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Inspection on 23/07/07 for Park View

Also see our care home review for Park View for more information

This inspection was carried out on 23rd July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is relaxed and has a friendly environment. The premises are secure and visitors are able to visit at any time and see their loved ones in private. Rooms are well personalised and residents encouraged to bring their own possessions into the home, subject to space availability. Residents said that the manager was always available and kept they and their relatives informed. Residents who completed surveys stated that they usually or always received the care and support they needed. The assessment process is robust. Potential residents are supplied with all the information needed to make an informed choice. Assessments are undertaken prior to admission, either in the resident`s home or in hospital wherever possible. Care plans are detailed; appropriate risk assessments are undertaken and regularly reviewed. Access to healthcare services is good and there is good monitoring of residents healthcare needs with good communication between the multi-disciplinary team. Complaints and allegation of abuse are investigated thoroughly and appropriate action taken where relevant. Recruitment procedures are robust and care staff have access to an established training programme.

What has improved since the last inspection?

Care planning has improved and is more comprehensive. A Pool Activity Level (PAL) checklist has been introduced to assist care staff in developing a social activities care plan and in providing activities that meet residents` needs. Residents have been encouraged to plant flowers and sensory items (wind chimes etc.) have been provided in the internal quadrangle garden. Some action had been taken to monitor and audit standards for administration of medication. Monitoring surveys have also been introduced for cleaning and food. A senior domestic post has been approved and has been appointed to. Links and access to multi-disciplinary services have been strengthened (continence, occupational therapy, physiotherapy, chiropody, dental, rapid assessment etc.). Residents are now enabled a choice of dentist, chiropodist and hairdresser. The home had established links with a home service for purchasing personal clothing and slippers for residents that could be provided with their names embroidered. It was reported that this had been beneficial to relatives and ensured clothing was more easily returned to the rightful owner. The deputy manager has recently completed an accredited dementia course via open learning and a care team manager was undertaking a dementia course. Training had been provided on the Mental Capacity Act that had also been cascaded to care staff. More specialised hoist slings had been purchased for residents and improvements made in the response for repair and maintenance of equipment although evidence of this was yet to show.

What the care home could do better:

It was disappointing to note that all requirements from the previous key inspection have been repeated. There was a lack of monitoring of residents` care needs evident during the inspection. Care staffing levels (an ongoing issue) and domestic staff hours were inadequate for the size of the home and dependency needs of residents. The standard of cleaning and maintenance had deteriorated considerably both internally and externally with heavily stained carpets and furnishings and malodorous smells evident in communal rooms and numerous residents` rooms. The gardens were also in need of maintenance and tidying. Infection control practices also gave cause for concern (not wearing protective clothing, handling of laundry, availability of liquid soap and paper towels). Residents` personal care and privacy and dignity needs were not consistently met. Some issues with medication remained that did not ensure residents received their medication as prescribed. The social activities coordinator worked only one day per week, the remaining hours being vacant. The provision of social and therapeutic activities is therefore limited, although some are provided by care staff who are already overstretched. The food served was generally good and appreciated byresidents but the quality of meat and a lack of individual choices, particularly at supper time concerned some residents. Several residents spoken with and stated in completed surveys that they were not offered a cup of tea when they woke up.

