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Inspection on 15/09/08 for Park View Nursing Home

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

This inspection was carried out on 15th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 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.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Park View Nursing Home 13 Gedling Grove Nottingham NG7 4DU The quality rating for this care home is: One star adequate 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: Date: Meryl Bailey 1 5 0 9 2 0 0 8 Care Homes for Adults (18-65 years) Page 2 of 34 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. Reader Information Document Purpose Author Inspection report CSCI Page 3 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 Adults (18-65 years) Page 4 of 34 Information about the care home Name of care home: Address: Park View Nursing Home 13 Gedling Grove Nottingham NG7 4DU 01159790776 01159790779 parkview@crystal-ns.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Crystal Nursing Services Ltd Name of registered manager (if applicable) Mrs Mary Catherine Upton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 18 7 0 0 care home 18 learning disability physical disability Additional conditions: 1 x LD(E) for a named service user - as identified in the registration report. Within the total number of beds, a maximum of 18 may be used for the category LD Within the total number of beds, a maximum of 7 may be used for the combined category of LD/PD Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Date of last inspection One star adequate service 0 9 1 0 2 0 0 7 A bit about the care home Park View is a home that offers nursing care for up to 18 people who have learning disabilities. Some have physical disabilities. The home is near local parks and there are trams and buses to the city centre. Care Homes for Adults (18-65 years) Page 6 of 34 The home currently provides single ensuite bedrooms across two separate units. Each unit has a separate lounge, dining room and quiet room. Information about the home is provided in the statement of purpose and service user guide. The weekly fees start from £760. Care Homes for Adults (18-65 years) Page 7 of 34 Our judgement for each outcome: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 34 How we did our inspection: This is what the inspector did when they were at the care home We saw most of the people who currently live there. We talked with some of them. We checked the care records of four people and looked at a sample of staff records. We had discussions with some of the staff. Care Homes for Adults (18-65 years) Page 9 of 34 The registered manager was not available during the visit, but we were able to speak with her by telephone on the following day to give feedback about the inspection. Information about a home that is collected before the site visit is also used as evidence to make judgements. We received a completed AQAA (Annual Quality Assurance Assessment) form in August 2008. What the care home does well Care Homes for Adults (18-65 years) Page 10 of 34 Care and support is planned and people who live at the home choose where they want to go each day. Risks are well managed so that people can do what they want as safely as possible. A small sensory room is provided and some people have lights and reflective images in their rooms. People told us of their holiday plans and day trips using the minibus. People receive personal support in the way they prefer and require. Their preferences were written in their care plans. Staff told us that most people just needed encouragement to meet their own personal care needs. Staff are fully aware of policies and procedures, which keep people safe at the home. Care Homes for Adults (18-65 years) Page 11 of 34 All areas of the home were found clean and staff told us there was a system to report maintenance issues for repair each week. There was always at least one qualified nurse on duty in the building and over 50 per cent of the care support staff had completed the National Vocational Qualification (NVQ) in care at level 2. The manager and staff hold monthly meetings with people living at the home to discuss improvements, changes in the home and choices of menus. Care Homes for Adults (18-65 years) Page 12 of 34 What has got better from the last inspection More day trips have been arranged with people choosing where they want to go. Staff have been informing the Commission of incidents as they occur so that we know appropriate action has been taken. Care Homes for Adults (18-65 years) Page 13 of 34 All staff have received further training in keeping people safe and how to report concerns. What the care home could do better Include alternatives on the menu and display it in large print with pictorial representations to assist people in choosing what to eat. Records for medication must be fully completed. This is to ensure people receive the Care Homes for Adults (18-65 years) Page 14 of 34 medication that is prescribed and appropriate for them. Display the complaints procedure in an Easy Read picture format. Provide photographs of staff on the duty rota so that people know who will be supporting them. Ensure each of the staff have supervision meetings with a supervisor at least six times each year. They must ask the Fire Care Homes for Adults (18-65 years) Page 15 of 34 Authority about propping open doors, particularly at night. This is to offer protection to people in the event of a fire. All openings of windows must be assessed and action taken to restrict openings where needed. This is to protect people from injury and intrusion. If you want to read the full report of our inspection please ask the person in charge at the care home. Care Homes for Adults (18-65 years) Page 16 of 34 If you want to speak to the inspector please contact Meryl Bailey Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge, CB21 5XE Phone 01223 771300 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 Adults (18-65 years) Page 17 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 18 of 34 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . People have their needs assessed before they move into the home to ensure the home can meet their needs appropriately. Evidence: There had been no new admissions since the last inspection. The four files we examined each contained a detailed preadmission assessment. There were also specialist assessments from social work staff and health professionals. Care Homes for Adults (18-65 years) Page 19 of 34 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . Care and support is planned and people who live at the home make choices with support. Risks are well managed. Evidence: There was a support plan on each of the four files we looked at. These