CARE HOMES FOR OLDER PEOPLE
Park View 18 - 20 Ellenborough Park South Weston Super Mare North Somerset BS23 1XN Lead Inspector
Alison Murray Unannounced 12 July 2005 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 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 View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Park View Address 18 - 20 Ellenborough Park South, Weston Super Mare, North Somerset, BS23 1XN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01934 626233 -1934 420789 Notaro Homes Ltd Mrs Sarah Jane Emin Care home with nursing 50 Category(ies) of Old age (50) registration, with number of places Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate 50 Patients aged 50 years and over requiring nursing care. 2. Staffing Notice dated 18/11/1999. 3. Manager must be a RN on Parts 1 or 12 of the NMC register. Date of last inspection 20 December, 2004 Brief Description of the Service: Park View provides nursing care for up to 50 older people. The home is an older property situated beside Ellenborough Park in Weston Super Mare. There are 44 single rooms and 3 that can be shared. Two passenger lifts ensure level access throughout the building.There is a secluded patio area to the rear of the building. Park View is approximately half a mile from the town centre, and a short walk from the sea front. The home is owned by N Notaro Homes Limited. Mr Notaro owns several other care homes in the town. They share a minibus and pool training resources for staff.Mrs Sarah Emin is the registered manager of Park View. Mrs Jill Camm is the registered manager of Park View. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a very hot day. Mrs Emin, the registered manager was on holiday. Mrs Camm, operations manager for Notaro Homes Ltd, was providing management cover. Although some care and staff records were reviewed, the main focus of the inspection was care outcomes for residents. The majority of the 5-hour inspection was spent in conversation with residents, and observing care practices. What the service does well:
There was a friendly, informal atmosphere in the home. Residents said that they received good care. They like the staff team, and feel that they are treated with respect. Staff have worked hard to build up good relationships with residents and their relatives. There was evidence that they work well with the GP and other health professionals. Residents all said how nice it was to be given unexpected treats. It was clear that the spontaneous gesture of offering ice cream cones to everyone in the home was much appreciated. It was also apparent that the ice cream and cones had been purchased before the start of the inspection! Residents and staff were keen to praise the activities organiser. They said that they enjoyed the planned programme of activities. Regular trips out in the home minibus are well supported. Over the past 2 years, Mr Notaro has significantly improved the standard of accommodation in the home. Communal and individual rooms are attractively decorated, and provide a comfortable environment for residents, staff and visitors. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 6 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.
Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 and 5. Park View does not provide intermediate care, so standard 6 does not apply. Prospective residents and their families are given good information about the services offered at Park View. Staff involve family and other health professionals in their assessment of the needs of prospective residents. EVIDENCE: A copy of the service user guide was readily available in all empty bedrooms. This was clearly written, and offered good information about the range of services offered at Park View. Since it was written, Mrs Camm, the previous manager has been promoted to the post of Operations Manager, and Mrs Emin appointed as home manager. These changes were not reflected in the Service User Guide. Relatives of a newly admitted resident said that they had visited a number of homes, before deciding on Park View. They said that Mrs Emin had asked them about their relative’s care needs, and carried out her own assessment of these. They felt that this had been communicated well to other staff. Although Mrs Emin was on holiday when their relative was admitted to the Park View, they felt that everyone was aware of his care needs. They said that all the staff had made them feel welcome.
Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 9 During the inspection, Mrs Camm arranged to carry out a pre admission assessment at a neighbouring care home. She liaised with the prospective resident’s family, social worker and the manager of the other home, to ensure that she had access to the information she required. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11 The health and personal care needs of the residents at Park View are well met, by an attentive and respectful staff team. Relatives are kept informed of changes in condition. Care and medication documentation is sound, but needs to be kept under review. EVIDENCE: Many of the current residents of Park View are very frail. Not all were able to initiate a conversation. Those who were, said that they were happy with the standard of care they received. All the residents consulted, or observed during the inspection were neatly dressed in appropriate clothing. The inspection took place on a very hot day. After lunch, a group of residents sat out on the patio. Staff were careful to ensure that umbrellas shaded them. All had easy access to drinks, and staff were observed to regularly check that they were comfortable. There was evidence of a good rapport between staff and residents. A number of residents named ‘favourite’ staff. One lady commented that she was made to feel ‘special’.
Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 11 Another lady was being nursed in bed. She said that staff were doing ‘everything they can to make sure I am comfortable’. A relative said that his mother was very unwell. He was waiting outside her room while staff changed her position, and offered her a drink. A care chart confirmed that this happened regularly. He commented that whenever he visited, his mother looked peaceful and comfortable. The staff always kept him informed about changes in her condition. A review of this resident’ s care records confirmed that the GP had been consulted regularly. Staff had sought, and then acted upon the advice of other health professionals. A total of 4 care plans were reviewed. A care plan had been written for each area of identified need. At a recent visit to the home, Mrs Camm had already identified that staff had not reviewed these every month. Since her visit in June, all the plans had been reviewed and updated. Daily reports indicated that two of the residents sampled, had wounds that required dressing. Wound care plans were kept together in a separate folder. These had been well completed, and showed that the wounds were healing. Mrs Camm agreed that it would be good practice to cross-reference these in the resident’s individual care plan. During the inspection, two of the trained nurses were ordering prescriptions for the following month’s medications. They said that they had recently taken on this role, because of the long-term sickness of another staff member. They demonstrated a good understanding of the ordering procedures. The medicine administration records were clearly written. In a number of cases, staff had not signed to confirm that the prescribed medicine had been received into the home. There were also a few gaps in signage to confirm that a prescribed medicine had been administered. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Residents are given the opportunity to take part in a good range of activities. Relatives and friends are actively encouraged to visit. The standard of food provided is good, and sufficiently flexible to be able to offer residents ‘treats’. EVIDENCE: The majority of this inspection was spent meeting with, and observing residents. It was clear that they were given the opportunity to choose how to arrange their day. One resident said that he had been out for a walk that morning, but had returned, as it was too hot. He said that he was looking forward to getting himself a drink from the water cooler near the lounge. Those residents, who were able, moved freely around the home. Staff were heard to ask less mobile residents if they would like to sit in one of the communal lounges, or in their own room. When the inspection started, a large group of residents were involved in an activity session. All were paying close attention to the activity organiser’s reading about poisonous plants! Afterwards, a number of residents and staff praised the activities organiser for her enthusiasm. She has devised a varied programme of arranged and informal activities. These are publicised in the home newsletter. Residents are also given the opportunity to go out on trips in the home’s minibus. Several people said that they were looking forward to a trip to Cheddar, planned for the following day.
Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 13 All those consulted confirmed that visitors are always made welcome. Regular visitors were greeted by name, whilst less familiar ones were escorted to the relevant resident. One resident said that she appreciated the way that staff had enabled her to keep in contact with her regular church. She found this very comforting. All the residents made positive comments about the standard of the food provided. One person said ‘its not how I used to cook, but it is very nice though’. The lunch served looked and smelt appetising. It was clear that a choice was available. The majority of more able residents chose to take this in the ground floor dining room. Staff assisted the less able residents in the first floor dining room. Both rooms were attractively decorated, with tables neatly set. Adapted cutlery and plate guards were provided where appropriate, to assist residents to eat independently. During the afternoon, staff offered all residents and their relatives an ice cream cone. A large number of people commented how much they appreciated this. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and their relatives know how to complain should the need arise, and feel comfortable that their complaint would be addressed. EVIDENCE: The home has a clear and comprehensive complaint procedure. Residents and their relatives said that they would feel comfortable about raising any concerns should the need arise. Staff keep a record of concerns and complaints made. This demonstrated that issues raised were thoroughly investigated, and the complainant informed of the outcome of this investigation. A copy of ‘No Secrets in North Somerset’ was readily accessible to staff. Those consulted showed a good awareness of adult protection issues. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 Park View offers good all round accommodation. EVIDENCE: All areas of the home were inspected. With the exception of one bathroom, the standard of housekeeping was very good. All staff demonstrated a good awareness on infection control procedures. Maintenance records confirm that the home is kept in a good standard of repair. Over recent years, Mr Notaro has invested heavily in the fabric and decoration of the home. The main work is now completed, with remaining resident bedrooms being decorated when they become available. Two passenger lifts offer easy access to all areas. The home has a good range of patient hoists and specialist equipment. The communal rooms are decorated to a high standard. The ‘Primrose Lounge’ was completed last year. This room was quite hot during the inspection. Staff had opened the doors to allow easy access to the patio area. Although understandable, this reduced the effect of the air conditioning units.
Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 16 It was clear that residents were able to personalise their rooms with pictures and small items of furniture. The maintenance person was heard to arrange a suitable time to collect furniture belonging to a new resident. All those consulted said that their bedroom was comfortable and homely. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staff recruitment procedures are robust. Staffing levels are appropriate to the needs of the current residents. EVIDENCE: A review of the duty rota, and conversations with residents confirmed that staffing levels were appropriate to the need of the current residents. One of the senior nurses is on long-term sick leave. It was clear that the other trained nurses are rising to the challenge, leading and directing staff. The records of three recently employed staff were reviewed. These contained evidence of a robust recruitment procedure. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 38 Procedures are in place to ensure that the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: All the records seen during the inspection were well maintained, and securely stored where necessary. Health and safety procedures were generally good, with evidence that routine checks, tests and drills are carried out. One hoist was observed to be in need of repair. Mrs Camm immediately took this out of action. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x 3 2 Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15.2 Requirement All care plans must be reviewed at least once a month This requirement was made at the inspection on 20/12/04. It has not been met within the agreed timescale. There must be a clear audit trail of medicines received into the home and administered to residents. Staff must ensure that satisfactory standards of hygiene are maintained in all areas of the home. The identified patient hoist must be repaired or replaced. Timescale for action 12/08/05 2. OP9 13.2 12/07/05 3. OP26 16.1 12/07/05 4. OP38 13.5 12/08/05 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. 2. Refer to Standard OP1 OP7 Good Practice Recommendations The Statement of purpose and service user guide should be amended to include Mrs Emins details, and the new address of the local CSCI office. If a resident has a wound care plan kept in a separate folder, this should be cross referenced in the main care
D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 21 Park View 3. OP25 plan. Doors and windows in the Primrose Lounge should be kept closed in hot weather, to ensure optimal working of the air conditioning units. Park View D53 - D02 S20283 Park View V237840 120705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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