CARE HOMES FOR OLDER PEOPLE Park View Kings Chase Witham Essex CM8 1AX Lead Inspector Diana Green Unannounced Inspection 23rd July 2007 09:30 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 DS0000028381.V348133.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 DS0000028381.V348133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park View Address Kings Chase Witham Essex CM8 1AX 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) 01376 512443 01376 510137 parkview@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Mrs Carol Ann Hunt Care Home 80 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (80) of places Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 80 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 21 persons) Service users under the Mental Health Act 1983 must not be admitted to the home The total number of service users accommodated in the home must not exceed 80 persons One service user aged 87 years with dementia whose name was made known to the Commission in August 2004 to be cared for in the OP unit 27th July 2006 Date of last inspection Brief Description of the Service: Park View is a large fully detached purpose built two-story building situated in the centre of Witham and close to all amenities, facilities and public transport links. The home provides accommodation for up to 80 elderly people (over 65), within 4 self-contained units. The accommodation comprises 80 single bedrooms with 79 en-suite facilities. Communal facilities include 4 lounge/dining rooms, 2 lounges, quiet room and a smoking room. There is a large conservatory overlooking the local park. There are 9 bathrooms, all equipped for assisted bathing. Two passenger lifts provide access between floors, one of which can take an ambulance stretcher. Car parking for visitors is provided to the front of the building and there is an enclosed and accessible courtyard garden area. A local park is directly adjacent to the property providing some rooms with pleasant views. The fees range from £421.59 - £476.25 weekly. Additional costs apply for chiropody, toiletries, sundries, hairdressing and newspapers. This information was provided to the CSCI on 14/08/07. Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection undertaken on the 23/07/07 and lasted 8.5 hours. The inspection process included: discussions with the manager, the deputy manger, the cook, the laundry assistant, nine residents, nine care staff, four visitors and feedback from relatives and health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen, the laundry and the sluicerooms; an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Twenty-five standards were inspected and ten requirements and five recommendations made. The manager, deputy manager and staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection? Care planning has improved and is more comprehensive. A Pool Activity Level (PAL) checklist has been introduced to assist care staff in developing a social Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 6 activities care plan and in providing activities that meet residents’ needs. Residents have been encouraged to plant flowers and sensory items (wind chimes etc.) have been provided in the internal quadrangle garden. Some action had been taken to monitor and audit standards for administration of medication. Monitoring surveys have also been introduced for cleaning and food. A senior domestic post has been approved and has been appointed to. Links and access to multi-disciplinary services have been strengthened (continence, occupational therapy, physiotherapy, chiropody, dental, rapid assessment etc.). Residents are now enabled a choice of dentist, chiropodist and hairdresser. The home had established links with a home service for purchasing personal clothing and slippers for residents that could be provided with their names embroidered. It was reported that this had been beneficial to relatives and ensured clothing was more easily returned to the rightful owner. The deputy manager has recently completed an accredited dementia course via open learning and a care team manager was undertaking a dementia course. Training had been provided on the Mental Capacity Act that had also been cascaded to care staff. More specialised hoist slings had been purchased for residents and improvements made in the response for repair and maintenance of equipment although evidence of this was yet to show. What they could do better: It was disappointing to note that all requirements from the previous key inspection have been repeated. There was a lack of monitoring of residents’ care needs evident during the inspection. Care staffing levels (an ongoing issue) and domestic staff hours were inadequate for the size of the home and dependency needs of residents. The standard of cleaning and maintenance had deteriorated considerably both internally and externally with heavily stained carpets and furnishings and malodorous smells evident in communal rooms and numerous residents’ rooms. The gardens were also in need of maintenance and tidying. Infection control practices also gave cause for concern (not wearing protective clothing, handling of laundry, availability of liquid soap and paper towels). Residents’ personal care and privacy and dignity needs were not consistently met. Some issues with medication remained that did not ensure residents received their medication as prescribed. The social activities coordinator worked only one day per week, the remaining hours being vacant. The provision of social and therapeutic activities is therefore limited, although some are provided by care staff who are already overstretched. The food served was generally good and appreciated by Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 7 residents but the quality of meat and a lack of individual choices, particularly at supper time concerned some residents. Several residents spoken with and stated in completed surveys that they were not offered a cup of tea when they woke up. 