Inspection on 09/03/07 for Park View

This inspection was carried out on 9th March 2007.

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 14 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 05/06/06

Park View 10/11/05

Park View 17/05/05

Park View 09/12/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 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 9 March 2007 09:00 th DS0000062146.V325775.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.V325775.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.V325775.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.V325775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th June 2006 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. DS0000062146.V325775.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 9th March 2007. Five relatives’ surveys were returned, one health professional survey was returned, no service user surveys were returned, and no staff surveys were returned. During the visit the inspector spoke to the registered manager and staff, to find out how the home was run and if the people who lived there were receiving the right care to meet their needs. 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 and professionals and observations of care practice have been used to help to form a view whether service users needs are met or not. The inspector looked around the home and looked at records. Information received by the CSCI since the previous inspection 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, however, over the past year and at this inspection significant improvements were noted. One relative commented, “we are pleased and very grateful for the care our daughter receives and the welcome we receive on visiting her and would like to express our thanks to all associated with Park View”. Another commented “it puts our minds at rest to know that ………is well looked after and her needs are met”. Another commented “just to say things are improving slowly but surely, we seem to be getting on the right track”. And another said “Personally I am happy with the care my son receives and that alone is reassuring for any family or relative. I feel sure there is more to be done; a lot has been achieved over a period of time and it is realised that there is stillroom for improvement. I have seen, over time, they have improved the standard of care in every aspect” The site visit was led by Regulation Inspector Mrs C Bettison and the visit lasted eight hours. DS0000062146.V325775.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The managers and staff are making good progress to improve all of the standards in the home. The service user plans include helping people to keep their independence and learn new skills. DS0000062146.V325775.R01.S.doc Version 5.2 Page 7 Service users are now being helped to enjoy activities that they like, both in the house and out in the community, this means have an interesting life and do not get bored. The staff are very caring and treat service users with respect and dignity. The staff team are the same ones that have been with the home for about a year or longer which means that they know the service users and what their needs are. Training has been provided to all staff to make sure all staff are up to date with basic training in moving and assisting, basic first aid, basic food hygiene, infection control and fire awareness. Special training has been provided to all staff 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. More than half of the staff have got a certificate (NVQ Level 2) which says they know how to work with the service users in the home and how to meet their needs. Managers are now making sure that staff have individual time with the staff to talk about their job, training and other things. What they could do better: The service user plans need to be looked at and changed regularly to make sure they are up to date and service users get the support and care they need, when it changes and when they need it. The managers must make sure they check the service user plans, health action plans and the records to make sure that the service provided is of good quality and all of service users needs are met. Managers need to make sure that the activities that are now happening continue to happen and that service users are helped to try out new activities. The action plans to help make sure service users health needs are met need to be looked at again by the community nurse to make sure that all health needs are written down and can be met. The bungalows that service users live in are not good enough. Although they are safe, managers need to make sure that they are decorated and new furniture is bought to make them comfortable and homely for the service users that live there. DS0000062146.V325775.R01.S.doc Version 5.2 Page 8 The bathrooms and the equipment in the bungalows is not good enough to meet service users individual needs, the managers need to buy new baths that are suitable for the service users. The managers need to make sure that the home has a permanent team of staff that are trained and are able to meet the service users needs. The managers need to make sure that the new staff joining the home are helped to get to know the service users and what their needs are and that staff leaving are able to pass on any information needed. The system to assess the quality of care and other things in the home needs to be developed more to make sure that everyone is asked about the running of the home and improvements are made. 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. DS0000062146.V325775.R01.S.doc Version 5.2 Page 9 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.V325775.