The lounge and dinning room are well planned to meet the requirements of the resident group. There is adequate space for residents to sit quietly and or meet with their friends. The bathroom and toilet facilities are satisfactory. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 17 All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain activities. Cleaning schedules were in place; domestic and clinical waste was disposed of in an appropriate manner. The home was generally well maintained. There were no health hazards noted. Residents spoken with expressed a good deal of satisfaction with their physical environment. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 18 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. The numbers and skills of the staff were adequate to provide a good standard of care. The home’s recruitment and training processes ensured that residents were protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were sufficient members of care staff on duty on the day of the inspection to meet residents’ needs. Staff duty roster for a period of one month was scrutinised and discussion with staff members including the manager and assistant manager indicated that the day and night staffing levels were adequate to meet the assess needs of the residents accommodated. We looked at the recruitment files for 3 staff including a new member who had joined the team. They all contained appropriate documentation including application form, references, POVA First and CRB, bar a current photograph. The manager said that this shortfall would be addressed. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 19 Staff interviewed and their training files evidenced that regular training had taken place; this included moving and handling, fire safety, food hygiene, infection control, medication, safeguarding vulnerable adults, dementia and health and safety. There were 5 care staff members who have completed their NVQ (National Vocational Qualification) level 2 and 1 member was working towards this assessment. This gave a ratio of 55.5 of care staff with this qualification, hence the availability of experienced staff members on each shift. Feedback from 2 relatives was very positive; “My father is well looked after by a friendly, courteous and competent staff team”, reported one of them. Residents spoken with said that the staff were knowledgeable and felt confident in their abilities to meet their needs. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 20 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): Standards 31, 33, 35, 36, 37 and 38 Quality in this outcome area is good. Systems in place ensured effective management of the home. Whilst health and safety was being attended to, fire drills must be undertaken at suitable intervals so that staff and residents are aware of the procedure to be followed, in case of a fire. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner/manager continued to be responsible for the operation of the home. He was being well supported by his son - the assistant manager. The last Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 21 inspection report dated 23.08.07 indicated that his son was undertaking an NVQ level 4 in care and management, which he completed in July 2008. He was planning on submitting an application in October this year, to become the registered manager. With this in mind, the Commission would no longer require the owner/manager to achieve an NVQ 4 qualification in care and management. Staff care practices were being monitored. The annual survey to seek the views of residents, relatives and significant others was due in October this year. The manager said that the outcomes together with remedial actions, if any, would be shared with residents and participating relatives. Staff and residents spoken with praised the management of the home; they said they felt appropriately supported and could speak with the manager and assistant manager at any time. No monies were managed on behalf of residents. All records viewed were found to be in good order. Staff had received formal supervision but the frequency needed minor attention; this must be carried out on at least 6 occasions throughout the year. This would ensure monitoring of staff’s work performance and development needs. Health and safety arrangements were satisfactory. Records indicated that staff had received health and safety training. Weekly tests of break glass points had been carried out but no fire drills had occurred. Fire drills must be undertaken at suitable intervals, in order to ensure that staff and residents are aware of the fire procedure to be followed, in case of a fire. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 22 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 & sche. 2 Requirement Recruitment files must include a recent photograph of the individual staff, as specified in schedule 2 of the regulations. Fire drills must be undertaken at suitable intervals, in order to ensure that staff and residents are aware of the fire procedure to be followed, in case of a fire. Timescale for action 10/10/08 2 OP38 23 (4) (e) 15/10/08 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 OP7 Good Practice Recommendations The care plan should include the signature of the resident and their representative as appropriate; this would demonstrate their participation in the care planning process. The frequency of staff formal supervision should be DS0000014946.V371760.R01.S.doc Version 5.2 Page 24 2 OP36 Parkview Lodge increased to two monthly, at minimum. This would ensure monitoring of staff’s work performance and development needs. Parkview Lodge DS0000014946.V371760.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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