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 DS0000028381.V348133.R01.S.doc Version 5.2 Page 8 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 DS0000028381.V348133.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good based upon sampled inspected standards 1, 3, & 6 Residents were well informed, had their needs assessed prior to moving in to the home. Changing/developing needs were assessed to ensure they were appropriately met. This home does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a recently updated statement of purpose and a service user guide/welcome pack (viewed in several residents’ rooms). Relatives spoken with confirmed that a copy of the statement of purpose had been made available to them. Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 10 Five service user files were sampled. All had an assessment of needs undertaken by the manager/deputy manager prior to admission that included all elements as detailed under this standard. The assessment comprised a tick box that was used to inform the care plan. Information was brief but did cover all needs. Care management assessments were obtained where relevant and held on file. This home does not provide intermediate care. Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate based upon standards 7, 8, 9 & 10. The standards of care planning and access to healthcare were good but residents’ personal care and privacy and dignity needs were not consistently met. Whilst the standards for administration and recording of medication were in the main good, a lack of robust monitoring did not ensure residents received their medication as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans were reviewed during the site visit including one respite stay. All were person centred and completed in detail. Risk assessments undertaken included individual risks for falls; moving & handling; pressure ulcers; continence; and nutrition. All risk assessments and care plans had been reviewed regularly. Daily records were comprehensive and detailed good monitoring of needs and how the resident spent their day. However for one resident receiving respite there was no consent to the care plan recorded. Care Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 12 staff were also observed not to be following care plans. For example one care plan stated to use a guarded plate and utensils but the resident had not been provided with either. The records confirmed evidence of good monitoring of health care needs with prompt referral to GPs and health care professionals and appropriate follow up action being taken. The home was supported by the local GP practice whose representative attended regularly and on request. There was evidence of access to outpatient services, dental, chiropody and eye tests annually. District nurses and community psychiatric nurses attended as relevant. Care plans included guidance to staff in following advice from district nurses. Positive feedback was received from a district nurse and community psychiatric nurse who were undertaking reviews of residents’ needs. A liaison nurse provides advice and support to the home and acts as a link between hospital and community. Picture information had been provided on notice boards for residents’ information for the shop and chiropodist visits. There has been improved support from continence services to the home. Referrals are also made to a local rapid assessment unit, which has improved residents’ access to therapy services. The manager reported that the loss of a link community psychiatric nurse means that all referrals have to go through the GP which has had an impact on the residents’ care as there is a time delay, and referrals are not always forwarded. Feedback from some relatives indicated that staff did not have time to spend with residents and they had to wait to receive personal care. Residents said they had to wait during the night to receive assistance and felt there were too few staff on duty. During the lunchtime period, several residents who needed some assistance with eating/supervision were observed in their rooms without any staff providing assistance or monitoring them. One had fallen asleep with their food in front of them and another resident with sight impairment had no protective clothing and had therefore spilled food on their clothes and on the floor. Feedback was also received from a relative that their loved one’s health and wellbeing had improved considerably since admission to Park View. The home had a policy and procedures for the safe administration and recording of medication. Medication was administered by care team managers who had received training and been assessed as competent to give medication. A current list of those staff signatures and initials was available. There were two clinical rooms, one on each floor of the home where medication was stored. There were three trolleys used for storage and medication rounds that were secured to the wall. The ground floor medication room was inspected. The room had an air conditioning unit installed and daily monitoring and recording of room temperatures was undertaken and recorded. The drug refrigerator was kept in the district nurses’ room nearby and was not checked on this occasion. Controlled drugs were stored separately in each clinical room. Records inspected had a photograph of the resident and a medication profile on each individual record. Night care team managers were responsible for the ordering, receipt and return of medication and prescriptions were seen by them. There was no overstocking of medicines evident. Records sampled were Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 13 generally well recorded. However the dose of one liquid medication had been transcribed inaccurately on the medicines administration record (MAR). Another instruction for PRN medication was also unclear. As were instructions recorded on the charts used for administration of creams held in residents’ rooms; also there was no record for one prescribed cream available. There was no start date