included action plans for each area of need with clear risk assessments linked to them. Each action plan was reviewed as needed. All those seen had been reviewed within the last three months. At the end of each review a timescale was given for the next review. In addition to the full support plan there was a daily plan for each person. People told us they could choose what they wished to do each day and they could get up and go to bed when they wanted. One person was returning from a local shop at the beginning of the inspection visit. Another person chose to have lunch at a pub. Care Homes for Adults (18-65 years) Page 20 of 34 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . People are enabled to enjoy a positive lifestyle. Healthy meals are provided, but choice of meal is not fully promoted. Evidence: The deputy manager told us five people were at Day centres or college on the day of this inspection. There were daily plans on peoples files that confirmed activities that were planned each day. One person was in hospital and two people went to visit her during the afternoon. Some people were in the lounge with television on in the upper unit and most people have their own televisions in their rooms. A small sensory room is provided, but not in use during the visit and some people have lights and reflective images in their rooms. Two people living in the home told us of their holiday plans to go to Crete the following week with the manager and another support worker. Others had already had holidays elsewhere. People told us they use local facilities including going to the local pub, Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: shopping locally and going into the city centre. There was a minibus available and one of the staff told us he usually drives to take people to various places of interest in the region and out for meals sometimes. Staff described respectful care when assisting with personal care. People we spoke with told us that staff helped them when they needed it and we observed staff knocking on doors before entering. At all times during the visit we observed staff interacting positively and respectfully with people. The cook told us the menu contained meals selected by people who live at the home. We saw the four-week menu on the wall in the dining rooms and a variety of meals were included. Only one option was given for each meal, but the cook said that she would prepare alternatives if people did not want the set meal. The menu was displayed in small print and people were not aware of what meal was available for the day. People told us they usually enjoyed the food. There was a dining room on each floor with sufficient room for all people to sit together with staff. Care Homes for Adults (18-65 years) Page 22 of 34 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Healthcare needs of people living in the home are met and they receive personal support in the way they prefer and require. However, the current medicine administration could pose a risk to people. Evidence: The four care plans that we looked at contained individual routines and preferences for personal care. The support needed was clear and people told us that staff helped them when they needed it. Staff told us that most people just needed encouragement to meet their own personal care needs. There was a nurse responsible for each unit during the day and one person was supported by staff at a hospital appointment during the visit. A copy of a letter from a doctor included the following comment, The nurses at Park View Nursing Home have always provided exemplary care in my experience. All healthcare appointments are recorded on the care files, including chiropody, dentist and GP. Medication was stored securely. On checking the Medicine Administration Record sheets we found most medication that was prescribed was printed on the sheet by the pharmacist, having been prescribed by a doctor. However, for five people there were Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: added handwritten entries that had not been signed or verified as accurate. One was for Lactulose and a nurse told us she had given it, but as it was not currently prescribed, she used someone elses bottle and gave it twice in one day. An entry in the file for this person on 23/03/08 stated that Lactulose had been discontinued, as it was no longer required. However, we have received a copy of a letter from a doctor stating that Lactulose is a safe preparation to give to the person concerned. It is not good practice to take medications prescribed for one person and give to another. We found for most medication the record sheet was initialled as given or a code entered to explain why it was not given, but there were two gaps at teatime on 12/09/08 that had not been initialled. A nurse on duty said she remembered administering these, but forgot to go back to sign the sheet. On checking copies of reports of audits carried out by the responsible person on behalf of the provider company we noted he had found there were gaps found in Medicine Administration Record sheets for most months. Care Homes for Adults (18-65 years) Page 24 of 34 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 . Complaints and Safeguarding procedures offer protection to people at the home. Evidence: The complaints procedure was displayed on the wall in the entrance hall, but it was not in a suitable format for the people that live at the home. Staff said they used to have one with pictures, but had not seen it for a while. The registered manager stated in the Annual Quality Assurance Assessment (AQAA) form completed in August 2008 that in the last twelve month the home had received one complaint, which was not upheld. We looked at a file containing Compliments and Complaints, where details were written in full. There had also been one occasion when an allegation of abuse was made and this was appropriately dealt with under local Safeguarding Adults procedures. Staff told us they had received training in Safeguarding Adults since the last inspection. They said that this training was provided by the local authority at County Hall and included procedures for reporting concerns. There were no rewritten records or certificates of this training on their files (see Staffing Section). People we spoke with that live at the home told us they would tell staff or Mary, the manager if they had any concerns about anything. Care Homes for Adults (18-65 years) Page 25 of 34 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 . A clean and comfortable environment is provided. Evidence: The upper and lower accommodation units were mainly well maintained and provided a comfortable environment. Certain adaptations had been made to keep people safe. For example, due to challenging behaviour displayed