Inspection on 16/03/09 for Park View

This inspection was carried out on 16th March 2009.

CSCI found this care home to be providing an Adequate service.

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Park View 18/03/08

Park View 09/03/07

Park View 05/06/06

Park View 10/11/05

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Park View 100-104 County Road North Hull East Yorkshire HU5 4HL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christina Bettison     Date: 1 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Park View 100-104 County Road North Hull East Yorkshire HU5 4HL 01482448911 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kingston upon Hull CC Name of registered manager (if applicable) Ms Judith Lawtey Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Parkview is a purpose built establishment; it consists of three bungalows each of which have 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. The home is registered to provide care and accommodation for up to 15 people who have a learning disability, and who may also have other physical needs, however since 12th May 2006 one of the bungalows has closed and some of the people have been re located leaving a total of eight people, four in each bungalow. The empty bungalow is now used for activity sessions, meetings, supervisions and a staff space. The home is close to local shops and next to a small park, and approximately 5 miles from the city centre of Hull. Public transport to various parts of the city is accessible and in addition people have access to a mini bus. Additional charges are made for the following: newspapers/magazines and sweets and hairdressing. Information on the 15 Over 65 0 care home 15 Care Homes for Adults (18-65 years) Page 4 of 37 Brief description of the care home service is made available via the statement of purpose, service user guide and inspection report. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is a one star. This means that the people who use this service experience adequate quality outcomes. This service continues to provide good outcomes for the people who live there since the previous inspection however there has been inadequate attention given to the refurbishment of the building and the provision of satisfactory moving and handling and bathing equipment. A number of requirements have been made in relation to the environment and a warning letter will be sent to the provider. Because of the lack of improvement in the environment the overall quality rating has remained as adequate. Care Homes for Adults (18-65 years) Page 6 of 37 This visit was unannounced, Judith Lawty the manager and the staff team assisted us throughout the visit. During the visits we observed peoples experiences of living at Park View so that we could understand what it was like for people to live at this service. Throughout the visit we looked at the environment, and made observations on the staffs approach to and their ability to support people. We also checked some samples of documents that related to peoples care and safety. These included needs assessments, daily records, care and health plans, risk assessments and staff training records. Before the visit the registered manager had completed an Annual Quality Assurance Assessment report AQAA. This report provides information about how the service operates. We have used some of this information within the report. Before the site visit we also looked at a range of other information we had received about the service since the last inspection. This includes information provided by local authority agencies, the homes monthly reports, adult protection referrals and complaints made about the service. People who use the service were given surveys (in picture formats) relatives helped some people to complete these and three were returned. Staff that work at the service were given surveys and four were returned. Placing social workers were given surveys and none were returned. Health professionals were given surveys and two were returned. On the day of the visit staff were spoken to and their comments have been included in this report. This was a key inspection and we checked all the key standards. Feedback was given to Judith Lawty, the manager and advice and guidance was also given throughout the visit. The inspector would like to thank the people who live at the service and the staff for their co operation during our visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Care files would benefit from being tidied up and more areas of need to be covered, i.e. finances, contact with family and religous and cultural needs. Health plans would benefit from further development to ensure that all of peoples health and healthy lifestyle needs are covered. Risk assessments need to be completed for the safe use of bed side rails to ensure that people are protected from the risk of harm. Care Homes for Adults (18-65 years) Page 8 of 37 The building must be refurbished with some urgency, despite staffs best efforts it is not fit for its intended purpose and this affects peoples quality of life. Baths and moving and handling equipment needs to be provided that meet the needs of the people living there and protect their health and safety. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are fully assessed meaning that staff know what their needs are and are able to meet them. Evidence: There have been no new admissions to the home since the previous visit, the people that live in the home have done so for many years. Therefore the standard in this area was not assessed and remains good. Care Homes for Adults (18-65 years) Page 11 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a stable and consistent staff team and detailed plans guide staff in how to meet peoples complex needs, however some areas of risk have not been identified, assessed and minimised meaning that people may not be kept safe from the risk of harm. Evidence: Three care files were examined as part of this site visit and all three included an assessment and care plan completed by the placing LA, a focus page for initial important information and an individual plan covering the majority of peoples needs. Plans included very detailed communication passports ensuring that all staff knew how people communicated. However plans would benefit further from including identification of needs in finance, culture and faith needs and contact with family and friends. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: In addition to this there were management plans for epilepsy and dealing with behaviours that may pose a risk, morning and evening routines, likes and dislikes, activities etc. Reference to the development and maintenance of peoples independence is included throughout the plans. There is good case file monitoring in place and most of the documents seen had been updated regularly and amended when needs change. There was evidence that peoples needs had been reviewed regularly using both the Social Services Fair Access to Care review system and Person Centered Planning. There had been significant improvement made in the recording of discussions and action to be taken in both kinds of reviews and that all parties views had been recorded and changes agreed are now being transferred to the plan so that peoples changing needs are met. There were good records maintained by staff to indicate how peoples needs were being met. There were a wide range of risk assessments in place to ensure that people were in general being protected from the risk of harm. However at the previous visit it had been identified that for people who are using bed side rails, risk assessments as per the MHRA guidance had not been completed. The manager told us that she had still not completed these however they had identified that some people had bed side rails in place when Hull City Council had taken over management of the home and following re assessment it had been decided that they did not need them. Risk assessments must still be completed and written evidence available for this area of risk that demonstrate that any decisions made regarding the use or not to use bed side rails are made in the best interests of the person involved and that they are kept safe from the risk of harm. This remains an outstanding requirement and a Code B notice (PACE) was issued on the day of the visit to inform the manager that they were in breach of the care standards regulations. Staff told us;Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: The service supports residents to thrive, it enables them to grow in confidence and experience new activities Care Homes for Adults (18-65 years) Page 14 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities provided within the home and community mean that people have the opportunity to participate in activities that meet their individual needs, wants and aspirations. Evidence: Three care files were examined as part of this visit. All three files contained an activity plan and there was evidence to indicate that these plans were being followed. One person attends an exercises class at the Ennerdale leisure centre, goes shopping, bowling and to the cinema, attends church every other Sunday and parents visit twice a week. This person went on holiday to Blackpool. Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: In another file the person goes bowling, shopping, on outings and attends a flower arranging class. They enjoy an aromatherapy session and have regular visits from their family. This person went on holiday to Lytham st Annes with one other person and staff support. In the third file examined this person goes bowling, swimming, enjoys meals out and attends football and rugby matches and enjoys the red disco provided by Hull University. This person went on holiday to Donnington park and stayed in a log cabin. One person went on a trip off roading for their 40th birthday celebration. Observations indicated that staff members continue to interact very well with the people and there was a warm, friendly and relaxed atmosphere in the bungalows during the course of the visit and family links continue to be good in the home. Holidays are in the process of being planned for this year and staff are taking into account experiences of last years holidays and observations to ensure that holidays planned are what the people want and will enjoy. Trips are being planned for this year, a group are going to see the stage show of Mama Mia in London and one person is going to see Daniel ODonnell, another person is going to the wrestling. Menus were planned but were subject to change if people preferred alternatives. Menus reflected that staff promoted a healthy eating menu and tried to balance this with peoples likes and dislikes and special treats on occasions. The staff members generally prepare the meals with people helping if they were able to or wanted to. The assessment of the kitchens by Hull City council under the food safety act graded them as an A which is excellent. Service users told us with the help of their relatives;I am hardly in, my social life is great, I usually go somewhere on Saturdays and my mum comes to see me on a Sunday Staff are very good and take care of all my needs very well both in my home and outside activities. I have visits from my parents two mornings a week Health professionals told us;I believe the care staff show a level of understanding and awareness of the needs of the individuals they support in order to meet those needs. The staff support each one Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: as an individual and provide activities and choices to their level of ability and understanding. They speak and discuss of the activities they believe they enjoy and listen to the views of service users staff told us;I am key worker for .......... he loves the theatre and we,ve been to see Meat Loaf, the Buddy Holly story and Queen tribute. He went for day trip on the train and I supported him to attend a family wedding Care Homes for Adults (18-65 years) Page 17 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples basic health needs are met and medication is well managed however further development of health plans will ensure that all of peoples health needs are identified and met and people are kept safe from the risk of harm. Evidence: Three care files were examined as part of the inspection process which evidenced that in general peoples healthcare needs are met. Records evidenced that appointments had been attended with dentist, chiropody, psychology, psychiatry, GP and the community nurses and staff are recording outcomes of these visit to indicate how peoples health needs are being managed and met. Health screening had been completed by the community nurse in May 2006 and there has been no update since then. The provision of community nurse support continues to be inconsistent meaning that further work on the action plans and liaison with other health professionals and updating of records has not been achieved. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: The plans had been prepared over 2 years ago and although the home are ensuring that peoples health needs are met it would be beneficial for the plans to be updated more regularly so that areas of health need do not get overlooked and the home are able to be pro active in meeting needs rather than re active. None of the people that live in the home self medicate. There are written policies and procedures in place for staff to adhere to regarding the administration of medication and medication records were examined as part of the inspection and found to be in good order. Staff had received trained and been assessed as competent to administer medication. Protocols were in place for the administration of medication PRN (as and when required) so that staff are able to identify when people can be given this medication in what circumstances ans how often. There are still significant concerns about the provision of appropriate bathing facilities to meet peoples individual needs. This is detailed further in the environment section of this report. Care Homes for Adults (18-65 years) Page 19 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are well managed within the home and service users and their relatives are listened to, staff are aware of the Protection of Vulnerable Adults policies and procedures and their responsibility within these, this means that people are fully protected from the risk of abuse, neglect and harm. Evidence: There have been no complaints to CSCI since the previous inspection. The home has had one complaint from a relative that has been dealt with and resolved, in addition to this the home have had two compliments, these are;On 9.6.08 a relative sent flowers, chocolates and a card to thank the staff for going the extra mile when her daughter had been ill. On 7.1.09 a relative had sent a card thanking all the staff for giving the residents a lovely christmas From the care files examined it was evident that people that self harm or display behaviours that are difficult to manage now have behaviour management guidelines. Any restrictions or limitations are documented in the form of a behaviour management plan. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. There have been some occasions in the past year where the people who live in the home have hit out at each other or there had been some incidents of unexplained bruising. These have all been referred to the safeguarding adults co ordinator and dealt with accordingly. There are no concerns about the homes ability to safeguard the people that live there. From discussion with staff and staff training records it was evident that most of the staff including the manager and senor staff have received training or briefing on the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this and some staff have completed mental capacity act and deprivation of liberty training. Care Homes for Adults (18-65 years) Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment does not provide people with comfortable and homely surroundings in which to live, appropriate equipment is not being provided meaning that the home cannot meet all of peoples individually assessed needs and their rights are not being upheld. Evidence: An inspection was undertaken on 17.5.05 which highlighted the need for improvements to be made to the environment, subsequent inspections repeated these requirements. Despite this there have only minor improvements made to the environment in almost 4 years. Although the resources section of Hull City Council have informed the manager that the home is on their plan for refurbishment they have not given any indication of the work to be undertaken and what the timescales are. The home is very run down and this has got worse over time, there are numerous holes in the plasterwork, curtains hanging off the tracks, damaged doors, furniture is mismatched, old and broken and carpets are badly stained. Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: It was noted at the previous inspection;Bathrooms are still institutional, stark and uninviting. The baths are very old. One of the people 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). The relatives of this person informed the inspector that their daughter had not had an immersion bath for over 2 years and that this was an aspect of the home that they were still unhappy about. This is clearly unacceptable and the bathrooms at the home must be refurbished and specialised bathing facilities provided with some urgency. The occupational therapist had written to the principal manager for learning disabilities service at Hull City Council on 8.8.07 stating;I am sure that you are aware that ...... is not able to use the bath at her home , nor has she been able to for approximately two years. ..........one of her rights within her own home is not occurring and had not occurred for a long time and this needs to be urgently resolved During the course of this visit we were informed by the manager that since 2005 the environment at the home has been identified as poor and in particular the bathrooms. She told us that the there is still some confusion about the ownership of the building and Hull City Council state that they do not own the building therefore they cannot undertake any work. It has been established that the NHS and a charity (the spice trust) own the building but no one is taking responsibility for the works. She also told us that she feels the bathrooms are not fit for purpose and the home is in need of redecoration and new furniture. The regulation 26 visits regularly highlight the bathrooms, poor decor and quality of furniture as issues. During the course of this visit the following was observed;Bungalow 102 This bungalow is currently uninhabited but the service still has the beds registered. Damaged plasterwork Broken, dated and mismatched furniture Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: Ill fitting windows (staff comment that they are draughty) Well worn