Inspection on 05/06/06 for Park View

This inspection was carried out on 5th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Park View 16/03/09

Park View 18/03/08

Park View 09/03/07

Park View 10/11/05

Park View 17/05/05

Park View 09/12/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Park View 100-104 County Road North Hull East Yorkshire HU5 4HL Lead Inspector Christina Bettison Unannounced Inspection 5th June 2006 09:00 DS0000062146.V298934.R01.S.doc Version 5.2 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 DS0000062146.V298934.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000062146.V298934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park View Address 100-104 County Road North Hull East Yorkshire HU5 4HL 01482 448911 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Kingston upon Hull CC Ms Judith Lawtey Care Home 15 Category(ies) of Learning disability (15) registration, with number of places DS0000062146.V298934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17/5/06 – random Brief Description of the Service: Parkview is a purpose built establishment; it consists of three bungalows each of which have five single ground floor bedrooms, a lounge/dining room, one bathroom and two separate toilets. The three bungalows share a large garden but each has its own patio area. The home is registered to provide residential care to 15 service users who have a learning disability, and who may also be wheelchair users, however since 12th May 2006 one of the bungalows has closed and the some of the service users have been re located leaving a total of eight service users, four in each bungalow. The empty bungalow is now used for activity sessions, meetings, supervisions and a staff space. The home is close to local shops and next to a small park, and approximately 5 miles from the city centre of Hull. The previous owners submitted a voluntary cancellation to their registration in August 2004 and since that time Hull City Council have been managing the home. All bedrooms are for single occupancy. Ample car parking spaces are available. Weekly fees are: £886.00. Additional charges are made for the following: newspapers/magazines, hairdressing, chiropody, transport for social activities and sweets. Information on the service is made available to current service users via the statement of purpose and inspection report. DS0000062146.V298934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key inspection and the unannounced site visit took place over 1 day on 5th June 2006. Prior to the site visit 9 relative surveys were posted out of which 4 were returned, 8 service user surveys of which none were returned, staff surveys of which 3 were returned. Surveys were also sent to health professionals and care managers and returned; During the visit the inspectors spoke to the registered manager and two staff, to find out how the home was run and if the people who lived there were receiving appropriate care. The service users that live at Park View have complicated needs and are not able to tell the inspector of their views therefore in this report comments from relatives, social workers and independent advocates have been used to help to form a view whether service users needs are met or not. Observations of care practice were made to assess service user satisfaction. The inspectors looked around the home and looked at records. Information received by the CSCI over the last twelve months was also considered in forming a judgement. Prior to the visit the inspector referred to complaints received and notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre- inspection questionnaire. The CSCI have had serious concerns about the standard of care and management at the home and on the 1st February 2006 the CSCI issued Statutory Requirement Notices outlining the failures to comply with Care Standards Act 2000. The site visit was led by Regulation Inspector Mrs.C.Bettison who was accompanied by Regulation Inspector Mrs.K Dee, the visit lasted eight hours. What the service does well: All service users have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact. A good recruitment policy is in place so that service users are protected from harm. DS0000062146.V298934.R01.S.doc Version 5.2 Page 6 A temporary management team from social services has been brought in to help the staff team and raise standards of care in the home. What has improved since the last inspection? What they could do better: Although relatives and staff said that the staffing situation is much improved and that the care staff on most days are known by the service users, staffing is still of concern the home still relies on high numbers of agency staff to fill the gaps in the rota. Staff must be provided with special training, e.g. how to deal with behaviour that may harm service users or staff and to help them to meet the special needs of the service users. The manager must ensure that during supervision, aspects of practice are discussed with staff and action is taken to make sure staff can provide care to service users and keep them safe. The registered person must make sure that staff meet the complicated health needs of service users and special health advice is followed. Service users must be helped to identify and meet their health care needs. A quality monitoring system must be introduced to make sure that everyone is asked about the running of the home and improvements are made. DS0000062146.V298934.R01.S.doc Version 5.2 Page 7 To make sure that the home is safe and comfortable for people living there redecoration must take place, maintenance must be attended to and the dining tables must be replaced. 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. DS0000062146.V298934.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000062146.V298934.