by some people the televisions in the lounges were held securely in cupboards and pictures were secured to the walls. Bedrooms were pleasantly decorated and personalised with individual items and photographs. Some people had lights and reflective images in their rooms, selected to meet their individual preferences. All areas were found clean. Some people told us they liked their rooms very much. One person was unhappy about a small amount of flaking paint behind his radiator and another persons extractor fan was not working. Staff told us there was a system to report maintenance issues for repair each week. Items needing repair were recorded in the maintenance book. There were automatic release and closure mechanisms on doors so that they would close in the event of a fire, but we found two were not working and these doors were propped open. Staff told us there had been some difficulty with these, as new batteries had not always solved the problem (see standard 42). We also found that some windows had restrictors fitted, but were not all in use and other window openings were not restricted (see Standard 42). Care Homes for Adults (18-65 years) Page 26 of 34 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 needs of people who live at the home are met by sufficient appropriately trained staff. Evidence: The staff rota demonstrated that there were a sufficient number of staff on duty. People living at the home were not aware of who was coming on duty for the afternoon. Staff members spoken with stated that they felt there were always enough staff and there was flexibility between floors. Extra staff were provided where people needed support to attend hospital. Extra staff had been at hospital with one person until 11.30 on the previous evening. There was always at least one qualified nurse on duty in the building and during the daytime there were two. A nurse and one carer were awake during the night. Three staff files of people working on the day of the inspection visit gave evidence that satisfactory references and criminal records bureau (CRB) checks had been obtained prior to commencement of work at the home. There were various certificates of training and a new staff member had completed a full induction. The manager had told us on the Annual Quality Assurance Assessment (AQAA) form that over 50 per cent of the care support staff had completed the National Vocational Qualification (NVQ) in care at level 2 and others were undertaking Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: the course. We spoke to one of the staff who had completed the first two modules. Staff told us of specific training in learning disability and dealing with challenging behaviour. They described different tactics used in different circumstances with different people. Distraction was used to avoid aggression wherever possible. Staff recorded actions they had taken in the daily notes. There were some supervision notes on each of the staff files that we saw, but these were neither regular nor held six times in the last six months. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 home is well managed and people benefit from formal quality monitoring systems. Health and safety is mostly protected, but further action is needed to promote safety. Evidence: Either the registered manager or the deputy manager is available at the home at all times. Both are registered Learning Disability Nurses. The deputy manager was present during this inspection. The Annual Quality Assurance Assessment (AQAA) form was completed comprehensively and returned to us in August 2008. This told us that they have monthly meetings with people living at the home and discuss improvement, changes in the home and choices of menus. As a result they have purchased additional garden furniture, had a handrail installed, and increased the number of day outings. Regular surveys are also used to monitor the quality of the service. The manager reported that most responses in a recent survey had been positive. Where there was a negative response the manager and the Responsible Individual for the company had met with a relative to discuss concerns and followed this up be telephone to ensure the relative was satisfied with the response. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: Staff training certificates and discussions with staff have informed us that staff have received some training in the safe working practices. There were records kept in the home of safety checks for water. Two automatic release and closure mechanisms on doors were not working and these doors were propped open, which would be dangerous in the event of a fire. We also found that some windows had restrictors fitted, but were not all in use and other window openings had not been assessed for security risks. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes  No  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 Adults (18-65 years) Page 31 of 34 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 Description 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 Description Timescale for action 1 20 13 The practice of administering 31/10/2008 one persons medicines to another must cease. This is to ensure a full audit trail of all medicine administered to each and every person in service. 2 20 13 There must be a system in place to ensure all nurses complete the medicine administration record accurately and handwritten entries must be signed and verified. 31/10/2008 This is to ensure people receive the medication that is prescribed and appropriate for them. 3 42 13 After consultation with the 31/10/2008 Fire Authority ensure that the propping open of internal doors, particularly at night, is Page 32 of 34 Care Homes for Adults (18-65 years) in accordance with fire regulations. This is to offer protection to people in the event of a fire. 4 42 13 All openings of windows must 31/10/2008 be assessed for the risk of exit or entry via windows and action taken to sufficiently restrict openings where needed. This is to protect people from injury and intrusion. 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 17 Include alternatives on the menu and display it in large print with pictorial representations to assist people in choosing what to eat. Develop a Homely Remedies Policy for all staff to follow. Display the complaints procedure in an Easy Read picture format. Provide photographs of staff on the duty rota so that people know who will be supporting them. Ensure all staff have 1:1 supervision meetings with a supervisor at least six times each year. 2 3 4 5 20 22 31 36 Care Homes for Adults (18-65 years) Page 33 of 34 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 © (2008) 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. 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