CARE HOMES FOR OLDER PEOPLE
Park View (Ilfracombe) Furze Hill Road Ilfracombe Devon EX34 8HQ Lead Inspector
Jo Walsh KeyUnannounced Inspection 10:00 26th April and 2nd May 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Park View (Ilfracombe) Address Furze Hill Road Ilfracombe Devon EX34 8HQ 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) 01271 865657 Mr Andrew S Crowe Mrs Maria Crowe, Mr Geoffrey Crowe Shirley Ann Darling Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22) of places Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The manager must obtain the Registered Manager’s Award by 2006 The Manager must undertake NVQ 4 in care Date of last inspection Brief Description of the Service: 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 of the property. The home has a designated resident smoking room, separate from the main lounge. The range of fee is £274 to £383 per week. The CSCI report is kept in the manager’s 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. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two days during which time most of the residents were spoken to. Some time was spent with people who live in this home and observations were made during the inspection. All observations were followed up by discussions with the staff, manager and looking at records. Surveys were sent to a number of residents, their relatives and to health care professions prior to the inspection and their comments are included throughout this report. The home were also asked to complete a pre inspection questionnaire, which provides information about staff, training and how the home manages health and safety issues. This information has helped to inform the inspection process. What the service does well:
Residents spoken to and those who completed surveys said that their needs were well met and comments included ‘‘ my experience over time has been favourable with any problems being tackled and resolved rather than ignored, I am very happy here everyone is very kind and helpful.’’ One relative made the following comment in their survey, ‘’It is a family concern, well organised to provide a caring atmosphere which is always apparent’’ Potential new residents are offered the opportunity to visit the home and an assessment of their needs is completed to ensure this is the right place for them. One resident said they had looked at several homes but felt this one ‘’was homely and this better suited my needs’’. They confirmed that the manager had spent time talking about what sorts of things they enjoyed and what support staff would need to provide. This ensures that the home is able to meet individuals’ needs. Residents’ personal and health care needs are well met and care plans are in place to ensure that staff provided this care in a consistent way. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 6 All bedrooms are en suite providing a level of privacy and dignity for residents. The communal areas are pleasant and residents were observed moving freely and using all the different communal rooms. The staff group have remained stable and work well as a team to provide care and support in a way that suits individuals’ needs and preferences. Residents said that they can choose when they get up, what they do with their day and that staff treated them with respect and dignity. One relative said ‘‘my relative always appears clean and well dressed, which must entirely be due to Parkview staff. They appear prompt in contacting the general practitioner over any medical issues.’’ What has improved since the last inspection? What they could do better:
Although improvements have been made to the content of care plans, enabling staff to have a better understanding of individuals needs, further detail is
Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 7 needed for some plans to ensure that all aspects of care and support are provided consistently. An example of one person who was being monitored for weight loss, and staff were aware that they needed to encourage the person to eat, however there was no mention of this aspect of care in their plan. Plans of care need to be shared, agreed and reviewed with the individual and/or their representative where possible. This would ensure that the individual is involved in making decisions where possible about their care and how it should be provided. None of the current care plans have been shared with individuals they concern. The home only offers limited activities and this does not meet all the needs of the current resident group. Some residents spoken to said they would be interested in joining in more activities such as quizzes if they were offered. One relative said in their survey ‘’I feel that activities e.g. table games, more entertainment, local groups could be encouraged. Some of the residents are able to take part and it would stimulate and give enjoyment to them.’’ Other suggestions were made to ensure that those residents who are less able to participate in group activities are still provided with a stimulating environment. The home is about to have a new conservatory built and need to make sure that access to this, which forms part of the main entrance is accessible to those less mobile or who use wheel chairs. Currently access is difficult as there is no ramp and the pathway leading up to the entrance is pitted with holes that could present a trip hazard. All communal toilets should have soap dispensers and paper towels to help with the risk of infection control. Staff would benefit from further training in care of people with dementia. The home needs to ensure that the views of the residents and their carers/families are sought to help improve the quality of care provided. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: Residents said that they chose Parkview by either visiting themselves or their relatives doing it for them. The Manager, where possible visits prospective residents before admission in their own homes or in hospital in order to complete an assessment and be sure that the home can meet their needs. Copies of the care management assessment and care plan are obtained and this helps the home to plan for the individuals care. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 10 Two staff confirmed that prior to a new person moving in the manager goes through their needs and important information is written up on a white board in the staff room for staff to refer to. The manager said that since the last inspection, where it was recommended that all residents are given a copy of the homes statement of terms and conditions, this is now happening. This was not tested although those residents who returned surveys said they had been given enough information about the one prior to admission. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most residents’ care is well planned, providing staff with information they need to meet residents’ needs. Improvements are needed to ensure that those residents with complex needs have plans that fully identify their needs. Residents’ health needs are met and supported by the appropriate involvement of other health professionals. There are good systems for managing medications. Staff and the management team promote most residents’ privacy and dignity. EVIDENCE: The manager has worked hard to improve the quality and content of individuals care plans. Three plans of care were looked at in some detail. They are organised into sections that helps staff to find information quickly when
Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 12 needed. Some plans do still require more detail to ensure care is provided consistently and that all needs are identified with clear guidelines about how these needs are to be met. The example of one resident who had lost a significant amount of weight over the pat months, and was observed at lunch time to eat very little and no other choices of food offered to her was given. This person’s plan had no mention of poor appetite or what was in place to ensure that their dietary and fluid intakes were kept at sufficient levels. Staff were aware of the needs of this individual when spoken to, and said that often they would offer some toast or other snack if the main meal was not eaten, but this was not witnessed, and the plan of care was not detailed enough to ensure their needs were met. Plans of care are not currently shared and agreed by residents or their carers. Involving people in their plan of care would ensure that all their preferences and daily routines could be included Health care needs are clearly set out and any involvement with health care professions is recorded with actions needed. Six general practitioners returned comment cards and all were positive. One did comment that transport is not always proved to the surgery. The manager said that they always provided transport if needed, but there were times when a doctor was asked to visit the individual at the home, because of ill health and infirmity. The home has good systems in place of the safe handling of residents medications and those wishing to self medicate have a risk assessment completed and reviewed regularly to ensure they can manage safely. One carer was observed to sign medication had been administered before the person had actually taken the medication. The staff member said they checked that all medication had been taken before leaving the dinning room, but agreed that it was not good practice to sign before the individual took their tablets. Staff were observed to be treating most people with respect and dignity, although at times they missed cues to interact with those individuals who have more complex needs due to dementia. One person was given very little time by staff to respond to requests and questions at lunchtime. Their meal was taken away before they had time to answer whether they had finished and this was discussed with the manager. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Routines are flexible but social activities do not meet residents’ expectations and preferences. Residents benefit from contact with their family and friends, which is encouraged and supported by the home. Residents enjoy a balanced diet which takes into account the likes and dislikes of individuals, although there is limited choices available at lunchtimes. EVIDENCE: Residents spoken to said that they could choose when they got up, what time they went to bed and to some degree, when they had their meals. One person said that if they went out with their family the staff would make sure that their meal was ‘kept back’ for them. On the day of the inspection residents were observed to be moving around the home freely, some getting up late and choosing to spend time in their rooms.
Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 14 Staff also confirmed that they offer support and care at times to suit individuals, where possible. The routines of the home did appear fairly flexible to suit individuals’ needs and preferences. The home only offers a limited activities programme. On the first day of the inspection some singers came in the afternoon to entertain the residents. People did appear to be enjoying this and several said that they would like more entertainment. Two people said in their surveys that there were not enough activities and this was also highlighted by staff as an area the home needed to improve on. When observing residents in the lounge, it was noted that some people sat for quite long periods without any kind of social engagement. One person was looking around for things to occupy themselves with, but there were no appropriate books or objects within their reaching distance. This was discussed with the manager and it was agreed there could be things put in the environment that could improve the quality of engagement. One relative said in their survey that they would like to see the television turned off in the lounge and more activities offered. The home continues to offer a reasonably balanced diet and most resident said they enjoyed what was offered. One or two did say there was only one choice at lunchtime for the main meal, and this was reflected in the menu board and menu plans. The manager said that if they are aware of individual likes and dislikes, they will provide an alternative, for example one person does not like pork so they will be given chicken. This would not be a choice for all residents on a given day though. It was also noted that one person who had a poor appetite and refused their main meal, was not offered any kind of alternative, although the manager said they do often ask if they would prefer something else. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Residents are safeguarded from abuse. EVIDENCE: Residents spoken to and those who completed surveys said they knew who they could talk to if they had any concerns and most said that they believed any issues would be dealt with. There have been no new complaints raised to the home or to CSCI since the last inspection. The home has a robust recruitment process that ensures staff have all checks completed in order to protect residents. Staff also have training in looking out for abuse, and those spoken to appeared aware of what they should do, if they suspected abuse. Residents’ finances are appropriately managed and records seen showed they were accurate and kept up to date. This also further protects residents.
Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 16 Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a homely environment, although some areas of refurbishment are needed and access into the home needs to be improved. EVIDENCE: Since the last inspection the providers have installed new double doors in the sun lounge and are about to install a new conservatory at the entrance of the property. They need to ensure that this is ramped or made level so that it is accessible by wheelchair and for those less mobile residents. There are patches of potholes on the pathway leading into the home, which also need attention to ensure good, safe access. Since the last inspection the home have moved the smoking area form the entrance hall to a small lounge area. This has improved the smell of the
Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 18 entrance to the home. The registered providers need to look at installing an air ventilator in the smoking room, which the manager said they are currently looking at. The communal toilets used by resident did not have paper towels and these should be in use to help prevent the risk of cross infection. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents are met though the number and knowledge of the staff. Staff are trained adequately to do their jobs. EVIDENCE: On the first day of the inspection three staff were on duty during the morning, two on during the afternoon plus the registered manager. The home also employs a cleaner 5 mornings a week and the registered provider does the cooking. Staff confirmed that this was the usual amount of staff and that this was sufficient to ensure needs were met in a timely fashion. Staff spoken to appeared to have a reasonable knowledge of the residents needs, although further training would be of benefit in relation to working with people with dementia. Staff confirmed that they are given training in all areas of health and safety and that they are encouraged to do NVQ training. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 20 The pre inspection questionnaire indicates that over 50 of staff has already achieved NVQ2 or above, which is the expected quota to ensure care staff can do their job effectively. The home operates a good recruitment procedure that clearly highlights the processes to be followed. Three staff recruitment files were looked at during the visit. The documentation was consistent with evidence of a safe and robust recruitment process being carried out before a person is employed at the home. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,25,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed although improvements are needed to show how the home is run in the best interests of the residents. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff are protected. EVIDENCE: Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 22 The registered manager has almost completed her registered managers award and will then need to go on and do the NVQ4 in care. She has worked at the home for a number of years and has a good knowledge of the residents and their needs. Although the home have asked residents to complete questionnaires, these have been too vague and nothing has been done with this information. It was agreed that questionnaires need to be more focused on specific issues relating to care at the home and that the results of any surveys should be used to help improve the quality of care provided. The records for handling residents’ fiancés was checked and found to be accurate and up to date. This ensures residents are protected. Fire safety equipment, for example fire extinguishers, had been regularly serviced and the fire log showed regular checks and maintenance on emergency lighting and fire alarms. The pre-inspection questionnaire demonstrated that mandatory training was well managed at the home. Training records and discussion with staff confirmed this. The home does not keep copies of induction training although a training log is used. It was agreed they should keep a copy of his training log in the future. Risk assessments are now in place for all areas of health and safety. Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement Care plans must include risk assessments and be developed and reviewed with the resident and/or their representative. (Previous date set for compliance 30/10/06) Timescale for action 30/09/07 2. OP26 13 The home must ensure that all communal toilets have soap dispenser and paper towels. The registered provider must ensure that access in and out of the home is suitable for less mobile and wheelchair dependent residents. 30/07/07 3 OP19 13 30/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 25 1. OP12 The home should ensure that they provide regular activities that are suitable to the needs and preferences of the residents. The home should replace some of the old worn furniture in the communal areas and refurbish the sun lounge area. The manager should ensure she completes her RMA and NVQ4 in care The home should ensure that the results of any surveys completed are collated and results made available to residents and CSCI. The results should be used to improve the quality of care and support provided. The home should ensure staff receive training in infection control. 2. 3. 4. OP19 OP31 OP33 5. OP38 Park View (Ilfracombe) DS0000022148.V331078.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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