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 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 needs assessments means that people’s individual needs are identified and are able to be met and the home has a service user guide in an accessible format so that service users and their representative have information about what is provided in the home. DS0000062146.V325775.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Local Authority has taken over the registration and management of the home. At the random inspection on 10th August 2006 it was noted that a service user guide has been developed for each bungalow and produced in a format that is accessible to service users and meets Regulation 5 and NMS 1.2. 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.V325775.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users needs are generally met and service users and their representatives have been consulted, however the quality of the ongoing maintenance and up dating of the service user plans is inconsistent. EVIDENCE: Three service user care files were examined as part of this site visit. At previous inspections both key and random it was noted that significant improvements had been made in the development of the service user plans and detailed personalised risk assessments. At the random inspection on 10th august 2006 it was noted that: DS0000062146.V325775.R01.S.doc Version 5.2 Page 13 “The service users plans examined were very detailed and had been reviewed three monthly. There was good evidence of the staff meeting the diverse needs of service users e.g. it was identified in one service users plan that one they like to wear perfume and has two particular types they like. There was detailed information on how to present the two perfumes and how the service user would choose which one they wished to wear on that particular day. It was also highlighted that the service user prefers to wear trousers to promote their dignity. Anther service user goes to visit her parents twice a week and there was also detail in the service user plan of how they like to choose their clothes for the day.” At this inspection it was noted that files had been tidied and duplicated documents had been removed leading to clearer direction for staff, however, there were still some inconsistencies in the quality of the information and recording. All of the service users plans contained areas for service users to improve their independence skills. For example, one service user was being enabled and encouraged to make his own sandwiches and toast whilst another was drying her own hair with assistance, all service users were being encouraged to choose their own clothing for the occasion with staff support. Whilst all of the service user plans had been clearly written, detailing directions for staff there were inconsistencies in the evaluation and updating of the records. Two of the plans had been evaluated regularly whilst one had not been evaluated since January and there had been some issues regarding health monitoring noted in diary sheets for a particular service user that had not been picked up and actioned by senior staff. In another examined it had been noted in the Person Centred Plan meeting in early January that this particular service user eats much better when presented with finger food that they can manage themselves. It was agreed by all present to introduce this kind of food more into their diet and monitor the outcome however this had not been transferred to the service user plan and therefore not all staff would be aware of this change. 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. There was evidence that service users needs had been reviewed regularly using both the Social Services “Fair Access to Care” review system and “Person Centred Planning”. There had been significant improvement made in DS0000062146.V325775.R01.S.doc Version 5.2 Page 14 the recording of discussions and action to be taken in both kinds of reviews and that all parties views had been recorded however it is essential that any changes agreed are transferred to the service users plan so that service users changing needs can be met. The specialist epilepsy nurse commented, “It is difficult to determine the choice of the individuals living at Park View and what life they would choose to live due to their learning disability. Where individuals have made some choices regarding social activities this appears to be supported by staff. The staff communicate well with service users and their families, respects privacy and dignity and allow service user to make choices.” DS0000062146.V325775.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. A range of activities within the home and community mean the service users have the opportunity to participate in stimulating and motivating activities that meet their diverse needs. EVIDENCE: There was evidence in care files that service users needs/likes/dislikes in respect of activities and lifestyle had been identified and recorded. Religion had been recorded and whether the service user is practising or not. Risk assessments were in place for activities that posed a risk to service users. DS0000062146.V325775.R01.S.doc Version 5.2 Page 16 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 have improved significantly. Regulation 26 visits were still highlighting the need for an activity programme to be developed at the visit in February 2007 and although the records in the home indicated that some activities were being provided, the records available only covered the time since January 2007 and this needs to be maintained and improved upon. The staff take service users out into the community with the home’s minibus, public transport or locally for