CARE HOMES FOR OLDER PEOPLE
Park View Park View Priory Road Warwick Warwickshire CV34 4ND Lead Inspector
Lesley Beadsworth Key Unannounced Inspection 22nd August 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Park View Address Park View Priory Road Warwick Warwickshire CV34 4ND 01926 493883 01926 491134 parkview@warwickshire.gov.uk 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) Warwickshire County Council, Social Services Department Mrs Annis Irene Tombs Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: Park View is a Local Authority home for elderly people, with thirty-five beds. It provides 28 permanent care places, 7 short stay/respite care places and 12 day care places. It is situated amongst largely sheltered housing on the edge of Warwick town centre. There are local shops within easy walking distance, but quite a steep hill into the town, making walking or pushing a wheelchair strenuous. There is car parking to the front and rear of the home. The home is within walking distance of the train station and ‘bus routes. Accommodation is provided on three floors. The ground floor is used for people on short stays and those coming in for day care, and has a restaurant, a conservatory, a lounge/diner, a hairdressing salon and the short stay bedrooms as well as the laundry, kitchen and domestic and staff offices. On each of the first and second floors are a lounge, a dining room and fourteen bedrooms, all with en-suite facilities. Each floor also has two bathrooms and a communal WC, and a very small office. The home is staffed over twenty-four hours. It has a management team of a registered manager, two assistant managers and two care officers, all full time, plus a clerical officer who works twenty hours a week. In addition the full staffing complement includes care assistants, domestic staff, a laundress and cooks. The home also has a small bank of staff to call on when needed. The home does not provide nursing care. Residents who require nursing attention receive this from the community nursing service, as they would in their own homes. The AQAA and the manager advised that the fees for permanent residents for 2007/8 are a maximum of £387.00 exclusive of hairdressing, chiropody, newspapers and toiletries. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection included a visit to Park View. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. A survey provided by us was completed and returned. Some of the information contained within these has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 09.45am and 08.50pm. What the service does well:
All care files contained evidence of pre-admission assessments taking place and of care plans being devised from them in order to meet the residents’ needs. The care plan (service plan) format is written in a way that reflects the strengths and preferences as well as the concerns or needs of the individual and which also addresses equality and diversity. All residents observed or spoken with during the visit were well groomed and looked well cared for. The home has a very secure procedure for the safety of medication cupboard keys. Senior staff were seen to follow this procedure throughout the visit. Some time was spent in the lounges. Observations showed that residents were cared for in a respectful manner and all residents spoken with confirmed that they were looked after very well and with respect. This ensures that their dignity and self-esteem are maintained. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 6 Residents were occupied and stimulated due to the organised activities carried out in the home and the interaction of staff. One relative said in a survey returned to us, “Interaction between staff and residents makes for a lively and stimulating lifestyle.” This was also apparent in observations made with a lively environment throughout the day. The home also celebrates special occasions including residents’ birthdays and in the past year has been able to celebrate three 100-year birthdays, which residents spoke about. A further comment by a relative in answer to the question in our survey, “What do you feel the care home does best?” was “Giving residents trips, events and celebrating (e.g. birthdays.)”. Visitors are made welcome and there was a comfortable rapport between them and the staff. Visitors looked at ease in the home and a relative spoken to spoke extremely highly of the home, the care provided and the way in which the family were made to feel welcome. Care plans and discussion with residents and staff showed that residents have choices in their daily lives, such as when to go to bed and when to get up, what to eat and where, whether to join in organised activities and what to wear. Bedrooms looked at showed that residents were able to bring in personal possessions and pictures, photographs and ornaments were seen in these rooms. A meal was taken with the residents and the mealtime was a social event with chatter and laughter throughout the mealtime. Care staff served the food from a heated trolley in the dining room and the meal was well presented and tasty and residents said that they enjoyed their meals at the home. Assistance and support with eating was available to residents as was required and was offered and given in a sensitive, discreet and unhurried way. The home keeps a record of complaints or concerns made to them and deal with them through the Local Authorities complaint procedure. A relative advised in a completed survey that, “Park View always listens and responds.” The records kept and the comments made by relatives and residents shows that the home takes complaints seriously, that they give people confidence that they will be taken seriously and that they will be acted upon. Staff have the knowledge and skills required to safeguard residents from abuse.
Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 7 The home was mainly well decorated and furnished. Apart from soiled carpets in the restaurant and first floor corridors the areas of the home viewed were clean, well maintained and free of any offensive odour. The home offers comfortable and attractive accommodation. The home has aids and equipment to assist residents to maintain independence. These included a tracking hoist to assist residents to transfer from their bed or chair, adjustable hospital-type beds with adjustable heights, pressure relieving mattresses and hand rails in ensuite toilets. The home has good infection control systems to safeguard residents from cross infection. Training undertaken by staff includes mandatory training such as Moving and Handling, Emergency (First) Aid and Basic Food Hygiene and other training such as Infection Control, Dying and Death, Dementia and Equality and Diversity. All new staff undertake Induction training. What has improved since the last inspection?
The requirements made at the last inspection had either been met, partly met or were no longer applicable at this inspection. • Some staff have undertaken training related to dementia needs and further training is planned for other staff. • The home is on target to meet the required number of 50 of the care staff to have the National Vocational Qualification (NVQ) Level 2 in Care qualification before the end of the year. • The manager has now been registered with us. • A representative of the registered provider makes an unannounced visit each month and forwards a report to the registered manager and to us. Other improvements since the last inspection include new floor covering to the first and second floor dining rooms, and second floor corridor, new furniture in the first and second floor lounges and dining rooms and two bedrooms have been redecorated. There have been regular residents meetings throughout the year and minutes are made available for residents and visitors to read. All staff are currently completing workbooks related to Protection of Vulnerable Adults so that the have the knowledge and skills to safeguard residents from abuse. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 8 What they could do better:
The resident and/or their representative had not signed one of the care plans looked at with no reason recorded as to why not. There was no other evidence to support that the resident had been involved or had agreed with their plan of care. There were no risk assessments related to the potential for individuals to develop pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area), or to the occurrence of falls. These omissions do not safeguard the welfare of residents. One of the residents had no weight record for the previous two months and without this it cannot be determined that nutritional needs are met. There was also a bath register in each care file but these had not been completed for two to three weeks. The medication of the residents who were case tracked, and others at random, were audited. There were a few gaps in the signatures on the Medication Administration Record Sheets (MARS) and some errors identified in the number of tablets remaining compared to those signed for. This has a potential of risk to the residents’ health and welfare. There were two containers of prescribed ointments found in bedrooms that although correctly labelled did not have the date of opening. This is necessary because the contents can become unstable if they have been open for too long. Creams should be disposed of two months after opening and ointments containing an active ingredient should be disposed of one month after opening. One staff file looked at did not contain a new Criminal Records Bureau (CRB) check prior to transferring from another Warwickshire County Council care home. CRB checks are not portable even between homes belonging to the same provider. New staff must be checked against the Protection of Vulnerable Adults list prior to being offered employment. The residents would benefit from staff undertaking further training in specialist subjects in order to meet such specialist needs as Parkinson’s disease, sensory impairment and continence. About 40 of the staff are due for an update in fire training although the registered manager advised that this was planned. This is necessary if residents and staff are to be protected in the event of a fire. There was no evidence available to show that the tracking hoists used in bedrooms had been serviced or maintained in order to safeguard residents using them. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Effort is made to meet cultural and religious needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service User Guides were found in each of the bedrooms visited. These explained the services provided by the home. A visitor spoken with also confirmed that these documents had been provided when their relative came to live in the home. Three care files were looked at as part of the case tracking process. The social work team had carried out assessments for the prospective residents prior to referrals being made to the home and copies of these were found in the care files.
Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 12 The referrals were followed by a visit by a senior member of staff to assess if the home was able to meet their needs. A format provided by the Local Authority is used on these visits and has headings that cover the required areas of need. These assessments were used to form the care plan. The registered manager advised that anyone thinking of moving into Park View could visit the home beforehand although those residents spoken with said that their family had visited on their behalf. The care plan (known by the home as the service plan) format is written in a way that reflects the strengths and preferences as well as the concerns or needs of the individual and which also addresses equality and diversity. Church services are held in the home for the current resident group, with Communion being brought into the home by local ministers as residents choose. A Baptist service is currently held once a month. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. There are shortfalls in care plans that carry the risk of residents not being involved in their care. Residents have access to health care professionals and they are cared for in a respectful and caring manner. There are some concerns around the medication process that could mean risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at as part of the case tracking process. As previously discussed strengths and preferences are recorded alongside needs and concerns and the care that is required to be provided by care staff in order to meet the identified aims for that individual. Those care plans looked at were appropriate, covering all areas of need. Whilst they were well organised, which helped the reading of the records, the format asks for a great deal of information, which would make extracting specific information prolonged. They were up to date having been reviewed and revised monthly and as required. The section relating to personal hygiene emphasised the need for care to be given in a dignified manner and this was seen during the visit.
Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 14 One of the plans had not been signed by the resident and/or their representative with no reason recorded as to why not. There was no other evidence to support that the resident had been involved or agreed with their plan of care. One of the residents had no weight record for the previous two months and without this it cannot be determined that nutritional needs are met. There was also a bath register in each care file but these had not been completed for two to three weeks. Daily records were in evidence and had been completed by the care staff. These showed daily activities and occupation as well as looking at how needs are met and any changes in needs or general condition. Residents on going health care needs were being met with evidence of visits to, or visits by the GP, District Nurse, optician, and chiropodist being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared for although one resident was seen to need nail care. This was mentioned to the registered manager who advised that this resident refused to have this care given. This needs to be included in the care plan along with any systems in place to assist the resident to have clean nails. Risk assessments were available for moving and handling (assistance with transferring from one place to another), self-administering of medication and nutrition, although these had not been reviewed or updated. There were no risk assessments related to the potential for developing pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area), or to the occurrence of falls. These omissions do not safeguard the welfare of residents. However measures to prevent pressure sores, such as pressure relieving mattresses and cushions, were in use. A district nurse was visiting a resident twice a week to attend to a trauma wound but the registered manager advised that there were no other residents with pressure sores. The home has a very secure procedure for the safety of medicine, and other, keys. Senior staff were seen to follow this procedure throughout the visit. Senior staff are responsible for medication and they have undertaken an in depth medication ‘Distance Learning’ course. Most of the care staff have undertaken training with the home’s designated pharmacist. Medication is stored in locked medication trolleys, in a locked room on each of the three floors, with controlled drugs stored appropriately on one of these floors. The medication of the residents who were case tracked, and others at random, were audited. There were a few gaps in the signatures on the Medication Administration Record Sheets (MARS). A course of antibiotics was not recorded
Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 15 on the MARS as having been received but the original packaging said that 28 had been dispensed. There was a signature gap on the relevant MARS, two further signatures and 26 tablets remaining, indicating that the medication may not have been given at the time of the gap on the MARS but with no explanation as to why. A further error was noted with 56 Sodium Valporate tablets received for a resident, 43 tablets were remaining; there were 16 signatures and one signature gap. This indicates that there were signatures recorded, and /or a gap, when the medication was not given. These errors create a risk to the health of the residents concerned and rigorous auditing of medication and of staff competence needs to be carried out by the registered manager to prevent these errors occurring. There were two containers of prescribed ointments found in bedrooms that although correctly labelled they did not have the date of opening, which is necessary as the contents can become unstable if they have been open for too long. Creams should be disposed of two months after opening and ointments containing an active ingredient should be disposed of one month after opening. Time was spent in the lounges with residents and observations showed that residents were cared for in a respectful manner and all residents spoken with confirmed that they were looked after very well and with respect. This ensures that their dignity and self-esteem are maintained. There was a comfortable level of banter and communication between the resident and staff and residents were seen to be very much at home and relaxed when moving around the building. Residents care files also contained the residents’ preferred names and staff were heard to use these when addressing residents. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home also caters for day care service users who use the conservatory adjacent to the large dining room known as the restaurant. Residents of the home, both permanent and short stay, join these service users for activities provided there, if they wish. An activity programme on display in the home included Bingo, Reminiscence, Fizzical Fun (armchair exercises), Church services, Karaoke and other entertainment. Trips to pubs and shopping are organised using the Organisation’s vehicle. One relative said in a survey returned to us, “Interaction between staff and residents makes for a lively and stimulating lifestyle.”
Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 17 Observations throughout the day also reflected this. Residents were also following their own hobbies such as knitting and those spoken with said that they had plenty to keep them occupied. The home celebrates special occasions including residents’ birthdays and in the past year has been able to celebrate three 100th birthdays, which the residents recalled and spoke about. A further comment by a relative in answer to the question “What do you feel the care home does best?” in our survey included, “Giving residents trips, events and celebrating (e.g. birthdays.)” There have been regular residents meetings throughout the year and minutes are made available for residents and visitors to read. Visitors looked at ease in the home and a relative spoken to spoke extremely highly of the care provided and the way in which the family were made to feel welcome. There were no restrictions made to visiting and could be with their friend or relative in the communal areas or the privacy of their own bedroom. A relative suggested in our survey that there needed to be someone at reception to receive visitors, as although staff welcomed them very well they had to leave what they were doing to welcome visitors. Care plans and discussion with residents and staff showed that residents have choices in their daily lives, such as when to go to bed and when to get up, what to eat and where, whether to join in organised activities and what to wear. Bedrooms looked at showed that residents were able to bring in personal possessions and pictures, photographs and ornaments were seen in these rooms. One bedroom also had a glass cabinet full of ornaments and was brought in by the occupant of the room. A meal was taken with the residents in one of the small dining rooms upstairs. The dining room was small and it would be difficult to ensure all the residents on that floor were able to sit there, especially with walking frames and/or wheelchairs. However on the day of the visit it was a cosy environment and the mealtime was a social event with chatter and laughter throughout the mealtime. Care staff served the food from a heated trolley in the dining room and the meal was well presented and tasty. Drinks were available throughout the meal and served in appropriate glasses. The menus are varied and nutritious with residents saying that they could make choices of what to eat. They also made positive comments about the food at Park View. A relative also said in a completed survey that the food seemed very good. Assistance and support with eating was available to residents as was required and was offered and given in a sensitive, discreet and unhurried way. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 18 The kitchen was visited and found to be clean and generally well managed. Temperatures of fridges and freezers in the kitchen and throughout the home had been taken and recorded on a daily basis to ensure that the appropriate temperatures to prevent food deterioration, and possible food poisoning, were maintained Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. The home has appropriate policies and procedures to safeguard residents. recruitment procedures generally safeguard residents from the employment of inappropriate staff but there was a short fall that had the potential to put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no complaints, concerns or adult safeguarding referrals made to us since the last inspection. The home keeps a record of complaints or concerns made to them and address them through the Local Authorities complaint procedure, which is also linked with the Quality Assurance Programme. The procedure is straightforward and is available to residents and visitors. It is displayed in the home and given to residents and/or their relatives in the Statement of Purpose and Service User Guide. A relative advised in a completed survey that, “Notices are pinned around the building – plus this was also included in original documentation” and, “Park View always listens and responds.” Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 20 The records kept and the comments made by relatives and residents shows that the home takes complaints seriously, that they give people confidence that they will be taken seriously and that they will be acted upon. Complaint records showed seven complaints related to different issues, regarding staff attitude, missing money, care of residents’ clothing, the lack of televisions in short stay bedrooms and the development of a pressure sore during a short stay. All of these complaints were satisfactorily investigated, the results shared with the complainant and the action taken recorded. The records kept and the comments made by relatives and residents shows that the home takes complaints seriously, that they give people confidence that they will be taken seriously and that they will be acted upon. The home has an Adult Protection policy in place. All staff were completing a Protection of Vulnerable Adults workbook to give them the awareness they would need to identify and prevent adult abuse. Staff spoken to showed an understanding of this and said that they would not hesitate to report any suspected or alleged abuse to the senior person on duty. Although the recruitment procedure generally safeguards residents from the appointment of inappropriate employees, one staff file did not hold any evidence of a Protection of Vulnerable Adults check or a Criminal Records Bureau disclosure that was relevant to Park View. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24,26 Quality in this outcome area is good. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour and generally safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Park View is a traditional purpose built care home that was refurbished and modernised to a good standard several years ago. Accommodation is provided on three floors. The ground floor is used for people on short stay and those coming in for day care. It has a large dining room known as the restaurant, a conservatory, a lounge/diner, a hairdressing salon and the short stay bedrooms as well as the laundry, kitchen and four staff offices. On each of the first and second floors are a small lounge, a small dining room and fourteen bedrooms, all with en-suite facilities. Each floor also has two bathrooms and a Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 22 communal toilet, and a small lockable office which houses care files and the medication trolley. The home was mainly well decorated and furnished with new and attractive furniture in the lounges and new attractive floor covering added to the recently decorated and furnished dining rooms on the first and second floors. The second floor corridor had been decorated and recarpeted and looked bright and clean. The first floor corridor is in need of attention, as both the carpets and wallpaper were soiled and ‘past their best’. The registered manager advised that funding had been allocated for carpet to be replaced and decorating to take place in this financial year, and also for replacement of the restaurant carpet, which was also badly soiled. Apart from the soiled carpets mentioned, the areas of the home viewed were clean, well maintained and free of any offensive odour. The home offers comfortable and attractive accommodation. The laundry room had washing machines with the programmes required to maintain infection control and there are adequate tumble driers. The room was clean and well organised apart from some clean washing that had been placed on the floor for sorting. This would create the potential for cross infection. The bedrooms of the three residents case tracked and three further bedrooms were viewed. Each was personalised by the occupant’s belongings of pictures, eiderdowns, photos, ornaments and small pieces of furniture. The AQAA returned to us by the home also stated that residents were able to furnish their bedroom themselves if they wished. Aids to maintain residents’ independence were provided. Ensuite facilities had handrails in place around the toilet and wash hand basin and one bedroom had a hoist tracking system to assist the occupant to transfer from the bed. The registered manager advised that this system was temporarily fitted and so could be moved to any bedroom in which a resident needed it. The home also had several other tracking hoists that could be used in the same way. Hospitaltype beds with adjustable heights and pressure relieving mattresses were also in use for those residents who needed them, thereby maintaining independence and protecting the well being of residents. All bedrooms viewed were clean and free of offensive odour. Hand washing facilities throughout the communal areas consisted of soap dispensers and disposable towels that assisted in preventing cross infection. Staff also had access to disposable aprons and gloves to wear as protective clothing to further maintain infection control. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There are sufficient care staff available to meet the needs of the residents. A shortfall in employment checks had the potential to put residents at risk. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and staff spoken with felt that the home had sufficient staff to meet the needs of the people living there. However consideration should be given to monitoring if there are sufficient night staff to cover effectively and safely the bedrooms over three floors. There were two care staff rotered to work during the night from the hours of 9.45pm and 7.45am. A rota showed what hours staff work and confirmed if the hours have been worked. The rota showed that there are three care staff in the morning and two in the evening on the first and second floor and one care assistant throughout the day on the ground floor with the respite/short stay residents. This was the case on the visit. The home is on target to meet the required number of 50 of the care staff to have the National Vocational Qualification (NVQ) Level 2 in Care qualification before the end of the year. 12 staff have NVQ Level 2 in Care and six more
Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 24 staff are working towards it. One member of staff is working towards NVQ Level 3 in Care. This qualification shows that staff are competent in their role. Three staff files were looked at and examination of these showed that two references are requested for each applicant. Two of the files contained Criminal Records Bureau checks and evidence that they had been recruited in a manner that protected residents from the employment of unsuitable people and being mindful of equal opportunities. However one member of staff who had recently transferred from another Warwickshire County Council care home had not had a new Criminal Records Bureau (CRB) disclosure carried out on starting employment at Park View. CRB checks are not portable even between homes belonging to the same provider. New staff must be checked against the Protection of Vulnerable Adults list prior to being offered employment. Records showed that there has been training undertaken by staff since the last inspection, and the registered manager advised that there are several subjects