Inspection on 17/09/08 for Park View Residential Home

This inspection was carried out on 17th September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Park View Residential Home 24/09/07

Park View Residential Home 19/09/06

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Park View Residential Home 118 Gammons Lane Watford Hertfordshire WD25 0HY Lead Inspector Claire Farrier Unannounced Inspection 09:00 17 & 18 September 2008 th th 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 Residential Home DS0000065952.V371333.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 Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park View Residential Home Address 118 Gammons Lane Watford Hertfordshire WD25 0HY 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) 01923 242431 01923 240131 aubany.home33@yahoo.co.uk Mr Frank Silva Mrs Z Silva Care Home 5 Category(ies) of Learning disability over 65 years of age (5), registration, with number Mental Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (5) Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. OP-5, LD(e)-5, MD(e)-5 All service users resident at the home must be fully ambulant and mobile. 24th September 2007 Date of last inspection Brief Description of the Service: Park View is a care home providing personal care and accommodation for five older people with a learning disability and mental health needs that are secondary to the learning disability. It is privately owned. The home was opened in 2006, but the first residents moved in in February 2008. Park View is a detached family style house in a residential road. It is indistinguishable from the other houses in the road. The home is located close to the centre of Watford, with its shopping malls, community health facilities and hospital. There are local shops within a short walking distance and easy access to major rail, bus and road transport. All the homes bedrooms are single. None have en-suite facilities. There is no lift and the home is not suitable for service users with mobility difficulties. The garden at the rear is mainly laid to grass with a large paved patio. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective residents. The current charges are from £1,750 – £2,250 per week. Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We (The Commission for Social Care Inspection) spent two mornings at Park View, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. Both the people who live in the home completed a Have Your Say survey before the inspection. Four members of staff also completed Have Your Say surveys, and we have used the information from these in this report. We looked around the home and the garden. We met one of the people who live in the home, and we spoke to the staff. We looked at some of the records kept in the home, and the home’s policies and procedures. We also looked at the care plans so that we could see how people are involved in planning their own care and support. We talked to the manager about what we had seen during our visit. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. The AQAA is a self-assessment document that focuses on outcomes for the people who live in the home. It also provides us with some statistical information. What the service does well: The Annual Quality Assurance Assessment (AQAA) states, “We know that we give a service that provides value for money because our service users are happy and fully contribute to how the home is run.” The surveys from the people who live in the home had positive answers to all the questions. One of the staff surveys stated, “I am very happy working at this establishment as the care provided is of a high quality and the staff, including managers all work well as a team.” The ethos of the home is that it is the home of the residents, and the staff support them to live their lives as they wish to and to make their own decisions about every aspect of their lives in the home. All the staff are positive and enthusiastic about their work and their support of the people who Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 6 live in the home. The manager has established a very good system for personalised care planning in the home. The care plans show that people make decisions about everything that they do in the home. One person wants to look after chickens, and a new chicken run has been built in the garden so that he can do this. The home has a good quality of decoration and furnishings. It is comfortable, welcoming and homely. What has improved since the last inspection? What they could do better: The main area for improvement is training for the staff. There is no evidence of a training and development plan for the staff to provide them with the information and skills that they need for their work. None of the staff have had training in moving and handling or food hygiene, and not all have had recent training in fire safety or first aid. These are all mandatory for all staff. There is no training available for the staff on understanding mental health needs. The only training on moving and handling is by watching a DVD, and here is no training available for managing pressure care or nutrition. All of these are essential so that the staff have the skills to make sure that the people in the home are safe at all times. The staff work 12 hour shifts, and some people work very long hours each week. The long hours mean that staff may be too tired to provide a good quality of care for the people who live in the home, and there is a risk of errors due to poor concentration. The 12 hour shifts mean that there is little room for flexibility, so that hours can be arranged for when there is greatest need. The rotas and shift patterns may need to be reviewed when more people live in the home, to make sure that there are sufficient staff in the home at all times. Some of the staff who we spoke to during the inspection, and who completed surveys for the inspection, did not know what they should do if they thought Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 7 someone was being abused in any way. It was reported that training has been arranged on safeguarding with an external trainer. This training needs to include the Hertfordshire inter agency procedures, to make sure that correct procedures are followed and the people in the home are fully protected. 