recorded on some individual containers of medication and creams. One resident’s prescribed cream could not be found and had evidently not been available for ten days. Staff were observed to knock before entering residents’ rooms and residents spoken with said that staff were friendly and addressed them by their preferred name. However one resident was observed sitting in a recliner chair in the lounge and another resident’s door had been left open; both were in a partial state of undress. There was also a lack of attention to residents’ sensory needs (reference standard 7 & 8). There were no shared rooms. All residents’ rooms were single en-suite accommodation and treatment was therefore provided in their room ensuring their privacy was respected. One resident said they would like a key to their room but this had not been provided. Feedback received from visiting professionals indicated that residents’ privacy was in the main respected although there were occasional lapses. The home had established links with a home service for purchasing personal clothing and slippers for residents that could be provided with their names embroidered. It was reported that this had been beneficial to relatives and ensured clothing was more easily returned to the rightful owner. Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate based upon standards 12, 13, 14 & 15. The social and therapeutic activities provided at Park View are limited and do not enhance the lives of all residents. The home provided residents with a well-balanced and nutritious diet with choices accommodated but this is sometimes compromised by the quality of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was no activities coordinator on duty. The manager stated that since the activities coordinator left employment several months ago, no replacement had been found. Social activities were therefore limited to one day per week and care staff provided some activities at other times. A programme of activities was observed on display but it was not confirmed if these took place. A Pool Activity Level (PAL) checklist was seen. This was an assessment completed over a two-week period to produce a profile indicating which activities were most suited to the individual resident. Care staff were observed encouraging residents who were able to take part in a quiz during the afternoon. Staff Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 15 undertake fundraising to provide entertainment for residents, that is not funded by Runwood Homes. There are no group outings arranged although some individual residents are taken out occasionally. Residents who completed surveys stated that they enjoyed the sing a long and sometimes spent time drawing in their rooms. One said they liked being taken for walks and another that they appreciated staff getting their library books. Most residents who completed surveys stated that there were usually enough social activities that met their needs and some stated that there were always. Some residents said they preferred to stay in their own rooms. Several visitors were seen to visit the home during the day. Those spoken with said that they could visit at anytime and could see their relative in private. One relative said they were usually made to feel welcome but staff were always busy and this impacted on the care being provided and there was a lack of individual care. Another relative stated that most staff did not have time to talk with residents who chose to stay in their rooms and their loved one only saw staff when they brought meals or drinks. Efforts were made to communicate with relatives through the manager’s open door policy, residents meetings and telephone contact where needs had changed. There was some involvement with local groups, schools etc. during the festive season. All residents had a relative or representative to act on their behalf. Information was also made available to residents with regard to accessing advocacy services (Alzheimer’s Society etc.) if required. Some residents’ rooms had personal items of furniture and pictures that they had been enabled to bring into the home. Residents were observed to have their meals in their own rooms, or the dining room as they chose. There was evidence that some residents were enabled a choice of time in getting up/ going to bed etc. Efforts had also been made to improve residents’ choice of dentist, chiropodist and hairdresser. There was no menu on display. The home operates a four weekly menu: this was a corporate menu that had been developed for Runwood Homes following an analysis of the nutritional content of a sample of menus previously in operation at various homes, in order to ensure an appropriate nutritional input for residents. The manager said that menu-monitoring forms had been developed to obtain feedback from residents on the food. A vegetarian diet had also recently been developed. A mixed response was received from residents during the inspection. Some said they enjoyed the food and others that there was a lack of choice and the meat was sometimes not cooked and was tough. One said their roast dinner was cold when served and they were only served sandwiches at tea and not cakes as others who eat in dining room. Several of the dining rooms were seen laid with cutlery and condiments but no tablecloths. The lunchtime meal was observed and comprised a choice of Irish stew or pasta bake with carrots and peas followed by rhubarb crumble and custard and drinks of juice were also provided. Most residents appeared to enjoy their meal. The meal was sampled: some meat was rather tough and Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 16 grisly but the vegetables were nicely cooked and the food was hot. Other comments were received from residents: for example one resident who had diabetes said they had not been able to have canderal sweetener for two mornings; and they were given sugar in their tea when they don’t like it; another said “I sometimes have to wait until ten o’clock before I get a drink”. Some residents who needed assistance were noted not to receive appropriate supervision (reference also standard 8). Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good based upon standard 16 & 18. Appropriate policies, procedures and practices were in place to promote the protection of residents from abuse. The manager actively promoted awareness of protection issues through staff training, recruitment practices and respecting individual rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that was included in the statement of purpose. Feedback received from residents and relatives indicated they knew there was a complaints procedure and who to refer to if they had a complaint. However several said that issues raised were not addressed. The homes’ record of complaints detailed the investigation and action taken as a result. Eleven complaints had been received since the previous key inspection regarding concerns with staffing, continence care, malodorous smells, call bells not being answered, not ensuring visitors to the home signed on entry and exit and a leaking ceiling. All had been investigated and appropriate action taken where relevant. The home had a protection of vulnerable adults policy and procedures and a whistle blowing policy. The records confirmed that staff had received training in Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 18 protection of vulnerable adults. A manager was available on call for advice. There had been no allegations of abuse made since the previous key inspection. Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate based upon standards 19, 22 & 26. The standard of cleaning and maintenance at Park View is poor and does not provide a pleasant and hygienic environment for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The entrance of the home was untidy and the hallway was cluttered with items for fundraising (stated to be for social activities/ entertainment). The drive to the home was unkempt with dead plants and weeds on the pathway. The garden areas were overgrown and the quadrangle garden was untidy. Some corridors had peeling wallpaper and damaged doorways caused by transporting residents in wheelchairs and the use of hoists. The standard of cleaning was inadequate. (See also standard 27). The conservatory was cluttered with equipment and was only used for residents’ communion service. There were Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 20 heavily stained carpets and furniture throughout the home and a smell of urine in communal rooms, bathrooms and a numerous residents’ rooms. Despite these matters being raised at a previous key inspection and in the home’s quality audit report, action had not been taken to satisfactorily address the issues. One dining room floor had not been cleaned following breakfast (i.e. at 11:30am the floor was sticky). Care staff spoken with said that night staff clean the floors. The manager stated that Unit 4 corridors had been painted and new carpet provided since previous key inspection. A new carpet shampooer had recently been purchased but rooms still smelled strongly of urine. Relatives said that the standard of cleaning was inadequate at times and they had to ask for rooms to be cleaned. One said they found the smell and stained furniture upsetting although the care had been good. One relative stated, “the most disturbing feature about a visit to Park View is unpleasant odours and stained furnishings”. The lounge in the dementia unit (previously used for activities) was being used for storage of stained chairs that required disposal, indicating that there were too few staff (number & skill) to provide activities as all residents were either in the dining room or their own rooms. The first floor of the home was accessed by stairs and two well maintained passenger lifts. There were grab rails, and aids in bathrooms, toilets and communal rooms. More specialised hoist slings had been purchased for residents. The courtyard garden was accessible to wheelchairs and outdoors furniture (tables, chairs, parasols) was provided. Call systems were provided throughout all individual and communal rooms but some were not within reach of residents and some leads were not long enough to enable residents to call for assistance. Pressure relieving equipment was available and the district nursing service also provided specialist mattresses. The standard of cleaning was poor. Carpets were badly stained and there were malodorous smells in a number of residents’ rooms and communal rooms. Chairs/ furnishings were badly stained and needed disposal. The manager stated that a new carpet shampooer had been purchased but rooms still smelled strongly of urine. There were vacant domestic posts that the manager said they had difficulty in recruiting to and they were unable to use agency staff to provide cover. Two domestic staff were on duty to clean the whole of the premises, which is totally inadequate. The manager stated that she had commenced monitoring the standards of cleaning and was planning to undertake an audit. One resident said it was cleaned every day and they were ok about the standard but bins were not being emptied following use and their relative had to supply the plastic bag for bin. Most surveys from residents stated their rooms were cleaned satisfactorily. However one relative said that they had to ask for the room to be cleaned. The manager and deputy had undertaken training by the Health Protection Agency for managers and this was confirmed from the certificates seen. Current procedures for the home include a plan for outbreak of infection. Several staff had also received infection control training. The manager had Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 21 obtained the Essential Steps to Safe Clean Care, a Department of Health (DH) self-assessment audit and planned to undertaken an audit of the home. A copy of the DH guidance for care homes was also available. Some staff practices were of concern, for example care staff accessing the kitchen without wearing