for which staff were due to undertake refresher training. There was evidence in staff files and in the AQAA that new staff undertake Induction training that gives them the information and knowledge to carry out their job. Other training undertaken by staff includes mandatory training such as Moving and Handling, Emergency (First) Aid and Basic Food Hygiene and other training such as Infection Control, Dying and Death, Dementia and Equality and Diversity. The residents would benefit from staff undertaking further training related to the assessed needs of current residents such sensory impairment and continence. About 40 of the staff are due for an update in fire training and the registered manager advised that this was planned. This is necessary if residents and staff are to be protected in the event of a fire. All staff are currently completing workbooks related to Protection of Vulnerable Adults so that the have the knowledge and skills to safeguard residents from abuse. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is adequate. A person undertaking the appropriate qualification and who has previous management experience manages the home. Services operate in the best interests of residents. Systems are in place to protect the health, safety and welfare of the people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been at the home since September 2006 and has had fourteen years previous experience of managing care homes. She has the required qualifications of National Vocational Qualification Level 4 in Management and the Registered Managers Award. In addition to this she has Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 26 the social work qualification, the Diploma in Social Work and has undertaken the Person Centred Dementia Care training. Staff spoken with said that they felt supported by the manager although one suggested that staff morale may be low due to the amount of agency staff needed to cover absences and vacancies. Residents said that they would be able to go to her with their concerns. The home has the implemented the Department’s Quality Assurance Programme which consists of Policies and Procedures with audits and monitoring systems that link to them. An independent person visits the home once a month unannounced to carry out an audit on that the home is maintaining relevant and required standards. A report is then forwarded to us and to the registered manager. The home holds some monies for some residents, which was kept in a way that acted in the residents’ best interests. Records of any transactions made were kept and those checked at random were in good order. Corresponding money checks were accurate, and kept individually and securely. A notice in the home advised residents and visitors of Advocacy services to enable them to use this facility if needed. To further safeguard residents’ financial interests all staff have signed the policy regarding gifts and wills. The home was mainly a safe environment for people living and working there with evidence that equipment was being regularly serviced, apart from the tracking hoist system in some bedrooms. This information was not available at the time of the visit. All in-house fire checks on fire prevention and alarm system were up to date. Fire training was due for 40 of the staff and had been planned. As previously discussed the majority of staff had undertaken other mandatory health, safety, and welfare training. Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP8 Regulation 12 Requirement There must be an up to date risk assessment carried out for each residents regarding the chance of the development of pressure sores and the risk of falls and what action is appropriate to put into place. This will ensure that the risk to the residents is minimised. Medication must be given to the people living at the home as prescribed and recorded accurately. This will safeguard the welfare of the residents. Ointments and creams must be labelled with the date of opening in order to protect the well being of the residents using them. New staff at the home must not be confirmed in post without a satisfactory and up to date Criminal Records Bureau disclosure and Protection of Vulnerable Adults check. This will safeguard residents from the appointment of unsatisfactory employees. Training must be provided for staff related to the assessed
DS0000042008.V344504.R01.S.doc Timescale for action 15/10/07 2. OP9 13 15/10/07 3. OP9 13 30/09/07 4. OP29 19 15/10/07 5. OP30 18 30/11/07 Park View Version 5.2 Page 29 6. OP38 13(4) needs of current residents. This will ensure that staff have the required knowledge and skills to meet these needs. The previous timescale of 01/01/07 was not met. All lifting equipment used by residents must be serviced and maintained in line with the manufacturer’s recommendations. This will maintain the safety of the people using this equipment. 15/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations There should be evidence to demonstrate that residents have been involved in the drawing up of their care plan. Care plans should be devised in such a way that staff are able to easily locate the information they require to provide the appropriate care. All records of weight and personal care should be kept up to date. The identified floor covering and décor should be replaced. Given the needs of the residents and the layout of the building consideration should be give to the number of night staff on duty during the night. 3. 4. 5. OP8 OP19 OP27 Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Park View DS0000042008.V344504.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