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The needs assessments means that people’s diverse needs are identified however the absence of a service user guide means that service users and their representatives do no have information about what is provided in the home. The manager is developing a document and this will improve the information provided to service users. EVIDENCE: The Local Authority has taken over the registration and management of the home on a temporary basis. A service user guide has still to be developed for each bungalow and produced in a format that is accessible to service users and meets Regulation 5 and NMS 1.2. This was identified as a requirement from previous inspections and therefore remains an outstanding requirement. There had been no new admissions to the home since the previous inspection however service users whose care files were examined each had a full needs assessment and care plan completed by the funding authority. DS0000062146.V298934.R01.S.doc Version 5.2 Page 10 DS0000062146.V298934.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 8 and 9 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are generally met, however the quality of the ongoing maintenance and up dating of the service user plans and risk assessments is inconsistent. EVIDENCE: Four service user care files were examined as part of this site visit. At the previous inspection significant improvements had been made in the development of the service user plans and at this inspection further work had been carried out to develop detailed personalised risk assessments however the standard of the documentation was not consistent. There appeared to be several different documents relating to the same care task in different places in the file, which made it confusing for the reader. DS0000062146.V298934.R01.S.doc Version 5.2 Page 12 Some staff seemed to be using the recording tools inappropriately as some actions where recorded on a behaviour monitoring charts when the action was not related to behaviour monitoring. Some of the service user plans had been clearly written, detailing very clear care support directions for staff and had been evaluated regularly whilst other plans were more general and had not been evaluated regularly. There were risk assessment tools for moving and assisting, activities; bowling, cinema, swimming, fire, visitors, burns and scalds, use of the mini bus, use of bed rails, some of which had been reviewed however again this was inconsistent depending on which of the senior staff had responsibility. One service user had had a fall from a commode and following this the advice was that they must be hoisted and it stated please see risk assessment however when examined it was apparent that the risk assessment had not been amended. There was evidence that service users needs had been reviewed using either the Social services “Fair Access to Care” review system or “Person Centred Planning” or a combination of both, whatever system was used tools used for documenting this review gave very little evidence that the service users complex needs had been fully reviewed and any amendments to their plan of care made as a result of these reviews, therefore there is a risk that service users needs may not be met. The majority of the service users at Park View are dependant and contributing to the development of the service is complex, however, talking to members of staff throughout the day indicated that service users are consulted by other means wherever possible and this includes advocacy services where appropriate. DS0000062146.V298934.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 The Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. A limited range of activities within the home and community mean the service users do not have the opportunity to participate in stimulating and motivating activities. EVIDENCE: There was evidence in care files that service users needs/likes/dislikes in respect of activities and lifestyle had been identified and recorded. Risk assessments were in place for activities that posed a risk to service users. However information received from relatives, staff and from the care records indicates that service users opportunities to access leisure opportunities both in house and out in the community are limited. DS0000062146.V298934.R01.S.doc Version 5.2 Page 14 The staff take service users out into the community with the home’s minibus or locally for walks. Activities provided appeared to be the same for all service users and where there were individualised plans these were not been followed. A large proportion of the activities carried out at this time are outings in the local community or to the local shops. One service user particular likes going swimming and the exercise was identified as being good for him, however in one month he had only been swimming once. The inspectors were informed that holidays have been booked for all service users to Butlins at Skegness in the summer. Although this means that service users will enjoy the benefit of a holiday it does not recognize their diverse needs and consideration must be given to providing individualised holidays in the future. Family links continue to be good in the home; relatives commented on their involvement and in their relative’s life and stated that staff keep them informed. The menus contained a variety of meals that included fresh fruit and vegetables and took into account service users likes and dislikes that were highlighted in care files. The inspectors were informed that the menus had been assessed by the Social Services catering officer and the dietician and were found to be satisfactory. DS0000062146.V298934.