Inspection on 10/11/05 for Park View

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 30 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Park View 16/03/09

Park View 18/03/08

Park View 09/03/07

Park View 05/06/06

Park View 17/05/05

Park View 09/12/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Park View 100-104 County Road North Hull East Yorkshire HU5 4HL Lead Inspector Christina Bettison Unannounced Inspection 09:30 10 ,17 and 21st November 2005 th th Park View DS0000062146.V269567.R01.S.doc Version 5.0 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 View DS0000062146.V269567.R01.S.doc Version 5.0 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 Adults 18-65. 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 DS0000062146.V269567.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Park View Address 100-104 County Road North Hull East Yorkshire HU5 4HL 01482 448911 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) Kingston upon Hull CC Undergoing Registration Process Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2005 Brief Description of the Service: Parkview is a purpose built establishment, comprising three bungalows each with five single ground floor bedrooms, a lounge/dining room, one bathroom and two separate toilets. The three bungalows share a large garden but each has its own patio area. Residential care is provided to a maximum of 15 service users who have a learning disability, and who may also be wheelchair users. The home is close to local shops and next to a small park, and approximately 5 or 6 miles from the city centre of Hull. The previous owners submitted a voluntary cancellation to their registration in August 2004 and since that time Hull City Council have been managing the home. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the previous inspection on 17/05/05 additional visits have been undertaken on 06/07/05, 29/07/05, 07/9/05 and 17/10/05. Regular improvement meetings have been held to discuss progress and additional concerns raised. This unannounced inspection took place over 12 hours, over 3 separate days and was carried out because the CSCI have a number of concerns in relation to staffing numbers, high use of agency staff, staff skills and poor care practices. 5 POVA referrals in respect of five different service users have been made to the local authority and 2 complaints have been received since the previous inspection. Matun Wawryk Regulation Inspector accompanied the lead inspector for part of the inspection. A tour of the premises took place and staff files and care records were examined. Rotas, medication records, staff lists and training records were examined. 4 of the staff and the manager were spoken to. Care practices and interactions were observed during the inspection. The Commission for Social Care Inspection is working with the local authority to improve standards in the home, however if improvements are not made within reasonable timescales the CSCI will consider taking enforcement action. What the service does well: What has improved since the last inspection? A temporary management team from social services has been brought in to support the staff team and raise standards of care in the home. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 6 The management team are making some progress to raise standards in the home, work has started on improving service users plans and arranging reviews to ensure that staff know what service users needs are and are able to provide care to meet their needs. Senior managers have met with relatives and staff to discuss confidentiality and this is being discussed in staff supervision, to ensure that service users privacy and dignity is maintained. The Community Team Learning Disability have been asked to undertake Health Action plans to make sure that service users health needs are met. The manager has provided individual lockable cabinets in service users rooms for the safe storage of medication and to ensure service users medication is easy to get to. Complaints are now being logged and records kept of all action taken to resolve issues. This leads to service users and relatives feeling that their concerns are being listened to and responded to. The fire alarm has been replaced. Some staff training has been provided and all staff have had CRB clearances undertaken, thereby providing some safeguards that service users are protected from harm. What they could do better: Staffing is a major issue within the home, high use of agency staff; low numbers of permanent staff leads to poor care practices. Agency staff are not assisted to know what the needs of the service users are due to poor service user plans and lack of service specific training. Staffing must be provided in enough numbers and with the right skills to look after the service users and staff must be supervised to do the job properly. Staff must be provided with training and must be helped to work within Local authorities policies and procedures. The registered person must address the gaps in staff skills in mandatory training, especially moving and handling and service specific training. The registered person must ensure that departmental policies and procedures are updated to ensure that the staff team are guided in aspects of care practice. Service users plans must improve, Individual service user plans were available however they did not reflect the full range of needs of service users and did not ensure that all aspects of health, personal and social care needs are Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 7 identified and planned for. Plans were basic, not up to date and had not been reviewed. The registered person must ensure that staff know what to do for each service user and specialist advice must be followed. Service users must be supported to make and attend health care appointments. A quality monitoring system must be introduced to make sure that everyone is consulted about the running of the home and continuous improvements are made. To make sure that the home is safe and comfortable for people living there redecoration must take place, the fire alarm system must be improved, and the dining tables must be replaced. Staff facilities must be provided and private meeting rooms created in which to hold meetings, supervision, etc. The fire officer has visited the home and the resources section of the local authority has agreed to repair or replace the intumescent seals around the fire doors but this has not been done yet. 