protective clothing and baths not being cleaned following use. Liquid soap and paper towels were not provided for staff hand washing in all toilets, bathrooms and en-suites and bins were not provided in all en-suites. There were two clinical waste bins that were overflowing with waste and the manager arranged to have a third bin delivered that day. There were no hand washing facilities in one unit dining room and staff said they used wipes, however none were available. A fridge in a unit kitchen was also in need of cleaning. The laundry room is fairly small for the size of the home and does not allow for storage of individual boxes for sorting residents’ personal clothing. The laundry was equipped with two washing machines and two driers, a rotary iron and hand held iron and ironing board. The laundry assistant said that equipment frequently broke down and there were delays in it being repaired. Laundry staff confirmed they were following procedures for foul linen but raised concerns that care staff were not following procedures (i.e. use of alginate bags). Staff were expected to iron sheets and bed linen but there were too few staffing hours provided to enable this to be undertaken. The one laundry assistant on duty worked 30hours per week and also undertook domestic duties. A parttime domestic assistant worked at weekends. . Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate based upon standards 27, 28, 29 & 30. The staffing levels were not sufficient to ensure residents’ needs were appropriately met. Recruitment practices were thorough and promoted the protection of service users. Staff are able to develop skills and qualifications through an established training programme but this does not always meet specific needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were periods during the day when there were no staff in communal rooms with residents and no staff were supervising residents in their own rooms when they were eating. Some residents did not have call bells within reach to enable them to call staff. Residents and relatives said that there were too few staff and they had to wait to receive assistance. Relatives said that staff did not have time to talk with residents and those who preferred to stay in their own rooms felt isolated. Feedback was also received from a relative that “ staff are always overstretched and changing increasing the risk of things going wrong”. Feedback was also received that residents were unable to understand care staff whose first language was not English. Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 23 The ancillary hours provided for cleaning and laundry and maintenance need to be reviewed together with job roles. Those being provided at inspection were inadequate for the size of the home and their roles were not clearly defined; for example the maintenance person was also responsible for gardening and decorating and the domestic staff were responsible for carpet shampooing. Care staff were also expected to provide care, undertake activities and to provide some domestic type duties i.e. cleaning floors and laundry duties. The home had 14 care staff with NVQ level 2 training A further 8 staff had applied to undertake NVQ level 2. The percentage of staff with NVQ level 2 training was therefore less than 50 needed to meet the standard. However it was positive that four domestic staff were also undertaking NVQ training. The recruitment files of five recently employed staff were inspected. All had evidence that the required checks had been obtained (two satisfactory references, CRB/POVA checks) and copies of birth certificates, passports, and photographs obtained before the individuals commenced employment at the home. All had received a statement of terms and conditions of employment. The manager reported that all staff received induction to Skills for Care Standards (records were not inspected). The home had an established training programme. Training had also been provided on first aid, moving and handling, abuse, fire safety health and safety and food hygiene. A care team manager was undertaking a dementia course and the deputy manager had recently completed an accredited dementia course. Training had been provided on the Mental Capacity Act that had also been cascaded to care staff. A resident was subject to epileptic seizures and no training had been provided for care staff in how to manager a seizure. Feedback received from the relative indicated that it was only following instruction being given by them that they felt care staff were competent. Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate based upon standards 31, 33, 35, 37 & 38. The manager aims to run the home in the best interests of residents with appropriate guidance and direction for staff but low staffing levels and inadequate monitoring of care practice does not ensure residents receive consistently good quality care. Health and safety procedures are in place but practices are not always well monitored, placing residents and staff at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 25 The registered manager is competent and experienced and has been employed at the home for several years and is undertaking the Registered Managers’ Award. A deputy manager also provided support to the manager and had recently completed an accredited dementia course via open learning. Relatives spoken with said they found the manager very approachable and she kept them updated on any changes. Feedback from healthcare professionals was positive stating that there was always a good response from the manager and advice was always followed. Controversial feedback was received in surveys with one stating that issues were not always dealt with and another that the manager dealt with problems quickly. The home’s quality audit included a number of issues that had not been dealt with. The inspection also highlighted a lack of monitoring of care practice and health and safety issues (reference standards 8, 19, 26 etc.) that impacted on the care and environment