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 The outcomes for service users in this area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Although screening and action plans have been developed for health needs, there are significant gaps leading to some of service users health needs not being met. EVIDENCE: The home have worked in partnership with the community nurse in facilitating the development of health action plans, comments received from the nurse stated “The home have worked very closely with me to address health needs of individuals thus ensuring positive health improvements are benefited by the clients.” There was evidence in the files of regular appointments with the GP, consultants, specialist epilepsy nurse, dentist, chiropody, physiotherapist and dietician. All eight service users have now had a full health screening completed and the development of an action plan. However there are inconsistencies in the quality of this work. In one service users screening process it was identified that he had cataracts and that he must have regular appointments with the DS0000062146.V298934.R01.S.doc Version 5.2 Page 16 optician but this had not been documented in the action plan and there was no evidence that this had been facilitated for the service user. Another service users screening identified menopausal symptoms and their Hormone Replacement Therapy had been stopped however again there was nothing documented in the action plan and no evidence of this being monitored or followed up and another service user screening document referred to poor skin integrity, need for a new moulded seat for their wheelchair and recommended a best interest meeting for a medical procedure, none of these had been identified in the action plan or had been addressed. Two service users were identified as weighing just over six stones and they were previously weighed in February 2006, it was identified that their weight should be monitored however the home do not have the necessary equipment for this to happen. There is an ongoing issue accessing equipment for one service user from the Integrated Community Equipment Store. Relatives spoken to were not happy with this situation and would like it resolving as quickly as possible. The manager reported that this was being dealt with by a senior manager and that the equipment had now been ordered. Medication systems were examined; departmental policies and procedures were in place however the home had needed to develop their own addendums to the procedures to ensure that staff had the necessary guidance. The social services department should review the medication policies to ensure they meet with legislation and best practice guidance. Storage of all medications was found to be satisfactory; medications were stored appropriately and stock control was effective. The home did not have any controlled medication however a cabinet and register was in place should it be needed. Transcribing records were checked and found to be satisfactory, medication administration records were satisfactory. DS0000062146.V298934.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a satisfactory complaints system. Service users and their representatives are now listened to and protected from abuse whilst in the care home. EVIDENCE: The home has a detailed formal complaints procedure provided by Hull City Council. Complaints are now being logged and records kept of all action taken to resolve issues. There had been no complaints either to the home or the Commission for Social Care Inspection since the previous inspection. In contrast to previous inspections there were 3 compliments recorded; one from a service users sister complimenting the home in the improvements in the delivery of care, one from an agency worker commenting on the quality of the initial induction she had received and one from a manager of another home complimenting the staff on the quality of the information provided for a service users who was moving to a new home. In general relatives are satisfied with the standards of care at Park View and comments received by the Commission for Social Care Inspection from relatives in the form of questionnaires stated “it is a happier place now”, “although Park View has had a poor time in the past conditions have improved and continue to improve under the present staff and we are very pleased with the current care” DS0000062146.V298934.R01.S.doc Version 5.2 Page 18 From the care files examined it was evident that service users that self harm or display behaviours that are difficult to manage now have behaviour management guidelines. Any restrictions or limitations to service users are now documented in the form of Care plan or behaviour management plan. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of service users money and financial affairs. From discussion with staff and staff training records it was evident that most of the staff including the manager and senor staff have received training or briefing on the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this. The staff on duty displayed a good understanding of the vulnerable adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly, and the correct action taken. There had been no new referrals to the Protection of Vulnerable Adults team since the previous inspection, however the inspectors noted that there were a number of reports of unexplained bruising and/or scratches documented in the accident record for different service users. It was advised that a senior manager should review these on a regular basis and make the decision as the whether any constituted a Protection Of Vulnerable Adults referral or not. DS0000062146.V298934.