walks. Some plans have now been developed for service users and although some of the activities appeared to be same i.e. swimming, bowling and shopping there was evidence that activities were being individually provided and not in large groups and were taking into account service users diverse needs. One of the service users particularly likes visiting the McDonalds restaurant and another participating in flower arranging which were both being provided. A relative commented in response to; - does the service meet different needs of people (equality and diversity) “ the male service users go to football and the females go shopping”. The staff provides a men’s group and ladies group in house with the intention of increasing service users self esteem by providing activities that help to look and feel good. i.e. nails and hair for the ladies, a craft session is provided in house and also themed nights i.e. a curry night and an American night with food and TV programmes. The manager confirmed that the staff are aiming to consider service users diverse needs and as such one service user is now being supported to attend Hull FC rugby games at the KC stadium regularly and is currently enjoying this, if this continues he will consider purchasing a season pass for the next season, another service user attended the Motorcycle show at the NEC. One service user has got a ticket for the forthcoming concert of “The Who” at the KC stadium and two of the service users recently attended the Abba tribute band at the Hull City Hall. The inspector was informed that holidays are in the process of being planned and that staff and managers are consulting with relatives. They are considering Centre Parcs and Blackpool for small groups. Although this means that service users will enjoy the benefit of a holiday consideration must be given to providing individualised holidays and ensuring that service users diverse needs are recognised and met. DS0000062146.V325775.R01.S.doc Version 5.2 Page 17 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 and that communication is much improved. One relative stated “I would say that they meet more than …… needs. Staff have even come in on there days off to attend arrangements that have already been planned. ………..is a happy woman now. I think that is due to the care she gets at park View. Her trips out have made a big impact to her quality of life.” And another stated “ ……..has more choices now than she ever had. She is even taken out to choose her own clothes and sweets. The service …gets is second to none. All of her needs are met and she goes out a lot, which she enjoys. Plus they have themed nights once a month which she enjoys.” 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. The Kitchen and food provision has recently been assessed by the environmental health team and obtained a “good” grade of “B”. DS0000062146.V325775.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users health needs are generally met, however, the incomplete plans, recording and monitoring systems means that heath and well being concerns are sometimes overlooked leading to health needs not being fully met. EVIDENCE: The home have worked in partnership with the community nurse in facilitating the development of health action plans. 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. The provision of community nurse support has been inconsistent meaning that further work on the action plans; liaison with other health professionals and updating of the records has not been achieved. There was evidence in the files of regular appointments with the GP, consultants, specialist epilepsy nurse, dentist, chiropody, physiotherapist and dietician. Best of interest meetings had been facilitated to ensure robust DS0000062146.V325775.R01.S.doc Version 5.2 Page 19 decision making regarding health interventions for service users, i.e. dental treatment and scans. Monitoring of care files and records was inconsistent leading to service users health and welfare concerns being overlooked. One example of this is where a service user had a red sore mark under her breasts noted in the diary sheet in early January “sore under breast could this be due to bra being too tight?” however, at the point of inspection cream had been applied regularly but no action taken to the fitting of the bra. Senior staff had not monitored this file since January and therefore this issue had not been noted. Monitoring and recording of health concerns and outcomes appeared to be spread across the care file so it was difficult to track health outcomes, this was discussed with the manager who agreed that the recording in this area needed to be reviewed and improved. At the previous inspection it was noted that 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 did not have the necessary equipment for this to happen, this has now been resolved and the home have the equipment, however, the records of service users weights only went back to January 2007 this now needs to be maintained. Medication systems were examined; departmental policies and procedures were in place and the home have their own addendums to the procedures to ensure that staff had the necessary 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, Regulation 26 visits had noted inconsistencies in the recording of creams and lotions, this was being monitored by both this process and the management team and improvements were noted. DS0000062146.V325775.