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 Residential Home DS0000065952.V371333.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 Residential Home DS0000065952.V371333.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): 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are considering moving into the home have sufficient information, and a detailed assessment, to be confident that their needs will be met. EVIDENCE: The Statement of Purpose, which is the document that sets out the services that the home offers, is clearly written and has been reviewed regularly. However it needs to be more specific about the services that are provided in the home. The Statement of Purpose states, “Our aims to offer the service users an exceptionally high standard of care and rehabilitation. We deliver a comprehensive service of the highest quality that encompasses care, rehabilitation and resettlement.” It states that services are provided for “LDMD (Adults)”. In practice the aim of the home is to provide a service for older Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 10 people with a learning disability and mental health needs that are secondary to the learning disability. This should be clarified in the Statement of Purpose. There is no indication i8n the care plans of the people who currently live in the home that there are plans for their “resettlement”. The Statement of Purpose needs to provide an accurate description of the services that are provided. The Annual Quality Assurance Assessment (AQAA) states, “We provide a written service users guide that is easy to read. Staff assist in reading where required. All service users have a copy of the service users guide and have signed for receipt where able. In the next 12 months we plan to develop a more reader friendly version of the service user guide (using pictures and symbols) to assist our service users that cannot read.” Two people have moved into the home since the last inspection. Their files show that a full assessment was completed before they moved in, to make sure that the home was able to meet their needs. Assessments and information from other services, such as the Community Learning disability Team and the Community Support Unit (for mental health) provided additional guidance. Both people had trial stays in the home before they moved in, so that they could decide if it was the right place for them and so that the staff could get to know them before they moved in permanently. Contracts are in place that set out the services provided, and the rights and responsibilities of the residents. However the contract is not written in an easy read format so that people can understand it. All the staff who completed surveys for this inspection feel they have the right support, experience and knowledge to meet the different needs of the people in the home. There is no evidence that staff have had appropriate training in understanding mental health needs (see Health and Personal Care), but the staff who we spoke to showed that they understand the needs of the people who currently live in the home, and there is appropriate support from other professionals. Park View Residential Home DS0000065952.V371333.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, and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that they will receive a good quality of personal care and healthcare. However the lack of appropriate training may put people at risk or injury or of a poor quality of healthcare. EVIDENCE: We looked at the care plans for both the people who live in the home, and used them to track their care and support. The care plans are clearly written, with good details of all the residents’ needs and procedures and guidelines for meeting those needs. The home’s policy for care planning states, “The service user should be as involved in the care planning process as possible. This will ensure that their personal opinion and preference is taken into account fully.” The care plans have a person centred format, which emphasises and encourages each person’s independence and choices. For example, “X will say Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 12 when he is ready for bed and will allow staff to help.” The staff are to “prompt and praise” the person, and to “offer aid to change clothes.” The staff who we spoke to said that the care plans provide them with good information on each person’s needs, so that they are able to provide a good quality of care in the way that each person wishes. One staff survey stated that what the home does well is, “Providing good personal/individual care. Encouraging independence. Ensure that service users are mentally and physically well.” Another said, “We promote independence, freedom of choice and encourage service users to remain mentally and physically active as best as they can.” Appropriate risk assessments are in place to ensure that the people who live in the home can take part in the activities that they wish to. The risk assessments that we saw covered all aspects of each person’s life in the home and in the community. For example, making hot drinks, cooking, smoking, and going out independently. There is a moving and handling assessment for each resident, and assessments for the risk of falls, for nutrition, pressure sores and for behaviour. The procedures of the home are proactive in promoting good health. One person had health concerns when he moved into the home, and these were investigated appropriately. This has included several admissions to hospital, and guidance from a dietician. Everyone has regular nutrition assessments that include monitoring both their weight and