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,28,29,30 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The environment does not provide service users with comfortable and safe surroundings in which to live. EVIDENCE: Since the previous inspection there has been no improvements made to the home. The inspectors were informed that the Social Services department are keen to determine ownership of the building and are taking legal advice before any work takes place. Although the resources section of the Local authority state that home is on their plan for refurbishment this is a three year plan and the home have not been given any indication of the work to be undertaken and what the timescales are, the home must have a maintenance and renewal plan with timescales for the work to be completed. DS0000062146.V298934.R01.S.doc Version 5.2 Page 20 The home appears run down, there are holes in the plasterwork, damaged doors, carpets are badly stained, and on the day of inspection two of the bedrooms had a malodour. New dining tables had been purchased and at the previous inspection it was identified that they were totally unsuitable for the environment, making it appear institutional and limiting the communal space for staff and service users to move around. This posed a health and safety hazard. The manager had agreed to keep this under review and now agrees that they need to be replaced. This remains an outstanding requirement from the previous inspection. Since the closure of one of the bungalows there is now a private area for visitors and /or meetings consultations etc. Bathrooms were observed to be institutional, stark and uninviting. The specialised baths were quite old. Two service users had been identified as being unable to have a bath due to their specific needs and the unsuitability of the bathing equipment (moving and handling risk assessments), the inspectors were informed that the Occupational Therapist will be attending the home to advise on suitable equipment. This must be given urgent attention, as it is an unacceptable situation. A requirement has been made in respect of this. Since the previous inspection the intumescent seals around the fire doors have been replaced ensuring the safety of service users and staff in the event of a fire and most of the servicing records were up to date however there was no electrical hard wiring certificate and no evidence that a legionella check had taken place. DS0000062146.V298934.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing arrangements are not sufficient to meet the needs of the service users and further specialised training must be provided. Staff are not adequately supervised leading to poor care practices. The home is showing improvement and the management team has plans to improve staffing and training. This capacity to improve should result in better outcomes for people using the service. EVIDENCE: The local authority has taken over responsibility for the home on a temporary basis following the previous providers withdrawal. A temporary management team from social services has been drafted in an attempt to provide a stable platform in which to support the staff team and raise standards of care in the home, this has at times proved an overwhelming task and progress had been slow however improvements are beginning to be more evident. The inspector was informed at the previous visit that the home was moving to a position of closing one of the bungalows and then introducing a different staffing rota which will not include any agency staff. The home will need 504 DS0000062146.V298934.R01.S.doc Version 5.2 Page 22 care staff hours to cover the new rota and they have currently got 480. Two staff are on maternity leave therefore they intend to advertise and recruit to 2x32 hour posts and 2x 24 hours posts to cover the maternity leave and an additional 24 hour post to pick up the shortfall on the rota, however the inspector was informed that there is currently a freeze on filling posts within the department. These posts must be filled to ensure that this home can improve within the timescales stipulated. A total of 4 Service users have been relocated to more appropriate services enabling one of the bungalows to close. It closed on 12/5/06 leaving two remaining bungalows with 4 service users in each. The inspector was informed that the new staff rota will be implemented on the 7/8/06 as the staff team have not agreed to it therefore the management have had to give the staff a 90 day notice period. The care officer that worked in this bungalow has returned to her substantive post within the local authority. From examination of the rotas and from discussion with staff it is evident that the use of agency staff has decreased, however there are some shifts where 2 agency staff do work together this appears to be mostly at weekends. From the rota of the week commencing 22/5/06 it was apparent that weekends are the time when the agency staff are used more. On Saturday 27/3/06 out of 8 care staff 5 were going to be agency staff and on Sunday 28/5/06 out of 8 care staff 6 were going to be agency staff. There are still a number of staff vacancies at the home that are covered by the use of agency staff, however the majority of the agency staff have been with the home for over a year therefore this and the development of detailed care plans, behaviour management guidelines, increased supervision and training is leading towards creating a more consistent and reliable care to service users. Night staff is still of particular concern all 240 night care hours are covered by either agency or casual staff. The manager had completed a comparison of staffing of four weeks in November 2005 and the week commencing 30/5/06 and the use of agency staff. This demonstrated that; • week commencing 7/11/05 - 77 of the day shifts were covered by agency staff • week commencing 14/11/06 - 58 of the day shifts were covered by agency staff DS0000062146.V298934.R01.S.doc Version 5.2 Page 23 • • week commencing 21/11/05 – 55 of the day shifts were covered by agency staff week commencing 28/11/05 – 67 of the day shifts were covered by agency staff In comparison week commencing 30/5/06 only 42 of the day shifts were covered by agency staff. This is clearly an improvement however it is still a high use of agency staff and it is envisaged that when the new rota is implemented on the 7/8/06 this will dramatically reduce the reliance on agency staff. Training has been given a high priority within the home with staff members commenting that they attend a lot of training and have found it very beneficial. The majority of staff are now up to date with their mandatory training however there are gaps in values and attitudes, equal opportunities, disability equality training and race equality and anti racism training, therefore this requirement