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a 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. There had been three minor concerns logged: one in June 2006 regarding missing laundry and another in September 2006 regarding lack of information provided to a relative relating to their daughter, and another about a broken clock, all had been resolved satisfactorily. A relative commented “I had a complaint once; the complaint was dealt with the same day.” There were also two logged compliments from relatives who commented: “I want to thank staff for the prompt attention to my sisters health needs. Communication has improved and the improvement in the delivery of the service has greatly improved since last summer.” And the other stated, “The DS0000062146.V325775.R01.S.doc Version 5.2 Page 21 service has improved in the last six months. The clients are happier because of regular staff being in place and they are getting out and about into the community more such as going to the theatre, shopping and trips, eating out and travelling on buses. All the training the staff are having seems to beginning to work”. In general, relatives are satisfied with the standards of care at Park View and the inspector had a conversation with visiting relatives on the day of inspection. They commented: “Things in the home are very good now, staff and service users are much brighter. The staff group is more stable and seem more settled. Parents and carers are much more informed and there is open communication. The staff are more approachable and any issue raised however small is dealt with and resolved. We can see improvements in the service users well-being and they all have a better social life, our daughter is getting out much more that she used to, been to the cinema and the pub”. 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 documented in the form of a service user 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. There had been one new referral to the Protection of Vulnerable Adults team since the previous inspection regarding one service user kicking another, however the LA decision maker asked the manager to monitor the incidents and re refer if there were any more. DS0000062146.V325775.R01.S.doc Version 5.2 Page 22 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. 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 using available evidence including a visit to this service. The environment does not provide service users with comfortable and safe surroundings in which to live and does not meet their individually assessed needs. EVIDENCE: Since the previous key and random inspections there has been no improvements made to the home with respect to the environment. The inspector was informed that the Social Services department are keen to determine ownership of the building and are taking legal advice before any work takes place. However, this is taking a very long time to resolve and in the meantime service users are living in a home that cannot meet their individually assessed needs. DS0000062146.V325775.R01.S.doc Version 5.2 Page 23 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. The home still appears run down, there are holes in the plasterwork, damaged doors, and some carpets are badly stained. Bathrooms were still institutional, stark and uninviting. The specialised baths were quite old. One of the 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 relatives of this service user informed the inspector that their daughter had not been able to take an immersion bath for over 2 years and this was an aspect of the home that they are still unhappy about. It is now being planned that their daughter will travel all the way to Bransholme to have bath at another care home that has specialist bathing facilities. This is clearly unacceptable and the bathrooms at the home must be refurbished and specialised bathing facilities provided with some urgency. 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 inspections. A relative commented in response to “how do you think the care home can improve?” “Redecoration of the communal lounge, dining area, entrance, passageways to bedrooms and also the grounds to be made more pleasant and usable”. Since the closure of one of the bungalows there is now a private area for visitors and/or meetings consultations etc. The home was seen to clean and hygienic and there were no malodours on the day of the visit. DS0000062146.V325775.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users needs are met by staff in sufficient numbers and with the appropriate skills and competencies. The home is showing much improvement and the plans to consolidate a permanent, consistent and stable staff team will further improve the outcomes for people using the service. EVIDENCE: At previous inspections staffing had been a major area of concern with the home having a care staff group that were still working under their previous employers terms and conditions of employment and the manager and senior staff being from Hull City Council social services Department. The home had a large number of vacant hours covered by agency staff with little training and little knowledge of the service users needs. This was compounded by lack of training, poor quality of supervision and poor quality of service users plans that would have assisted staff in the delivery of care. DS0000062146.V325775.R01.S.doc Version 5.2 Page 25 There have been no new staff to the home since the previous inspection and 1 member of staff has left to take up another job elsewhere. All existing staff have an up to date CRB clearance and references. The staffing is an aspect of the home, which has greatly improved. It is planned that from April 1st 2007, the Registered Manager will become the permanent manager of the home, of the existing 4 senior care officers; - 2 will return to their substantive posts within the council, and the other 2 will remain at Park View, 1 senior care officer from another care home within the council