CARE HOMES FOR OLDER PEOPLE
Parc Vro Mawgan In Meneage Helston Cornwall TR12 6AY Lead Inspector
Ian Wright Unannounced 12 July 2005 10.30 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. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Parc Vro Address Mawgan In Meneage Helston Cornwall TR12 6AY 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) 01326 221275 01326 221275 Mrs Alison Stevenson Care Home 15 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (15) Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to Service users to include up to Service users to include up to Total number of service users 15 adults of old age (OP) 3 adults over 65 with dementia (DE(E)) 3 adults over 65 with a mental illness (MD(E)) not to exceed a maximum of 15 An Unannounced Inspection was completed on 25th November 2004 Brief Description of the Service: Parc Vro is a care home for up to 15 fifteen older people some of who may have dementia or other mental health difficulties. The home is situated in a rural location outside the village of Mawgan, near Helston. The registered provider is Mrs A. Stevenson. The home also provides day care for up to five people during week days. The home is wheelchair accessible, and has a lift to the first floor. The home has gardens which are accessible to service users. There is suitable parking for staff, service users and visitors. Date of last inspection Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over seven and a quarter hours. The inspection was carried out on an unannounced basis. The inspection focused on previous statutory requirements. Standards not inspected at the last inspection were also assessed. The inspector was able to speak to the majority of service users, and the staff members on duty. The inspector examined the medication system, care records, and inspected the building. What the service does well: What has improved since the last inspection?
Parc Vro provides a very positive environment for service users living there. Policies and procedures required by regulation have been finalised and are available to staff and service users as appropriate. These include a Service User Guide so service users are aware of services and facilities offered by Mrs Stevenson, and are aware for example how to make a complaint. Bathrooms have been refurbished- and a further adaptation to provide a walk in shower will be provided shortly. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 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 Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 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, 4, 5 Suitable information is provided to enable service users to make an informed choice to move in to the home. Suitable measures e.g. a pre admission assessment, and links with external professionals are in place so the registered provider can ensure staff can meet the needs of service users. EVIDENCE: There is a suitable statement of purpose and service user guide. Mrs Stevenson said service user guides have been issued to service users. Staff also carry out an appropriate pre admission assessment before service user’s are admitted. Service users and their representatives are able to visit the home before making a decision to move. Mrs Stevenson said support from external professionals was positive; for example there are suitable links with social workers, district nurses etc. Four staff have NVQ 2. Four staff have recently completed training regarding dementia. Training regarding healthy eating has also been completed by several staff. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 9 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 Service users personal and health care needs are met appropriately. EVIDENCE: All service users have suitable care plans. These contain satisfactory information to enable staff to deliver care. Care plans are reviewed appropriately. Mrs Stevenson described suitable links with GP’s, district nurses, and interventions by health care professionals are documented. One service user has had to go to hospital since the last inspection following an accident. Staff appear to have acted appropriately. The registered provider operates a satisfactory medication system. There is a suitable system of medication storage, administration and disposal of medication. Records are kept appropriately. There was not satisfactory evidence all staff had formal training regarding the handling of medication e.g. from the pharmacist, and this must be completed. The container for controlled drugs should be secured in the medication cabinet. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 10 Service users said staff are kind, and give personal care in a manner, which respects their privacy and dignity. Service users receive their mail unopened and wear their own clothes at all times. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 11 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) 14, 15 Appropriate arrangements are in place to enable service users to exercise choice and control over their lives. Service users have an varied, healthy and wholesome diet. EVIDENCE: All service users monies are handled by either their families or legal representatives. Appropriate information is provided regarding advocacy e.g. in the hallway, and in the service user guide. Suitable arrangements are made to assist service users to vote. The inspector shared a meal with service users- beef stew followed by fresh fruit cocktail. Service users were all offered an additional portion, had a drink with their meal followed by tea / coffee. The meal was to a high standardparticularly considering the kitchen was out of operation due to a refit. Service users said they were very pleased with food provided. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 12 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, 18 Appropriate arrangements are in place so any complaints are resolved effectively and service users are protected from abuse. EVIDENCE: Mrs Stevenson has received one minor complaint from a service user which has been resolved appropriately. Service users receive appropriate information how to make a complaint. The registered provider has a suitable adult protection procedure. All staff have a Criminal Records Bureau check and where appropriate staff have received a Protection of Vulnerable Adults check. Staff receive appropriate training regarding adult protection when they commence employment, and are required to read the home’s policy regarding this. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 13 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) 19-26 Parc Vro provides suitable accommodation to meet the needs of service users living there. The previous requirement to fit locks on bedroom doors is renotified. The home is clean, pleasant and hygienic. EVIDENCE: Parc Vro offers a clean and very pleasant environment. The home has a large lounge, and dining room for service user’s use. There are suitable bathroom and toilet facilities. Mrs Stevenson will be installing a ‘walk-in’ shower shortly. A new kitchen was being fitted at the time of the inspection. Service user bedrooms are individual, pleasantly decorated and suitable to meet their needs. Mrs Stevenson has located some keys for bedroom doors. Mrs Stevenson said other locks / door keys will be provided shortly. The requirement to fit door locks-and where appropriate issue service users with keys is renotified for the third time and must now be acted upon. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 14 Parc Vro is fully accessible for service users with a physical disability. For example there is a lift. The garden can be used by service users. Bathrooms have appropriate aids and adaptations e.g. bath hoist. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 15 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, 28, 29, 30 Suitable staffing levels are provided to care for service users. Recruitment practices and staff training are not satisfactory. This could result in service users not being cared for by appropriately recruited and trained staff. EVIDENCE: Suitable staffing is provided. At least two staff are on duty between 0800 and 2200, although the staff rota indicates there are usually more staff on duty. One waking night staff and one sleep in staff are on duty between 2200 and 0800. A cook and a cleaner are employed. Information obtained when staff are recruited has improved but is still not satisfactory. All staff must have information as outlined in Schedule 4 of the Care Homes Regulations 2002. Although staff, as appropriate, have a Criminal Record Bureau / Protection of Vulnerable Adults check, two references and at least one means of identity etc. must be obtained. Mrs Stevenson said staff have a three day induction. Staff do appear to be competent and knowledgeable. However there is no documentation (e.g. checklist) to evidence staff induction. This must be developed and implemented for all new staff. Mrs Stevenson has said she is committed to providing appropriate staff training. Staff have the opportunity to obtain a National Vocational Qualification in care. Many staff have completed ASET correspondence course training in a number of areas such as medication and infection control.
Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 16 However from the documentation provided there is still gaps in training required by regulation. This includes first aid, manual handling, infection control, handling of medication, food handling and fire instruction. The inspector suggests staff complete short courses e.g. from the health promotion agency / primary care trust (infection control), St John’s Ambulance (first aid), the pharmacist (medication), local college (food hygiene). Video based training / Management instruction (fire).This will meet regulatory requirements. The provider already employs a trainer to complete manual handling training. The registered provider has now been renotified for the fourth time regarding requirements for recruitment and staff training. Failure of the registered provider to provide appropriate: • Recruitment / staffing information • Training for staff • Documentation regarding these issues could result in legal action being taken by the Commission for Social Care Inspection. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 17 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) 31,32, 33, 36 37, 38 Service users benefit from a home which is suitably managed and run in their best interests. EVIDENCE: Mrs Stevenson is insightful of staff and service user needs, caring, knowledgeable and suitably experienced to manage the home. Mrs Stevenson is a very ‘hands on’ provider, acts as a positive role model for her staff, and is approachable to staff and service users. Mrs Stevenson provides appropriate day to day supervision of the staff team, and the team appears well developed, caring and effective. Mrs Stevenson has conducted a satisfaction survey among service users and their representatives. Service users were all very positive about life in the home, and described the home and staff as ‘good as gold’ ‘it’s a home from home’, ‘lovely’ etc.
Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 18 Records examined regarding the management of the home, and in regard to service users care are appropriate. No service user monies are handled by the registered provider. Health and safety precautions are satisfactory. However there was no record that emergency lighting has been tested since May 2005 and this must be completed. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 2 3 3 2 Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 20 Yes 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 29 Regulation 17 Requirement The registered provider must provide appropriate documentation for all staff employed from the date of this report as outlined in Schedule 4.6 of the Care Homes Regulations 2002. (Timescale of 31.3.05 not met fourth Notification) The registered provider must provide and be able to evidence appropriate training required by regulation as outlined in the report. Training regarding the handling of medication must also be provided. Copies of certificates (including NVQ training) must be maintained on individual staff files. (Timescale of 31.3.05 not met fourth Notification) All bedroom doors must have locks, and service users must be provided with a key if they have capacity. Where service users do not have capacity this must be assessed via a risk assessment.(Timescale of 31.3.05 not met third Notification). The registered provider must Timescale for action 1.11.05 2. 9, 30 13, 18 1.11.05 3. 10 12,16,23 1.11.05 4.
Parc Vro 29, 30 18 1.11.05
Page 21 D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 5. 38 13, 23 develop a satisfactory induction check list, and ensure this is used to evidence staff induction for all new staff from the date of this report. Emergency lighting must be tested at intervals recommended by the fire officer. 1.8.05 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. Refer to Standard 9 Good Practice Recommendations The container for controlled drugs should be secured in the medication cabinet. Parc Vro D52-D04 S9130 Parc Vro V222208 120705 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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