remains outstanding. The staff have not received training in how to manage presenting behaviours, from the accident/incident records it was apparent that staff are subjected to assaults from the service users from time to time. Given the needs of the service users living at Park View the need for this training must now be given a higher priority and remains an outstanding requirement. From discussion with staff and examination of records it is apparent that the senior care officers are aiming to ensure that staff receive formal supervision 6 times per year however the quality of these supervisions is inconsistent. This is detailed further in this report under conduct and management. Staff have not yet received an annual training and development assessment and profile therefore this requirement remains outstanding. There continue to be very low numbers of staff with National Vocational Qualifications level 2 although some progress has been made in registering six candidates. Communication in the home has improved, more staff meetings are being held and staff reported handovers now taking place. DS0000062146.V298934.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42,43 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. In February 2006 the Commission for Social Care Inspection issued improvement notices to the home because we were concerned about the management and standards of care in the home. There had been a high number of requirements outstanding from previous inspections and both the local authority and the management team had been slow to respond however the home is showing improvement. This capacity to improve should result in better outcomes for people using the service. EVIDENCE: DS0000062146.V298934.R01.S.doc Version 5.2 Page 25 The current manager has been seconded to the home from Hull City Council on a temporary basis; she is registered with the Commission for Social Care Inspection. The manager has undertaken a wide range of training related to the post of manager and has completed NVQ 4 in Management and the Registered Manager’s Award covering the appropriate care components. She has 22 years previous experience in a managerial and caring role. It became evident from examination of care records, accident reports, and supervision records that some staff are not following care plans, risk assessments and instruction/guidance given by senor staff. This leads to a poor care service for service users and places them at risk of injury. In some cases this had been left far too long to be addressed with staff in supervision and where it had been highlighted with staff the written records were poor and did not clearly evidence action taken by senior staff to address the issues. The manager must review staffs competence and where appropriate move to a more formal system of developing staff competence/skills. In the case of a particular member of staff the local authority must inform the CSCI what action has been taken to ensure that staff members have the necessary skills and competence to meet service users needs. The Local authority has a quality assurance system however this has not yet been fully implemented within the home, this means that service users and their families views are not utilised to help shape the way the service is provided in the future. Comments received for a relative stated, “ things do seem to be improving slowly, my only worry is the uncertainty of the placement continuing”. The local authority must make some decisions about the future of Park View and ensure that relatives and service users are involved in the decision making process and kept up to date with developments. Although the resources section of the Local authority state that home is on their plan for refurbishment this is a three year plan and the home have not been given any indication of the work to be undertaken and what the timescales are, the home must have a maintenance and renewal plan with timescales for the work to be completed. From observations and discussions with staff and management it was apparent that since the previous inspection there has been no further work undertaken to improve the home both in terms of its function and general appearance. The home appears run down, there are holes in the plasterwork, damaged doors, stained carpets and on the day of inspection there were mal odours to two of the bedrooms. DS0000062146.V298934.R01.S.doc Version 5.2 Page 26 New dining tables had been purchased and at the previous inspection it was identified that they were totally unsuitable for the environment, making it appear institutional and limiting the communal space for staff and service users to move around. This posed a health and safety hazard. The manager had agreed to keep this under review and now agrees that they need to be replaced. This remains an outstanding requirement from the previous inspection. Bathrooms were observed to be institutional, stark and uninviting. The specialised baths were quite old. Two service users had been identified as being unable to have a bath due to their specific needs and the unsuitability of the bathing equipment (moving and handling risk assessments), the inspectors were informed that the Occupational Therapist will be attending the home to advise on suitable equipment. This must be given urgent attention, as it is an unacceptable situation. A requirement has been made in respect of this. Since the previous inspection the intumescent seals around the fire doors have been replaced ensuring the safety of service users and staff in the event of a fire and most of the servicing records were up to date however there was no electrical hard wiring certificate and no evidence that a legionella check had taken place. DS0000062146.V298934.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 2 28 2 29 1 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 x LIFESTYLES Standard No Score 11 x 12 1 13 2 14 x 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 3 x 2 x 1 2 x 2 2 DS0000062146.V298934.