and badly stained carpets Lack of equipment in the kitchen Doors damaged Bedrooms used a storerooms Dirty There is a new Arjo specialist bath fitted in this bungalow however the bathroom is very stark, institutionalised and uninviting. Bungalow 104 Damaged plasterwork Broken, dated and mismatched furniture Ill fitting windows (staff comment that they are draughty) Well worn and badly stained carpets Doors damaged Inappropriate bathing facilities, very old bath, seals no longer effective, covered in lime scale and clinical and institutional bathroom. Kitchen ;- fridge/freezer doors rusty, worktops very stained, microwave broken. This bungalow has a room used as a sensory environment and staff have worked hard to make service users bedrooms homely and personal, 2 carpets have been replaced in the service users bedrooms but the two that remain are badly stained and worn. Bungalow 100 There is fridge located in the main entrance hall (for staff use) due to there being no staff facilities Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: Damaged plasterwork Broken, dated and mismatched furniture Ill fitting windows (staff comment that they are draughty) Well worn and badly stained carpets Doors damaged Inappropriate bathing facilities, very old bath, seals no longer effective, covered in lime scale and clinical and institutional bathroom. Kitchen ;- fridge/freezer doors rusty, worktops very stained. Padding on the back of the toilet was torn. Staff have worked hard to make service users bedrooms homely and personal. Staff told us ; I would knock the building down and rebuild it The only problem is the environment, in fact it is getting worse, it desperately needs doing, staff try hard decorating bedrooms and keeping it clean The buildings need modernising, redecorating and new bathrooms and make the gardens nicer In my opinion the service users at Park View are some of the best cared for living in the most run down building which can be disheartening for the staff and moral. There is nothing the staff can do to change the building. The service could offer a refurbished home but this appears out of our hands at the moment Care Homes for Adults (18-65 years) Page 25 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a stable, competent and caring staff team that are aware of their complex needs and are able to meet them. Evidence: The manager produced a staffing list that showed that the home is almost fully staffed and all staff are permanently employed by Hull City Council. Since the previous inspection 1 x senior care officer P/T has been dismissed and another senior care officer has increased their hours from part time to full time to fill the vacancy. 1 x senior care officer is due to retire, this post will be filled by a SCO being redeployed from another home within Hull city Council. 1 x care assistant has been dismissed and the vacancy has been advertised and 1 x care assistant has left to take up another post, this is being filled by an agency worker currently. In addition to this two programme workers have been appointed to assist with Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: activities. Staff are up to date with their mandatory training and have completed values and attitudes and equality and diversity training. Staff have completed training in how to manage people that present behaviour that may pose a danger to themselves or others. The home has now achieved more than 50 of staff qualified with NVQ level 2 or above. Service specific training provided has included epilepsy, communication, eating and drinking, makaton and bowel massage. The speech and language therapist has provided some training in intensive interaction. Recruitment within Hull City Council is robust however there have been no external appointments to the home since the previous inspection. Staff told us;We have a good and experienced staff team, some of which have known the service users a long time The service has a regular staff team that has impacted well on residents Health professionals told us;As I come from a nursing background I always pay attention to detail in the interaction between staff and clients. I have always found the care staff to be fully skilled I feel they work as a team, very hard, they interact with clients very well, are very caring and put themselves out for the clients organising out of town trips, taking them out daily and also making outside agencies welcome I believe there is an appropriate skill mix within the service to meet the needs of the people who live there I have observed on numerous occasions staff speaking respectfully, knocking on doors before entering and speaking confidentially Service users told us with help from their relatives;Staff are very aware and give me really good support Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: The staff are very good and kind and they treat us very well Care Homes for Adults (18-65 years) Page 28 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well managed by a competent registered manager and senior care officers and a stable staff team provide consistent care to meet peoples complex needs, however this is being compromised by Hull City Councils slow response to dealing with the refurbishment of the building, redecoration and provision of good quality furnishings and appropriate bathing facilities. Evidence: The manager is registered with the Commission for Social Care Inspection. The manager has undertaken a wide range of training related to the post of manager and has completed NVQ 4 in Management and the Registered Managers Award covering the appropriate care components. She has over 20 years previous experience in a managerial and caring role. The home is continuing to improve under the current management arrangements and provides detailed individual plans of care, meets peoples health needs and provides Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: adequate numbers of staff who are trained, competent and caring. (See the main body of this report) As part of the inspection all of the maintenance certificates were seen and were up to date. Staff were up to date with their mandatory training. The LA has a well developed regulation 26 visiting and reporting system in place that monitors the improvements being made and makes recommendations and the registered manager routinely uses the