experienced by residents. There is a corporate quality assurance programme that includes an annual audit of the home that is used to develop an annual plan. Internal audits undertaken comprised health and safety, cleaning standards, and medication. The home monitored all complaints and compliments and also had a suggestion box for residents and visitors. Relatives meetings had been held monthly since the home was registered. Visits required under regulation 26 had been undertaken and reports sent to the CSCI. The home has secure facilities for the storage of any money looked after on behalf of residents. There were clear individual records of this, with receipts kept and cash held in individual zipped ‘pouches’. Four residents’ records were inspected, and records, receipts and cash all balanced. Records held on behalf of residents were kept up to date and most were stored safely in secure facilities, although some care files were observed to be left out in view of visitors. Records viewed at this inspection included: care plans, medication records, statement of purpose, service user guide, staff recruitment and training records, maintenance records, accidents/incident records and fire safety records. The home had a health and safety policy manual. Training records confirmed that staff had attended relevant health and safety training. Some risks to health and safety (standard 26) were evident that pose a risk to staff and service users. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment and door closures, fire alarms and emergency lighting, hot tap water temperatures, etc.) However frequent breakdown of some laundry equipment make it difficult to effectively manage the laundering of bed linen and residents’ personal clothing and indicated that there may be a need for some equipment to be replaced. The manager Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 26 reported improvements had been made in the response for repair and maintenance of equipment although evidence of this was yet to show. Park View DS0000028381.V348133.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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X 2 X X X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Park View DS0000028381.V348133.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 OP7 Regulation 12(1) Requirement To ensure residents’ care needs are appropriately met: 1. Staff must follow the instructions on the care plan. 2. Close monitoring of care practice must be undertaken. To ensure residents have their medication as prescribed: 1.There must be no delays in this being obtained. 2.Instructions must be clear and accurately transcribed to the medication record. 3.Medicines with a limited shelf life must have the date of opening recorded. Timescale for action 31/08/07 2. OP9 13(2) 31/08/07 3. OP10 12(4)(a) 4. OP12 12(1) & 16(2)(m) & 16(2)(n) This is a repeat requirement Timescale of 18/08/06 not met. To ensure the privacy and 31/08/07 dignity of residents is maintained staff must: 1.Undertake frequent monitoring 2. Provide equipment to meet their sensory needs. To ensure that all residents are 30/09/07 able to engage in social and therapeutic activities to meet their needs: DS0000028381.V348133.R01.S.doc Version 5.2 Page 29 Park View 5. OP15 16(2)(I) & 16(4) 1.There must be sufficient staff hours identified for activities for the number of residents in the home and for residents to have activities every day. To ensure residents meals are appetising and meet their nutritional needs & choices: 1. Food must be served at the optimum temperature. 2. Meat must be tender when cooked. 3.Residents’ dietary needs must be met. 31/08/07 6. OP19 23(2)(b) & 23(2)(d) 7. OP22 23(2)(n) 8. OP26 13(3) To ensure residents live in a safe 30/11/07 and well-maintained environment: 1. Action must be taken promptly to deal with maintenance issues. 2. Action must be taken to replace peeling wallpaper and damaged walls. 3. The gardens must be tidied and maintained. 4. Action must be taken to remove or replace stained furnishings. To ensure residents are able to 30/09/07 call for assistance, call bells must be within their reach. This may need purchase of call bells with longer leads. To ensure the home is clean and 31/08/07 free from risk of infection: 1. Domestic staff must be provided in sufficient numbers. 2.Malodorous smells must be removed from the home. 3.Refrigerators in unit kitchens must be kept clean. 4. Staff must wear protective clothing when entering the kitchen. 5.Liquid soap & paper towels must be replenished and foot operated bins provided. DS0000028381.V348133.R01.S.doc Version 5.2 Page 30 Park View 9. OP27 18(1) & 12(1) 10 OP37 17(1)(b) 6. Red alginate bags must be provided for handling foul linen. This is a repeat requirement Timescale of 18/08/06 not met To ensure residents’ receive appropriate and timely care there must be sufficient staff on duty at all times to meet their dependency. This is a repeat requirement Timescale of 18/08/06 not met To ensure residents rights & interests are safeguarded records must be stored securely when not supervised. 31/08/07 31/08/07 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. 3. 4. 5. Refer to Standard OP7 OP13 OP15 OP28 OP30 Good Practice Recommendations So that residents are consulted on their care, evidence of their agreement to their care plan should be available for all residents including those receiving respite care. So that residents are socially stimulated, links with local community groups should be strengthened and group outings arranged. So that residents have drinks when they wish, hot and cold drinks should be offered when residents arise in the morning. The registered person should ensure 50 care staff have NVQ level 2 training. So that residents who have seizures receive appropriate care, staff should receive training on the action to take in the event of a seizure. Park View DS0000028381.V348133.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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