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 YA1 Regulation 5 Requirement The registered provider must provide a service user guide that sets out clear and accessible information covering all aspects of standard 1.2. (Timescales of 31/8/05 and 31/01/06 and 30/4/06 not met) The registered person must ensure that daily recordings, health action plans and service users plans are monitored by a senior person and highlight action taken to address needs or concerns. The registered person must ensure that risk assessments are undertaken for activities that present a risk to service users that all staff understand and follow, these must be updated as needs change. The registered person must ensure that service users have opportunities to access appropriate leisure activities both in house and in the community regularly and that DS0000062146.V298934.R01.S.doc Timescale for action 01/09/06 2. YA6 YA19 13 (1b) 31/08/06 3. YA9 13 (4 b and c) 31/08/06 4. YA13 16 (2m) 31/08/06 Version 5.2 Page 29 5. YA19 13 (1b) these recognise service users diverse needs. The registered person must ensure that service users have access to healthcare provision and a minimum of an annual health check is completed. (Timescale of 31/8/05,10/11/05 and 30/4/06 not met) The registered person must make arrangements or provide the necessary equipment to enable service users to be weighed. The registered person must ensure that the home is redecorated inside and that a planned maintenance programme is provided (Timescale of 31/8/05, 31/03/06 and 30/4/06 not met) The registered person must provide suitable baths to ensure that all service users are able to have a bath if they require one. (Timescale of 31/12/05 and 30/04/06 not met) The registered person must ensure that the large dining tables are replaced with smaller ones to ensure the safe movement around the home for staff and service users. (Timescale of 30/06/05 and 31/12/05 01/06/06 not met) The registered person must ensure that the home is clean and free from malodours. The registered person must ensure that 50 of staff are qualified to NVQ level 2. (Timescale of 13/03/06 not met) DS0000062146.V298934.R01.S.doc 01/07/06 6 YA19 23 (2n) 01/07/06 7. YA24 23 01/09/06 8. YA27 YA29 13 (5)23 (2j)23 (2a) 01/07/06 9. YA28 23 01/09/06 10. YA30 23 31/08/06 11. YA32 18 (1a) 01/09/06 Version 5.2 Page 30 12. YA33 18 (1a) The registered person must 31/08/06 ensure that at all times suitably qualified, competent and experienced person are working at the care home in such numbers as are appropriate for the health, welfare and safety of the service users. The use of agency/casual staff must be kept to a minimum, each shift having permanent members of staff on duty (Timescale of 9/3/05, 30/6/05, 10/11/05 and 29/3/06 not met). The registered person must 31/08/06 ensure that the vacant posts within the home are filled to ensure a competent and experienced staff team are working at the care home in such numbers as are appropriate for the health, welfare and safety of the service users. The registered person must 31/08/06 develop and implement a training programme, which meets the Sector Skills Council workforce training targets. (Timescale of 9/3/05, 31/8/05, 10/11/05 and 13/3/06 not met) The registered person must ensure that staff receive accredited training in how to deal with service users that display behaviours that are likely to cause harm to themselves and/or others. (Timescale of 10/11/05 and 13/3/06 not met) The registered person must ensure that staff receive training in equal opportunities, disability equality, race equality DS0000062146.V298934.R01.S.doc 13 YA33 18 (1a) 14. YA33 18 (1c) 15. YA35 18 (1c) 31/08/06 16. YA35 18 (1c) 31/08/06 Version 5.2 Page 31 and anti racism training. (Timescale of 31/8/05 and 13/3/06 not met) 17. YA35 18 (1c) The registered person must ensure that all staff has an individual training and development assessment and profile. (Timescale of 31/8/05, 10/11/05 and 30/04/06 not met) 30/06/06 18 YA8 YA36 18 (2) 19 YA39 24 The registered person must 01/07/06 ensure that the quality of supervision is improved and clearly identifies issues and that where necessary formal departmental procedures are implemented in a timely manner 01/09/06 The registered person must ensure the home’s quality assurance system is developed, and includes consultation with stakeholders, that information it produces is collated and a written report is produced and that it is sent to the CSCI and given to the service users. (Timescale of 9/3/05, 31/8/05, 31/03/06 and 01/06/06 not met) The registered person must ensure that the home has an up to date electric hard wiring certificate and that a test for legionella has been completed. The registered person must ensure that decisions are taken in consultation with stakeholders as to the future of the home and progressed in a timely manner. (Timescale of 10/11/05 and 30/04/06 not met) The registered person must DS0000062146.V298934.R01.S.doc 20 YA42 24 30/06/06 21. YA43 24 01/09/06 22 YA43 24 01/07/06 Version 5.2 Page 32 inform the CSCI in writing of what action is being taken to address staff competence and skills to meet service users needs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA14 Good Practice Recommendations The registered person should ensure that holidays booked in the future recognise and meet the diverse needs of the service users and that consideration should be given to the local authority funding this as part of the contract price. The registered person should ensure that all staff have access to, understand and apply all policies and procedures and that the additional policies and procedures introduced into services for people with a learning disability are accepted by the local authority as departmental. 2 YA40 DS0000062146.V298934.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000062146.V298934.R01.S.doc Version 5.2 Page 34 - 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. 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