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 DS0000062146.V269567.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Service users are not provided with enough information regarding the home they are living in. EVIDENCE: The Local Authority has taken over the registration and management of the home on a temporary basis. A service user guide has been developed for each bungalow and produced in a format that is accessible to service users, however this still requires further development to ensure it meets Regulation 5 and NMS 1.2. This was identified as a requirement from the previous inspection and therefore remains an outstanding requirement. There had been no new admissions to the home since the previous inspection therefore NMS 2,3,4 and 5 were not assessed at this inspection. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Service users do not have a service user plan that reflects their full range of needs, choices etc thereby placing them at risk. Without this there is no assurance that their care needs will be met. EVIDENCE: Six care files and individual plans were examined as part of the inspection process. Work has commenced on improving care files and service users plans. All care files have been transferred into a modular file and a working file as per the local authority file policy. However it was apparent that blank documents had been inserted into the file with a view to completion i.e. daily living assessment and personal communication passport however these had not been completed. The individual service user plans did not reflect the full range of needs of service users and do not ensure that all aspects of health, personal and social care needs are identified and planned for. Plans are basic and are not up to date. Eight service users reviews have been held however these concentrated on person centred plan type review that focussed on aspects of leisure and goal setting. This was particularly evident for one service user who had a care Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 11 plan for access to the community, shops and pubs, 1; 1 time tidying cupboards and a manicure. This particular service user had significant care needs, no verbal communication; needed full assistance with all daily living tasks, used a wheelchair and needed a hoist for all transfers, there were entries in the daily records that indicated an issue with skin integrity however there was no waterlow assessment and no care plans for personal care, communication or pressure area care. This was a similar pattern for all six care files examined. This is compounded by the high use of agency staff that do not have the historical knowledge of service users needs and who rely on the quality of the service users plans in which to ascertain their needs. Service user plans were not provided in a format that made them accessible to service users. Where service users display behaviours that can be difficult to manage and specific techniques or methods of communication are required in order to minimise the risks this was not found to be documented in the service user plan either in the form of a service user plan or behaviour management strategy. A recent complaint was received that a member of staff (agency) had locked a service user in her bedroom, the local authority complaint investigation concluded that this had happened to protect the service users privacy and dignity however it does not specify anywhere in the care file how the service users presenting behaviour must be managed. Any restrictions or limitations to service users must be documented in the form of care plan or behaviour management plan. Any incidents of the use of restrictive physical interventions must be recorded to identify the circumstances and nature of the intervention and the CSCI must be notified. Risk assessments had been completed for activities that presented risks to service users, however the majority of these were generic and did not specifically relate to a service user and the particular risks that related to their circumstances, needs or behaviours. e.g. a risk assessment had been completed for leaving a service user alone in the bath which specified that they could be left but should be monitored. It did not state how the monitoring should take place, therefore staff took different approaches to this and this caused differences of opinion amongst the staff group and may also pose a significant risk to the health, welfare and safety of the service user. Discussion with staff suggested that they had some awareness of service users particular needs and communication methods but were not enabled to Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 12 participate in the preparation of the care plans and were not made aware of changes needed to made following review or re assessments. Discussion with staff and the manager and observations confirmed that the staff team are making attempts to ensure service users confidentiality is being respected however this was proving difficult as there are no rooms available for handover meetings, meetings with relatives, reviews, supervision etc. From discussions with the manager and staff it was evident that confidentiality has improved within the home, however is still being monitored closely. There is a policy and procedure that clearly defines confidentiality and when this should be breached and staff had received briefings regarding this issue. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of these standards were assessed in full at this inspection however staff and relatives stated that service users are able to go out into the community and engage in social activities and that this has improved since the previous inspection, however the staffing shortages still pose a problem. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Service users healthcare needs are not adequately catered for. EVIDENCE: Six service users care files were examined as part of the inspection process. The service users that live at Park View have complex care needs and are very vulnerable there are no detailed care plans to ensure that care staff are instructed in how to deliver care. There were no skin integrity monitoring or waterlow charts, no nutritional assessment and /or eating and drinking plans for some service users. Very few weight records and the manager reported that they do not have any sit on scales to enable routine weight monitoring to take place. The Community Team Learning Disability have almost completed the process of health screening and this will lead to the development of Health Action plans to ensure that service users health needs are identified and services provided to meet these needs. There were minimal records to support that access to dentist, optician, audiologist, chiropody, community nurses and therapists was being facilitated on a routine basis for all service users. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 15 There were several examples in diary notes of poor care practice, and lack of follow on to attend to service users medical needs. One service user had recorded in daily records that they had a sore area, the records stated that staff applied cream with no evidence of consultation with medical services and from the entries this just got worse to a point where the service user had a much deeper sore and still no evidence of any action being taken. The home has policies and procedures for the administration of medication, there were no service users prescribed controlled medication however there were no facilities for the storage of controlled medication should any of the service users be prescribed any, despite this being a requirement from the previous inspection. There are currently no service users self-medicating, although the manager has provided individual lockable cabinets in service users rooms for the safe storage of medication and to ensure service users medication is accessible. Each bungalow has its own store for medicines and recording systems in use. These were on the whole found to be satisfactory. Staff spoken to confirmed that they had received some training for the administration of medication provided by the local authority. However this did not include a competency check or a workbook to complete at the end to ensure staff understand their responsibilities. There are some service users requiring specialist medication, which is only administered by district nurses or staff whom the district nurse has deemed competent and willing to do so. The home does not have a refrigerator for medication. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Complaints made to the manager of the home are handled appropriately and relatives are confident that their concerns will be listened to, taken seriously or acted upon. The staff team are aware of the Protection of Vulnerable Adults policies and procedures and their responsibility within these therefore strategies are in place to protect service users from abuse, neglect and harm. EVIDENCE: The home has a detailed formal complaints procedure provided by Hull City Council. Complaints are now being logged and records kept of all action taken to resolve issues. The manager had received two more complaints from relatives that were being dealt with appropriately and the CSCI had received two complaints that were forwarded to the local authority to investigate and one that was investigated by the CSCI details of which are included in this report. Some concerns were raised informally. This leads to service users and relatives feeling that their concerns are being listened to and responded to, however it also highlights that relatives continue to be unhappy with the service provided at Park View. A recent complaint was received that a member of staff (agency) had locked a service user in her bedroom, the local authority complaint investigation concluded that this had happened to protect the service users privacy and dignity however it does not specify anywhere in the care file how the service users presenting behaviour must be managed. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 17 Other examples given by staff included two service users that self harm and the staff have to stop them physically from doing this, staff reported that there is no guidance available in the form of care plan or behaviour management guidelines. Any restrictions or limitations to service users must be documented in the form of Care plan or behaviour management plan. See NMS 7. Any incidents of the use of restrictive physical interventions must be recorded to identify the circumstances and nature of the intervention and the CSCI must be notified. From discussion with staff and staff training records it was evident that some staff have received training or briefing on the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this. This is supported by the fact that there have been a number of incidents of unexplained bruising/scratching identified and reported to the local authority within these procedures. However some staff highlighted concern that issues reported to some senior care officers are not passed on to the manager or dealt with appropriately. A complaint had been received by the CSCI and investigated as part of this inspection the elements of the complaint are as follows; • • High numbers of agency staff being used and permanent staff leaving. Upheld see NMS 32-36 Manager not responding to concerns that are raised by staff. This was discussed with the manager who stated that she does make herself available to staff with an open door policy, the frequency of staff meetings have improved and a number of staff spoken to confirmed that the communication has improved since the manager and senior care officers from the local authority took over management of the home. Staff spoken to say they did feel supported. However the manager acknowledged that she doesn’t always keep a record of discussions with staff and outcomes and therefore there is little evidence that issues are being discussed and resolved. Although this element of the complaint is not upheld the manager is recommended to keep a supervision record of any discussions with staff relating to practice and/or service user issues and the actions taken and or instructions given. • Poor management of service users care, no care plans, BMP. Upheld see NMS 6,7, and 9. Service users left unsupervised on the toilet or in the bath. Upheld see NMS 9. • Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 18 • Agency staff not trained, experienced or skilled in the care of people with a LD. Upheld see NMS 32-36. Night staff have had no mandatory training. Upheld see NMS 32-36 No supervision. Upheld see NMS 36. Poor hygiene practices in the kitchen. • • • This was discussed with the manager, who stated that she felt this related to one particular service user. Prior to the local authority taking over this service user was denied access to the kitchen as it was felt unhygienic. The current staff are trying to enable the service user to have access to the kitchen to prepare his own drinks and snacks. The inspector was reassured that attention to hygiene practice is adhered to by the staff. Not Upheld • Noise from cleaning/washing during the night disturbing service users. This was discussed with the manager who stated that new cleaning rotas that have been implemented for the night staff. The manager did not feel that the washing machines would be heard in the bedrooms as they are behind closed doors and there is a bathroom in between. Not Upheld • Running out of pads, cleaning products, wipes, toilet rolls. The manager stated that there had been one or two incidents of this however it was due to the fact that staff were not informing managers when stocks were running low. This has been addressed with the introduction of a stock control system. Not Upheld. • Recent accidents/incidents; 5 POVA referrals in respect of five different service users have been made to the local authority, which at the time of this report where still under investigation and 2 complaints have been received since the previous inspection. From discussion with staff and staff training records it was evident that some staff have received training or briefing on the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this. This is supported by the fact that there have been a number of incidents of unexplained bruising/scratching identified and reported to the local authority within these procedures. However some staff highlighted concern that issues reported to some senior care officers are not passed on to the manager or dealt with appropriately. Upheld. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,28,29,30 Improvements have been made to the home, however despite these improvements service users continue to live in a home whose appearance continues to be generally run down with holes in plasterwork, damaged doors and a cluttered, untidy environment. EVIDENCE: From observations and discussions with staff, management and relatives it was apparent that since the previous inspection some work has been undertaken to improve the home both in terms of its function and general appearance. The outside of the home has been redecorated. Despite this work the home still appears run down, there are holes in the plasterwork, damaged doors and on the day of inspection it was drab and outdated. New dining tables had been purchased and at the previous inspection it was identified that they were totally unsuitable for the environment, making it appear institutional and limiting the communal space for staff and service users to move around. This posed a health and safety hazard. The manager had agreed to keep this under review and now agrees that they need to be Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 20 replaced. This remains an outstanding requirement from the previous inspection. There were no private areas for visitors and /or meetings consultations etc. Bathrooms were observed to be institutional, stark and uninviting. The specialised baths were quite old and service users toiletries were stored in baskets in the bathrooms. Two service users had been identified as being unable to have a bath due to their specific needs and the unsuitability of the bathing equipment (moving and handling risk assessments). This must be given urgent attention, as it is an unacceptable situation. A requirement has been made in respect of this. Three new hoists and a specialised bed for one service user had been purchased. Fly screens have been fitted to the kitchen windows as required by the environmental health officer The fire officer has visited the home and the resources section of the local authority has agreed to repair or replace the intumescent seals around the fire doors. It was reported that this work would commence in the week of 24/10/05, however at the date of inspection this work had still not been carried out compromising the health, welfare and safety of the service users and staff. The fire alarm has been replaced however all three buildings have not been linked, therefore staff in the other bungalows would not be aware that the alarm was ringing and could not assist in an evacuation. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Staffing in the home is of major concern. There is a high use of agency staff, very little supervision taking place, lack of training both mandatory and service specific and all of this leads to service users needs not being adequately met. EVIDENCE: The local authority has taken over responsibility for the home on a temporary basis following the previous providers withdrawal. A temporary management team from social services has been drafted in an attempt to provide a stable platform in which to support the staff team and raise standards of care in the home, however this has proved an overwhelming task and progress has been slow. There are still a large number of staff vacancies at the home that are covered by the use of agency staff, creating inconsistency and unreliable care to service users, this is now at crisis point with the manager and senior care staff commenting that they spend a large amount of their time covering shifts and using staff that do not have the skills and/or experience to meet the needs of this service user group. In addition one of the social services care officers has left to take up another post, this person will not be replaced, a full time permanent care worker has resigned and another two care workers are pregnant and will be undertaking Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 22 light duties. This compounds an already untenable position with regards to staffing in the home. Night staff is still of particular concern all 240 night care hours are covered by either agency or casual staff, however since the end of October 2005 the senior care officers have commenced sleep in duties to provide support to the night care staff. In October the manager had completed a review of staffing. Park View Care Home should have a minimum of 1,067 care staff hours to cover both days and nights. At this time 550 hours were provided by permanent staff and 487 hours provided by agency staff with an additional 30 hours covered by temporary and casual social services staff. This means that almost 50 of the staff provided at this time was either agency or casual/temporary staff. A review of staff used in the month of October demonstrated that on day shifts 47.5 of the staffing was permanent staff and 52.5 of staff were agency. On nights 15 of staff were permanent 76 of staff were agency and an additional 9 of staff were social services casual staff, however the permanent night worker has now been brought onto days leaving night staff covered 100 by agency and/or casual staff. This is an unacceptable situation and is compromising the attempts of the management team to meet requirements previously made by the CSCI. Some training has been provided to some staff, values and attitudes, catering and moving and handling, however this is minimal considering the amount of training that is required. Staff have not been able to attend much training because of the numbers of vacancies and the high use of agency staff, therefore staff do not have the skills and competencies to meet service users needs. The manager has completed a staff training audit which clearly evidences that there are gaps in staff skills in mandatory training and that staff have not been able to attend any service specific training. Staff had not received any training on equal opportunities, disability equality training and race equality and anti racism training. From observations some staff did not have the appropriate communication skills to interact with service users and were not all aware of how to deal with particular behaviours, the staff have not received training in how to manage presenting behaviours. During the inspection the inspector and manager observed a staff member making a service user sit on her chair before she could have a drink and making another service user have a drink when she was openly refusing it. The attitude of the staff member was bullying and must be addressed. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 23 During the course of the inspection the inspector was asked by a staff member how to use the nurse call system as she had up until that point been leaving the service user alone in the bathroom/bedroom whist she went to get assistance, this was one of the permanent staff members not agency. Daily records for one service user indicated …… unable to have a bath due to lack of knowledge in hoisting, his bottom half continually fell out the sling. This is unsafe practice. This was subsequently investigated by the manager who confirmed the two staff responsible were agency staff and they had used the incorrect sling for the service user. These incidents highlight the lack of skills, experience and competence of some of the staff at Park View to care for this group of vulnerable service users. From discussion with staff and examination of records it is apparent that although the senior care officers had started off with good intentions to ensure that staff received formal supervision 6 times per year it has not been possible to sustain this given the huge volume of work, conflicting priorities and staffing difficulties. Therefore the requirement to ensure that staff receive supervision and an annual training and development assessment and profile remains outstanding. There continue to be very low numbers of staff with NVQ level 2 and there appeared to be little progress being made to register staff for the qualification although most spoken to express a wish to undertake this. Communication in the home has improved, more staff meetings are being held and staff reported handovers now taking place. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42,43 Despite having a competent manager in place the temporary arrangements of the senior care officers and concerns regarding high numbers of agency staff and low levels of training result in some practices that do not promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The current manager has been seconded to the home from Hull City Council on a temporary basis; she is not currently registered with the CSCI. The local authority needs to ensure that a registered manager is in place to provide a consistent, stable platform in which the home can improve. The manager has completed NVQ 4 in Management and is currently undertaking the Registered Manager’s Award covering the appropriate care components. She has 15 years previous experience in a managerial and caring role. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 25 The Local authority has a quality assurance system however this has not yet been fully implemented within the home, this means that service users and their families views are not utilised to help shape the way the service is provided in the future. Some training has been provided to some staff, values and attitudes, catering and moving and handling, however this is minimal considering the amount of training that is required. Staff have not been able to attend much training because of the numbers of vacancies and the high use of agency staff, therefore staff do not have the skills and competencies to meet service users needs. The manager has completed a staff training audit which clearly evidences that there are gaps in staff skills in mandatory training and that staff have not been able to attend any service specific training, especially in how to deal with difficult presenting behaviours. The manager did not have a training plan for the home. The manager confirmed to the inspector that all records relating to service users were now stored securely and in accordance with the data protection act. Some work has been undertaken to improve the home both in terms of its function and general appearance. The outside of the home has been redecorated. Despite this work the home still appears run down, there are holes in the plasterwork, damaged doors and on the day of inspection it was drab and outdated. New dining tables had been purchased and at the previous inspection it was identified that they were totally unsuitable for the environment, making it appear institutional and limiting the communal space for staff and service users to move around. This posed a health and safety hazard. The manager had agreed to keep this under review and now agrees that they need to be replaced. This remains an outstanding requirement from the previous inspection. The manager reported that three new hoists have been provided. The fire officer has visited the home on the 9/8/05 with Mr Steve White from the Property Services section of the local authority and it was highlighted that the intumescent seals around the fire doors were ill fitting and should be replaced. It was reported that this work would commence in the week of 24/10/05, however at the date of inspection this work had still not been carried out compromising the health, welfare and safety of the service users and staff. The fire alarm has been replaced however all three buildings have not been linked, therefore staff in the other bungalows would not be aware that the alarm was ringing and could not assist in an evacuation. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 26 The manager confirmed that there has been no progress in the updating of departmental policies and procedures and identified that a number of these are out of date. It had been highlighted on a previous action plan that the manager would be responsible for updating them however she had not been asked to do this and did not feel she would have the time to undertake this, leading to staff lacking in guidance in aspects of care practice and therefore service users needs not being met. Staff spoken to appeared to be aware of where policies and procedures are kept, however could not say how they impacted on their practice or what specific guidance they gave and there were no records to evidence that staff had received briefings, training or any supervision regarding implementation of Hull City Councils policies and procedures. Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 1 x 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 1 2 3 2 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 1 1 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Park View Score 2 2 3 x Standard No 37 38 39 40 41 42 43 Score 1 2 1 2 x 1 1 DS0000062146.V269567.R01.S.doc Version 5.0 Page 28 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 YA1 Regulation 5 Requirement The registered provider must provide a service user guide that sets out clear and accessible information covering all aspects of standard 1.2. (Timescale of 31/8/05 not met) The registered person must ensure that the service users care plans reflect the full range of needs and detail what support staff need to provide to meet service users needs, plans must be reviewed at least 6 monthly. (Timescale of 31/8/05 not met) The registered person must ensure that where service