CSCI regulation 37 reporting system to keep the inspector aware of any events that have happened in the home. The QA process was not examined at this inspection however the home still need time to fully implement this within the home and ensure that they engage fully with the staff team, stakeholders, people who use the service and relatives and listen to their concerns and take action to make improvements within the home. Staff told us;Managers are supportive and approachable The manager has supported me through a personal crisis Managers are excellent, very supportive and very dedicated My line manager is always available for support and advice. I have regular supervisions. I do feel well supported and am able to approach my line manager for informal supervisions However since a key inspection undertaken on 17/5/05 there has been no improvements to the fabric of the building, redecoration and provision of appropriate bathing facilities in the home. CSCI have significant concerns about the poor standard of the home (this is detailed further in the environment section of this report) and because of this the manager was issued with a Code b (PACE) notice informing her that the home are breach of the Care Standards Act regulations. requirement relating to the environment remain ans outstanding requirement and as such the CSCI is considering undertaking enforcement action. Care Homes for Adults (18-65 years) Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (b) The registered person must 30/04/2008 assess the persons need for bed rails in line with the MHRA guidance and ensure that there is a correct match between the person, the bed, the mattress and the bed rail and keep a written record so that people are kept safe from the risk of harm. 2 18 16 (2m) The registered person must 01/07/2008 recognise and act upon peoples rights to be provided with appropriate equipment and bathing facilities to meet their individual assessed needs. (Timescale of 30/09/07 not met) 3 24 23 The registered person must 01/07/2008 ensure that the home is redecorated inside and that a planned maintenance programme is provided so that people live in a comfortable home that meets their needs. (Timescale of 31/8/05, 31/03/06, 30/4/06, Care Homes for Adults (18-65 years) Page 31 of 37 01/09/06 30/06/07 not met) 4 24 23 The registered person must 01/07/2008 ensure that furnishings, fittings and equipment are of good quality and suitable for their purpose so that people live in a comfortable home that meets their needs. 5 27 13 (5) 23 (2j) The registered person must 01/07/2008 23 (2a) provide suitable baths to ensure that all of the people that live in the home are able to have a bath if they require one. (Timescale of 31/12/05, 30/4/06, 1/7/06, 30/09/06 and 30/09/07 not met) 6 29 13 (5) 23 (2j) The registered person must 23 (2a) ensure that recommendations made by suitably qualified specialists (occupational therapist) are followed to ensure peoples rights to independence, safety and dignity is maintained. 24 01/07/2008 7 42 The registered person must 01/07/2008 ensure that the home is able to meet all of the needs of the people that live there by providing suitable bathrooms and equipment to meet peoples individually assessed needs. Care Homes for Adults (18-65 years) Page 32 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 The organisation must 31/07/2009 ensure that health plans are prepared and kept updated that identify the full range of health needs and state how these are to be met this will ensure that needs are not overlooked and that all of peoples health needs are met. 2 24 23 The organisation must ensure that doorways are of a width sufficient to allow wheelchair users adequate access so that the premises are accessible for the people that live in the home. 31/12/2009 3 24 23 The organisation must 30/06/2009 provide premises which are safe, comfortable, bright, cheerful, airy, clean and free from offensive odours and provide sufficient and suitable light, heat and ventilation. Specifically Page 33 of 37 Care Homes for Adults (18-65 years) replace worn and stained carpets, replace or refurbish all of the windows, repair damaged plaster and redecorate and provide sufficient storage space. this will mean that people live in a home that is homely and comfortable and meets their needs. 4 25 23 The organisation must ensure that peoples rooms that accommodate wheelchair users have at least 12 sq meters usable floor space, excluding an suite so that there is sufficient space for turning, transferring and accessing belongings and for medical equipment and nursing requirements. 5 28 23 The organisation must 31/12/2009 ensure that a range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. Specifically that there is a meeting room/office fit for purpose that is private and separate to the communal space so that peoples privacy is maintained. 6 29 23 The organisation must 31/12/2009 provide specialist equipment as needed for each individual including for 31/12/2009 Care Homes for Adults (18-65 years) Page 34 of 37 example Moving equipment and overhead tracking for hoists, appropriate bathroom fittings and equipment and storage recharging facilities for wheelchairs and mobility equipment in a discreet separate area this will mean that people live in a home that is homely and comfortable and meets their needs. 7 37 10 The organisation must provide the CSCI with a copy of the lease for the building and the responsible persons must take action to ensure that the home is fit for purpose and complies with the care standard act and regulations and other legal requirements. This will mean that the home is managed with sufficient care competence and skill and is safe and meets the needs of the people who live there. 31/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Care plans should include detail of peoples finances and how they are helped to manage this and details of how they maintain their religious and cultural needs and how contact with family and friends is supported. Care Homes for Adults (18-65 years) Page 35 of 37 2 39 The organisation should ensure that homes QA system is developed and includes consultation with stakeholders, that information is collated and a written report is produced. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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