will transfer across and the 1 vacancy will be advertised. One of the existing SCO who is returning to his post will be staying on to assist in the induction and settling in of the 2 new SCO to the home. The one remaining care officer at the home will return to his substantive post within the HCC as Park View does not have care officers in its staffing matrix. Ten of the existing care staff will transfer (TUPE) across to the employ of Hull City Council and remain at Park View, leaving 6 vacancies (days) and 6 vacancies (nights) to fill. 4 vacancies (days) and 6 vacancies (nights) have been filled by staff who will be transferring from another care home and the remaining 2 x posts will be advertised. All staff will them become permanent to the home. The new staff rota was implemented on 7/8/06 and all staff have settled into a new pattern of work and this has positively affected the outcomes for service users meaning that staff are working when they are most needed and to the benefit of the service. It is planned that when all of the posts are filled permanently the numbers of care staff provided and a further change to the rota will mean there will be 2 care staff in each bungalow and a floating member of staff on both early and late shifts. It is envisaged that this will assist in the provision of more activities. The inspector was informed that the staff vacancies are currently covered by the use of regular agency staff, however they have now been with the home for nearly two years, therefore this and the development of detailed service user plans, behaviour management guidelines, increased staff supervision and training is leading towards creating a more consistent and reliable care to service users. A relative commented “We now have the same staff all of the time, which is better all round. The only thing that can improve is that they don’t use agency staff as much. But I think they are hoping to resolve this problem by April.” DS0000062146.V325775.R01.S.doc Version 5.2 Page 26 The manager has completed a comprehensive training plan and keeps an up to date audit/matrix of training for staff. Training has been given a high priority within the home and has included the agency staff. Staff are now up to date with their mandatory training and most have completed values and attitudes training however there are still gaps in equality and diversity training. The majority of staff have now completed training in how to manage service users that present behaviour that may pose a danger to themselves or others. The few staff that haven’t completed it have got dates planned to attend. The home has now achieved 50 of staff qualified with NVQ level 2 or above. At the random inspection in August 2006 the manager informed the inspector that all senior care officers had been provided with a briefing on the quality of supervision provided and the effective recording/action to be taken following supervision. The quantity of supervision is as regular as it should be and the quality of the supervision records examined had improved significantly. Action is now being taken to address conduct/capability/sickness issues with some staff. Achievement and Development interviews have been completed for all staff. Senior staff have not been effectively monitoring the quality of the service users plans and recording and this needs to improve to ensure that service users needs are documented, kept up to date and met. As stated previously in this report, relatives have commented about the improvements made: “The service has improved in the last six months. The clients are happier because of regular staff being in place. All the training the staff are having seems to beginning to work”. “Things in the home are very good now staff and service users are much brighter. The staff group is more stable and seem more settled. The staff are more approachable”. DS0000062146.V325775.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are now receiving a service that is safe and their overall needs are being met, the home is being well managed and showing significant signs of improvement, however, this is being compromised by the Local Authorities slow response to dealing with environmental issues and the refurbishment of the home. DS0000062146.V325775.R01.S.doc Version 5.2 Page 28 EVIDENCE: The current manager had been seconded to the home from Hull City Council on a temporary basis however from April 1st 2007 she will become the permanent manager of the home; 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 over 20 years previous experience in a managerial and caring role. The management team and staff group have made very good progress towards raising the standard of care and supporting documentation in the home, this now needs to be sustained and further developed to ensure that service users needs continue to be met. There have been significant improvements made in the development of care plans and risk assessments, completion of accident reports, the quality and quantity of supervision. Staffing will be improved further with the introduction of new staff and the current staff being given contracts of employment with the LA. This is detailed in the staffing section of the report. In general relatives are satisfied with the standards of care at Park View and the inspector had a conversation with visiting relatives on the day of inspection. They commented: “Things in the home are very good now staff and service users are much brighter. The staff group is more stable and seem more settled. Parents and carers are much more informed and there is open communication. The staff are more approachable and any issue raised however small is dealt with and resolved. We can see improvements in