users display behaviours that are likely to cause harm to themselves and/or others, that a behaviour management plan is put in place that all staff understand and follow. (Timescale of 31/8/05 not met) The registered person must ensure that service user plans are provided in an accessible format to service users. (Timescale of 31/8/05 not met) The registered person must ensure that daily recordings are DS0000062146.V269567.R01.S.doc Timescale for action 31/01/06 2 YA6 15 10/11/05 3 YA6YA7 15 10/11/05 4 YA6 15 10/11/05 5 YA6 13 (1b) 10/11/05 Park View Version 5.0 Page 29 6 YA7 13 (6 and 8) 7 YA7 13 (4 b and c) 8 YA18 12,18 9 YA19 13 (1) 10 YA20 13 (2) 11 YA24 23 12 YA27 13 (5) 23 (2j) 23 (2a) monitored by a senior person and highlight action taken to meet needs or concerns recorded. The registered person must ensure that any incidents of use of physical interventions with service users are recorded and reported to the CSCI. (Timescale of 31/8/05 not met) The registered person must ensure that risk assessments are undertaken for activities that present a risk to service users that all staff understand and follow. These must relate to a specific service user and their specific circumstances and/or presenting risks. The registered person must ensure that staff develop and maintain appropriate relationships with service users and treat them with respect and dignity at all times (Timescale of 9/3/05 and 17/5/05 not met). The registered person must ensure that service users have access to healthcare provision and a minimum of an annual health check is completed. (Timescale of 31/8/05 not met) The registered person must provide Controlled Drugs cabinets that meet the requirements of the Misuse of Drugs Act 1971 (Timescale of 31/8/05 not met) The registered person must ensure that the home is redecorated inside and that a planned maintenance programme is provided (Timescale of 31/8/05 not met) The registered person must provide suitable baths to ensure that all service users are able to have a bath if they require one. DS0000062146.V269567.R01.S.doc 10/11/05 10/11/05 10/11/05 10/11/05 31/12/05 31/03/06 31/12/05 Park View Version 5.0 Page 30 13 YA32 18 (1a) 14 YA33 18 (1a) 15 YA33 18 (1c) 16 YA33 18 (1c) 17 YA35 18 (1c) 18 YA35 18 (1c) 19 YA36 18 (2) The registered person must ensure that 50 of staff are qualified to NVQ level 2 (still within timescale) The registered person must ensure that at all times suitably qualified, competent and experienced person are working at the care home in such numbers as are appropriate for the health, welfare and safety of the service users. The use of agency/casual staff must be kept to a minimum, each shift having permanent members of staff on duty (Timescale of 9/3/05 and 30/6/05 not met). The registered person must develop and implement a training programme which meets the Sector Skills Council workforce training targets.(Timescale of 9/3/05 and 31/8/05 not met) The registered person must ensure that staff receive accredited training in how to deal with service users that display behaviours that are likely to cause harm to themselves and/or others. The registered person must ensure that staff receieve training in equal opportunities, disability equality, race equality and anti racism training. (Timescale of 31/8/05 not met) The registered person must ensure that all staff has an individual training and development assessment and profile. (Timescale of 31/8/05 not met) The registered person must ensure that all staff receive supervision a minimum of 6 times a year. (still within timescale) DS0000062146.V269567.R01.S.doc 30/06/06 10/11/05 10/11/05 10/11/05 31/03/06 10/11/05 30/06/06 Park View Version 5.0 Page 31 20 YA37 8 21 YA39 24 22 YA40 24 23 YA42 18 24 YA42YA24 23 25 YA28YA42 23 26 A42 23 The registered person must ensure that the manager is registered with the CSCI to provide a consistent, stable platform in which the home can improve The registered person must ensure the home’s quality assurance system is developed, and includes consultation with stakeholders, that information it produces is collated and a written report is produced and that it is sent to the CSCI and given to the service users. (Timescale of 9/3/05 and 31/8/05 not met)) The registered person must ensure that all staff have access to, understand and apply all policies and procedures and these are updated in line with legislation and best practice guidance. The registered person must ensure that all staff are up to date with all mandatory training. (Timescale of 31/8/05 not met) The registered person must ensure that the home is kept tidy and that matters of routine decoarating and general maintanance are attended to. (Timescale of 31/8/05 not met) The registered person must ensure that the large dining tables are replaced with smaller ones to ensure the safe movement around the home for staff and service users. (Timescale of 30/06/05 not met) The registered person must ensure that facilities for staff are made available in which they can store personal items and to take adequate rest time away from service users. (Timescale of 30/06/05 not met) DS0000062146.V269567.R01.S.doc 31/12/05 31/03/06 31/03/06 10/11/05 10/11/05 31/12/05 31/12/05 Park View Version 5.0 Page 32 27 28 YA42 YA43 4 (a) 24 The registered person must replace the ill fitting intumescent seals on the fire doors . The registered person must ensure that decisions are taken in consultation with stakeholders as to the future of the home and progressed in a timely manner. 10/11/05 10/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Park View DS0000062146.V269567.R01.S.doc Version 5.0 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 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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