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Inspection on 18/12/08 for Park View (Ilfracombe)

Also see our care home review for Park View (Ilfracombe) for more information

This inspection was carried out on 18th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The home is clean and warm, all room are single and en suite which provides people with privacy and dignity. Individuals personal and health care needs are well met by a staff group who are reasonably well trained to understand the needs of frail elderly people. People who live at Parkview said ``I am still here so the care must be good, all the staff are really good, our needs are well catered for.`` The home offers a range of meals that takes into account individuals likes and dislikes. Three course are served for the main lunchtime meal.

What has improved since the last inspection?

Plans of care are are person centered and written in way that encourages staff to plan care around the needs and wishes of individuals. Activities are being offered more frequently and appear to meet the needs of the current people living at the home.

What the care home could do better:

Plans of care should be shared and reviewed with individuals and cover all aspects including social and cultural needs. The medication system must be more robust, all medication must be kept secure including insulin. Records relating to medications must be robust and where PRN (as needed) medications are prescribed, care plans must give clear instructions to staff as to when PRN should be considered. The communal lounge and toilets are in need of refurbishment. Recruitment practices must be more robust to ensure only staff who have all relevant checks in place are employed. This will help to ensure people are protected. All new staff should have an induction programme that follows the Skills for Council specifications.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Park View (Ilfracombe) Furze Hill Road Ilfracombe Devon EX34 8HQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Walsh     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Park View (Ilfracombe) Furze Hill Road Ilfracombe Devon EX34 8HQ 01271865657 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Shirley Ann Darling Type of registration: Number of places registered: Mr Geoffrey Crowe,Mrs Maria Crowe,Mr Andrew S Crowe care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Manager must undertake NVQ 4 in care The manager must obtain the Registered Manager?s Award by 2006 Date of last inspection Brief description of the care home Park View is a care home providing personal care and accommodation for 22 service users in the categories of old age (OP) and dementia, over 65 years of age (DE [E]). The home is situated in a residential area of Ilfracombe, adjacent to, and with direct access to, Bicclescombe Park. The Crowe family have run the care home over 20 years and it consists of a two storey building with a large car park situated at the rear of the property. All the private rooms are single and have en-suite facilities. There is a stair lift giving access to all areas of the home. The home has a conservatory, which is sited overlooking the garden at the side of the property and a sun lounge sited to the front Care Homes for Older People Page 4 of 25 0 0 Over 65 22 22 Brief description of the care home of the property. The home has a designated resident smoking room, separate from the main lounge. The range of fees are available from the home. The CSCI report is kept in the managers office and she will put up a notice in the front lobby to inform people that they are welcome to look at inspection reports if requested. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was completed during a week day in December and lasted approximately 6.5 hours. During this time people who live at the home were spoken to about their expediences of living at Parkview. We also spoke to four visiting relatives about their views on the home. Their views are included throughout the report. We spent time observing care practices, talking to the registered manager and staff and looking at some of the key documents. These included plans of care, medication records, staff recruitment and training files and records relating to individual monies. Prior to the inspection taking place surveys were sent to a sample of ten people, two were returned. We also sent surveys to health care professionals, one GP returned Care Homes for Older People Page 6 of 25 comments and we spoke to one community nurse during the inspection. We asked the home to provide us with some information prior to the inspection. This document is called an Annual Quality Assurance Assessment, and included information about how the home ensures health and safety issues are addressed. This information has helped us to make a judgment about the quality of care and support provided in the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that assessed needs Evidence: The files for the two newest people to the home were looked at and both had copies of the funding authority care plan and needs assessment, which had been used to inform the home in compiling a basic care plan for them. Most people who currently reside at Parkview are being funded by a local authority. The registered manager is aware that she needs to obtain their assessment in order for the home to make a clear judgment about whether they can meet assessed needs. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals person and health care needs are well met, but improvements are needed to ensure that medication systems and records are more robust Evidence: Three individuals files were looked at during this inspection and discussed with the registered manager. The format of the care plans the home uses has been changed to reflect a more person centered approach. Some of the sections are written in first person and start with for example I like to get up at... This allows the carers to plan for care in a way that the person has stated they prefer and wish. The home now need to ensure that they evidence that plans are shared, developed and reviewed with the individual. They should also now look to include more detail in the section about social needs, as this would help them to plan for any diverse needs as well as cultural or religious beliefs if known. Two of the plans of care for individuals who had come for emergency respite care needed some further details to ensure that staff fully understood their needs and any Care Homes for Older People Page 11 of 25 Evidence: risks attached to the way they care for these people. The registered manager ensured that the risk assessments were updated before the end of the inspection. People who live at Parkview said I am still here so it must be good care, the girls are all very good, I think we are treated really well here. Only two surveys were returned from a sample of ten, but both people ticked always to the question do you receive the care and support you need? They also ticked always to the question are staff available when you need them? Four visiting relatives were spoken to during the inspection and all stated they were happy with the care and support their relative got. One health care professional who returned a survey said Caring, efficient well managed staff. A visiting community nurse also gave positive feedback saying that the home always called the nurse team in with any concerns about skin care and looked after people well. The daily records show that health care needs are well met with visits from the doctor, the consultant psychiatrist as well as opticians and chiropody. Staff spoken to said that plans of care give them good information to help them understand individuals needs and they have daily hand overs and try to ensure that the daily records are kept up to date with any changes in care or general health and well being for each person. The medication records and storage system for medications was checked. One person was on a sedation medication for agitation and the prescription instructions stated take one at night, not on consecutive nights. The medication records showed this person had been administered the medication every night. The staff member in charge of medications were asked about this and said that the individual did get very agitated. She had also given a medication for sedation earlier than planned for one person. When we looked at the daily records there was no record of this persons agitation, all entries state that the person is fine. The staff member said they had received a verbal report saying the person had been very agitated and had noted they were agitated during lunch so had given them the sedation early. The medication instructions do not say give at any time, and the home need to discuss the use of this sedation medication with the individuals GP, and record clearly in the plan of care when and why PRN medication should be considered. This will help to ensure a consistent approach is used, and that other methods of calming may be considered before PRN medication is administered. Care Homes for Older People Page 12 of 25 Evidence: One persons medication had been increased to two tablets and this was recorded in the daily records, but any changes to medication records should be double signed to reduce the risk of mistakes. One individual is on daily insulin which is drawn up into syringes by the community nurse on a weekly basis. These are then stored in the kitchen fridge which is not locked. The registered manager was asked to check with the nurse and GP whether once the syringes are drawn up, should they still be stored in the fridge as the instructions indicate they should be kept at room temperature when in use. The home also needs to ensure that the insulin is kept secure, ideally with a separate locked fridge, and in the interim, in a locked container and ensuring the kitchen is locked when staff are not present. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of the home are flexible and social needs are reasonably well met Evidence: People spoken to said that the routines were flexible and that they could choose what time the got up and went to bed and where they spent their day. One person said I always go out with my family, I just have to let staff know when I am going, they ask me if I want any meals saving. Another person said I regularly get a taxi into town, and most afternoons I like a bit of time to myself in my room. Some people said that there were more regular activities, such as an entertainer who is booked to come every 4-6 weeks, and a theatre group that comes every quarter. The registered manager said that staff have taken on broad the need to provide more mental stimulation and regularly play games such as giant snakes and ladders and bingo. Staff were seen to be encouraging people to join in a game prior to lunch being served. Individuals who were asked said that they did not require any further activities, and several mentioned they had enjoyed the children coming from the local school to sing Care Homes for Older People Page 14 of 25 Evidence: Christmas carols. One person living at the home said that they had regular prayer meetings and that local clergy visited if requested. The home need to ensure that social and cultural needs are explored and plans of care include these details so that any identified needs can be planned for. Four visiting relatives said that they could visit at any time, that they were always welcomed by staff who were friendly and offered them drinks on most occasions. Individuals who live at the home said that they were able to use the phone to stay in contact with their family and friends. The home serves the main meal at lunchtime and it is always three courses with soup a main course and a pudding. People who live at the home said The food is very good, I enjoy my meals, I like the soup, we get a choice for the evening meal. There was no way of individuals knowing what the main meal was unless they asked the staff. The home had started to use a menu broad but this has stopped being used now. The home do not offer a choice at lunchtime, but staff said that because they were a small home they knew individuals likes and dislikes and the cook always provided an alternative when individuals did not like the main choice. This is not recorded anywhere. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views are listened to and acted upon Evidence: The home has a stated complaints process and individuals spoken to and those who returned surveys said they knew who they could make a complaint to and that it would be dealt with. The home has not had any formal complaints since the last inspection and nor has CSCI. Staff receive training in the protection of vulnerable people and those spoken to said they knew that any incident or suspicion needed to be reported straight away to the most senior member on duty. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service would benefit from some improvements to communal areas. Evidence: During this inspection all communal areas and some of the individual bedrooms were looked at. The registered provider has refurbished several of the bedrooms and they look clean and welcoming. Other areas of the home are now in need of refurbishment including the lounge and some of the furniture. The registered manager also needs to look at refurbishing the communal toilets that are near the lounge. They are difficult for staff to maneuver wheelchairs in and are looking tired and a little grotty. One health care professional who retuned a survey said premises a bit dingy and pokey to the question how do you think the service can improve? One visiting family said that although they were very happy with the care their relative got, they felt the premises needed some updating to improve the communal areas for people. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are reasonably well trained, but improvements are needed to ensure the recruitment practices of the home are more robust. Evidence: The staffing levels are sufficient for the number and needs of the current people living at the home, but should be kept under review. The current staff roat shows that is normally three carers on in the morning until early afternoon , then two carers, with two waking night staff. The home also employs a cleaner to work five morning per week and the registered provider does most of the cooking. Staff spoken to said that they were able to get their tasks completed with the number of staff per shift and that they worked well as a team so if someone was off sick they could normally find cover for each other so they did not go short staffed. Staff said they had training in all areas related to health and safety add had also had some training in dementia and the Mental Capacity Act. A sample of staff recruitment files were looked at and these showed that for some people they began employment at the home before all their relevant check had been completed. This could place people living at the home at potential risk. The registered Care Homes for Older People Page 18 of 25 Evidence: manager must ensure that individuals have a POVA first and references in place as a minimum before they are able to start work at the home. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in the best interests of the people who live there. Evidence: The registered manager has just completed her registered managers award and is about to begin the NVQ4 in care, which are the current regcognised qualifications needed to manager a care home. She has worked at the home for many years and has experience in caring for frail elderly people. The staff group and people who live at the home have confidence in the manager, she is well liked and respected. One staff member said she will always hep you out with shifts and personal issues so you can do your job. The registered manager has used surveys to assist her to gain the views of the people who live at the home, as part of the quality assurance. She now needs to collate the results and make them available to the people living at the home. Care Homes for Older People Page 20 of 25 Evidence: Monies kept on behalf of individuals is kept secure and records show that there is an audit trail. The home should ensure that receipts are obtained for services such as chiropody and hairdressing and give receipts for monies brought in by family members. This would ensure a more robust audit trail is available. The AQAA gave us information about how the home ensures that the premises and equipment are serviced or tested on a regular basis. Staff confirmed that they have training on all areas of health and safety. It was noted that one newer staff member had not completed an induction. The home are reminded that all new staff should complete an induction that meets the Skills for Care Council specifications. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 12 Medications must be securely stored, this relates to the insulin kept in the fridge to ensure that only staff who are qualified to administer medications have access to them, keeping people safe. 15/01/2009 2 29 17 All new staff should have relevant checks and references in place before employment commences To ensure only suitable staff are employed to work with vulnerable people 15/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 plans of care should be developed and reviewed with the individual or their representative. All sections including social history and needs should be completed to help the service plan for all needs. Any changes to medication records should be double signed Page 23 of 25 2 9 Care Homes for Older People to help prevent any mistakes. 3 9 Medications that are PRN should have clear instructions to staff in care plans as to if and when the PRN medication should be considered. The home should ensure the menu is available in a format that can be easily understood to people who live at the home, to enable them to make choices about what food the wish to eat. The home should record what meals have been offered to people each day, and should always offer a choice. The registered provider should look at a programme of refurbishment of communal areas including the main lounge and communal toilets near the lounge. The home should ensure that all new staff complete induction training to ensure they understand their role. 4 15 5 6 15 19 7 38 Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!