the service users well-being and they all have a better social life, our daughter is getting out much more that she used to, been to the cinema and the pub. Judith (the manager) is very approachable as are all the SCO and staff.” There were also two logged compliments form relatives who commented: “I want to thank staff for the prompt attention to my sisters health needs. Communication has improved and the improvement in the delivery of the service has greatly improved since last summer and the home is now managed better.” And another stated, “The service has improved in the last six months. The clients are happier because of regular staff being in place and they are getting out and about into the community more such as going to the theatre, shopping, and trips, eating out and travelling on buses. All the training the staff are having seems to beginning to work”. DS0000062146.V325775.R01.S.doc Version 5.2 Page 29 Since the previous key and random inspections there has been no improvements to the fabric of the building, redecoration and provision of appropriate bathing facilities in the home. The inspector was informed that the Social Services department are keen to determine ownership of the building and are taking legal advice before any work takes place. However this is taking a very long time to resolve and in the meantime service users are living in a home that cannot meet their individually assessed needs. This is detailed further in the Environment section of the report. As part of the inspection all of the maintenance certificates were seen and were up to date. Staff were up to date with their mandatory training. The LA has a well developed regulation 26 visiting and reporting system in place that monitors the improvements being made and makes recommendations and the registered manager routinely uses the CSCI regulation 37 reporting system to keep the inspector aware of any events that have happened in the home. This together with the manager’s willingness to accept areas of concerns demonstrates open and effective communication and good working relationships between the inspector and manager and a willingness to improve the service. The Local authority has a quality assurance system, which the manager has commenced with service user and relative’s questionnaires being completed, and relatives meetings are being held regularly however the QA system has not yet been fully implemented, within the home and needs further development. DS0000062146.V325775.R01.S.doc Version 5.2 Page 30 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 3 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 1 25 x 26 x 27 1 28 2 29 1 30 3 STAFFING Standard No Score 31 2 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 3 x 3 x 1 x x 3 x DS0000062146.V325775.R01.S.doc Version 5.2 Page 31 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 13 (b) Requirement The registered person must ensure that service users plans and daily recordings are monitored by a senior person and highlight action taken to address needs or concerns. (Timescale of 01/06/06 and 31/8/06 not met) The registered person must ensure that risk assessments are updated regularly. The registered person must ensure that service users are assisted to take part in the local community. 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 these recognise service users diverse needs. (Timescale extended) The registered person must recognise and act upon the service users rights to be provided with appropriate equipment and bathing facilities DS0000062146.V325775.R01.S.doc Timescale for action 30/06/07 2 3 YA9 YA13 13 (b) 16 (2m) 30/06/07 30/06/07 4 YA14 16 (2m) 30/06/07 5 YA18 16 (2m) 30/09/07 Version 5.2 Page 32 6 YA19 13 (1) 7 YA24 23 8 YA27 13 (5) 23 (2j) 23 (2a) 9 YA28 23 10 YA29 23 11 YA31 18 12 YA33 18 (1a) to meet their individual assessed 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 and 10/11/05, 30/4/06, 1/7/06 and 30/9/06 not met) The registered person must ensure that the home is redecorated inside and that a planned maintenance programme is provided (Timescale of 31/8/05, 31/03/06, 30/4/06, 01/09/06 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, 30/4/06, 1/7/06 and 30/09/06 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, 31/12/05, 01/06/06 and 1/9/06 not met) The registered person must ensure that service users that require equipment or adaptations to aid independent living are assessed by a qualified person and equipment is provided as required. The registered person must ensure that all staff understand their own roles and fulfil their job description. The registered person must ensure that the vacant posts within the home are filled to DS0000062146.V325775.R01.S.doc 30/06/07 30/06/07 30/09/07 30/06/07 30/09/07 30/06/07 01/04/07 Version 5.2 Page 33 13 YA35 18 (1c) 14 YA39 24 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. (Timescales of 31/8/06 and 31/10/06 not met) The registered person must 30/06/07 ensure that staff receive training in equal opportunities, disability equality, race equality and anti racism training. (Timescale of 31/8/05, 13/3/06, 30/4/06 and 31/08/06 not met) The registered person must 30/09/07 ensure the home’s quality assurance system is developed, and includes consultation with stakeholders, that information it produces is collated and a written report is produced and that it is sent to the CSCI and given to the service users. (Timescale of 9/3/05 and 31/8/05, 31/03/06, 1/6/06 and 01/09/06 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000062146.V325775.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000062146.V325775.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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