their BMI (body mass index), and the community nurse checks these assessments for any action that may be needed. The assessment for pressure sores includes body charts to monitor any marks or bruising. However the daily record for one person showed that a bruise was noticed on his arm, but there was no further recording or follow up to this information. The community mental health services have been involved with both the residents during their move into the home, and these are gradually reducing as their mental health has stabilised. The care plans contain good details and guidelines so that the staff can understand and manage each person’s behaviour. However there is no training available for the staff on understanding mental health needs. One member of staff is a registered nurse with experience of mental health, but the other staff have no specific training. The two people who currently live in the home still have intensive support from the community mental health services. However, this is reducing as they become settled in the home. And as more people move into the home, the need for training so that the staff are able to understand and meet everyone’s needs will also increase. Other training is also inappropriate for meeting the needs of the people in the home. For example, the only moving and handling training available is from watching a DVD. There is no practical element to this training, and it is not accredited for assessing that people are competent in practising safe procedures. There is no training available for managing pressure care or nutrition. Although the home has good procedures in place for assessments and monitoring, the training is not in place to ensure that that these are always carried out in practice. The home has sound systems in place to manage people’s medication safely. We checked a sample of medication records, which were free of errors, with no Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 13 signature gaps found on the MAR (medication administration record) charts. No one has controlled drugs prescribed for them at present, but the home has appropriate procedures for storing and recording controlled drugs if they are needed. The medication cupboard will not be large enough for the medication of five people when the home is full. The manager is aware of the need for a larger medication cupboard. Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are plans in place for a variety of individual social activities. However these cannot be fully implemented until more people move into the home. EVIDENCE: Activity development plans are in place for both the people who live in the home. The activity plan for one person includes daily walks to the shops and walks in the park, discussion of news, arts and craft, outings, reminiscence and structured games. These activities are linked to the objectives of decision making, exercise, social skills and awareness. However there is little evidence that these activities take place. During our visit to the home the person concerned spent most of the time in the lounge with his eyes closed. He was not responsive to the attempts of the staff to interest him in discussion or activities. The daily record showed that during the last week he had been for one walk, helped to make his bed and to dry dishes, and otherwise he had sat in the garden or watched TV. It was reported that he had improved since Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 15 moving into the home, and he was gradually taking part in more social activities. The other man spends most of the day out of the home, in the town and visiting friends. Good risk assessments and guidelines are in place to make sure that he is safe on his own, and that the staff know what to do if he does not return to the home when he is due (see Complaints and Protection). He has planned a chicken run and a vegetable garden for the home. The chicken run is in place, and he will be responsible for looking after the chickens. There is a separate activity unit at the end of the garden, with a large activity room, toilet and utility area. This is very rarely used at the moment. When more people live in the home it is likely that the variety of social activities will improve, and that both the current residents may be more involved with other people. However at this time the two residents live separate lives, and one has little social interaction. One staff survey commented the what the home could do better is “to arrange for service users to attend day centres to socialise with others, to share their experiences and to enjoy each others’ company. This is something that we will be looking to do in the near future.” There are no set menus for mealtimes, and both men choose individually what they want to eat at each meal. There is a daily record of the meals that they eat. Most of the food is frozen fast food such as pies, fish fingers and burgers, and frozen chips and vegetables, and tinned fruit and soup. They have a roast dinner on Sundays. There is no evidence that the diet provided has been assessed to be nutritionally balanced. The staff cook the meals, but no one has a certificate of food hygiene. Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 16 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live in the home are able to express their views and concerns. However the procedure for safeguarding people form abuse does not comply with local guidance and some staff are not aware of the procedures. There is a risk that incidents of abuse may not be reported and investigated appropriately. EVIDENCE: The home has a complaints procedure that explains the process and timescales for investigating any complaints. The manager is currently preparing an easy read version of the procedures so that the people who live in the home can understand it more easily. A small amendment is needed to the policy, to refer people who are not satisfied with the outcome of their complaint to the local authority (Social Services) who commissioned the person’s placement in the home. There have been no complaints to the home since it opened. The Annual Quality Assurance Assessment (AQAA) states, “We have a clear and simple complaints procedure. We offer avenues to provide feedback and suggestions in service user reviews, meetings, discussions, surveys, quality assurance.” Both the people who live in the home said in their surveys that they would speak to the manager if they were not happy. Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 17 The AQAA states, “We protect people from abuse, have a clear policy for abuse and whistle blowing. Raise staff awareness through training and perception training. In the last 12 months we have ensured staff training.” The home’s procedure for safeguarding the people who live in the home is a general one, and does not refer sufficiently to the local Hertfordshire procedures for investigating allegations of abuse. The policy for whistleblowing, which should define the responsibility of staff to report any concerns, is a summary of the Whistleblowers Act 1999 and is not specific on the actions that staff should take. It should include details of authorities to which staff can give information of their concerns, including CSCI and the local authority. The manager is aware of the proper procedures for reporting and investigating any allegations of abuse. However some of the staff who we spoke to during the inspection, and who completed surveys for the inspection, were not aware of Hertfordshire’s agreed interagency procedures. In Hertfordshire all allegations should be reported to Adult Care Services, and they take the lead in any investigation. However one staff survey stated, “If any service users/relative/advocate or friend has any concern about the home I would ask them if they want to discuss it with me or the manager. If the answer is yes, I would arrange a meeting. If the answer is no, then I would give them the telephone number of the social worker/CSCI/POVA so that they can raise their concern.” One member of staff who we spoke to said that they would talk to the alleged abuser to find out the facts before reporting the allegation to the manager. It was reported that training has been arranged on safeguarding with an external trainer. This training needs to include the Hertfordshire procedures, to make sure that correct procedures are followed and the people in the home are fully protected. We saw an example of good practice in safeguarding vulnerable people. One of the people who live in the home goes out independently every day, and spends most of the day out of the home (see Daily Life and Social Activity). The home’s procedure for missing persons is good, and has been followed in this case. Good risk assessments and guidelines are in place to make sure that this person is safe on his own, and that the staff know what to do if he does not return to the home when he is due. Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 18 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, 20, 21, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and gardens provide a comfortable, attractive and safe environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene. EVIDENCE: The house is domestic in style and was completely renovated before it was registered as a care home two years ago. The five bedrooms are large and are all fitted with sinks and vanity units, a phone point and TV aerial socket. There are three bedrooms on the first floor and two bedrooms on the ground floor. They are all decorated and furnished to a good standard. The two people who now live in the home have arranged their rooms to their own tastes, with Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 19 pictures and posters on the walls. In the Annual Quality Assurance Assessment (AQAA) the manager said, “In the last 12 months we have actively encouraged and assisted service users in personalising their own personal space. Added homely furnishings (pictures, clocks and vases) to make the home welcoming and comfortable. Purchased a 7 foot bed for a service user 6ft 4.” The home has a domestic kitchen and a lounge/dining room on the ground floor. The laundry room contains suitable and adequate machinery to meet the needs of the proposed service users. The bathrooms are domestic in style; one is fitted with a bath and the other with a walk in shower. All flooring in the bathrooms is non-slip with a toilet and hand washing facilities in each. The lounge doors open up onto the rear garden patio area and a suitable pathway is laid to access the garden with ease. A large outhouse at the end of the garden has been converted to provide a room for activities, with its own utility area and toilet. A chicken run has just been installed at the request of one resident, and he also has plans for a vegetable garden. A shelter on the patio provides a smoking area. However the home’s policy on smoking states that people are “not permitted to smoke outside the home if it infringes the rights of non smokers around them.” This should be amended to allow smoking in the designated area. The home appeared to be clean, and the staff follow appropriate procedures to maintain hygiene and prevent the risk of infection. The Annual Quality Assurance Assessment (AQAA) states that all staff have received training on prevention of infection and management of infection control. The Environmental Health Officer visited the home in June 2008, and awarded 4 stars for food hygiene. The bedrooms do not have liquid soap and hand towels so that the staff can wash their hands when providing personal care, to prevent the spread of infection. It was reported that the staff wear disposable gloves when they provide personal care, and then wash their hands in the bathroom. The manager felt that providing liquid soap and hand towels in the bedrooms might affect the domestic environment. She should seek advice on appropriate methods of hygiene control so that there is no risk of poor practice when more people live in the home. Water temperatures are monitored regularly to ensure that they are at a safe level to prevent any risk of scalding. Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff numbers in the home are sufficient to ensure that all the residents’ needs are met. However some people work excessive hours, which may affect the quality of their work. There is a lack of training in essential skills. EVIDENCE: The home has robust recruitment procedures in place, to make sure that the staff who work in the home are fit to work there and to safeguard the people who live there. We saw the files for two members of staff, and they both contained all the required information, including evidence of identity, references and CRB (Criminal Record Bureau) disclosures. We saw the staff rotas for the current week and the previous week. These showed that two people work in the home from 7.30 am to 7.30 pm, and one person from 7.30 pm to 7.30 am. All the staff work 12 hour shifts. The day staff have a break during their shift, which means that for two hours during the day there is only one member of staff in the home. One person worked 5 shifts, totalling 55 hours, for each of the two weeks for which we saw the rotas. Another person worked 5 night shifts in both weeks, with over 61 hours Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 21 logged for both weeks. These long hours are contrary to the Working Time Directive, which safeguards staff from the risk of losing concentration by working too long. The long hours that these staff work means that staff may be too tired to provide a good quality of care for the people who live in the home, and there is a risk of errors due to poor concentration. The 12 hour shifts mean that there is little room for flexibility, so that hours can be arranged for when there is greatest need. There is only one member of staff in the home during the evenings, which restricts the possibility of evening activities for the people in the home. One person spends most of his time out of the home (see Daily Life and Social Activities), and usually returns after the day staff have left. On one occasion he did not return when he was expected, which meant that the lone member of staff had to take responsibility for acting on the procedures for his absence. The staff who we spoke to said that they can contact the manager or the proprietor if they need advice or assistance at any time of the day or night. The surveys showed that the staff think that there are always enough staff in the home. One commented, “There is always enough staff to meet the individual needs, trained with lot of knowledge and experience to meet the needs of the service users.” The rotas and shift patterns may need to be reviewed when more people live in the home, to make sure that there are sufficient staff in the home at all times. There is no evidence of a training and development plan for the staff to provide them with the information and skills that they need for their work. The Annual Quality Assurance Assessment (AQAA) stated that during the next year there are plans to seek out accredited and other training for staff regarding mental health, learning disabilities and general skills, and for all staff to have completed the NVQ2 qualification. The AQAA stated that 4 of the 7 staff already have a qualification at NVQ level 2 or above, and one person is working towards it. However none of the staff have had training in moving and handling or food hygiene, and not all have had recent training in fire safety or first aid. These are all mandatory for all staff. Some have had accredited training in infection control. There are DVDs available in the home for some topics, but these do not provide a sufficient training to ensure that the staff are competent to work with vulnerable people and to keep them safe. The manager has contacted an external company to provide appropriate training, and this needs to be completed without undue delay. All the mandatory training should be completed as part of each person’s induction into the home. The AQAA stated, “We fulfil the Common Induction Standards for new staff.” In the staff surveys, comments included, “It is the policy of the home that every staff has to do an induction at least 3 days, and the induction is carry out by the Manager or Deputy. I was fully inducted by the manager when I started to work at Parkview.” And, “My induction was promptly carried out regarding the care of the service users and policy and procedures.” A Skills for Care induction form is completed for each member of staff, and the manager has signed them to confirm that the person has met all the competencies. However all the competencies are dated as completed on the same day, the day after the person started work in the home. The manager explained that not all training is completed on the first day, but the induction records do not show this Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 22 effectively. There is no training available for the staff on understanding mental health needs. The only training on moving and handling is by watching a DVD, and here is no training available for managing pressure care or nutrition (see Health and Personal Care). Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed for the benefit of the people who live there, and their views are actively sought and acted on. EVIDENCE: Everyone who completed a staff survey said that the manager meets with them regularly to give them support and discuss how they are working. “I have regularly meeting with my manager and get a feedback about my work performance. I am also very lucky to have a deputy manager who has a lot of experience in this field and does a lot of teaching sessions which I very much Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 24 appreciate.” The manager was appointed when the home opened, but left when there were no residents in the home. She has now returned, and she needs to contract the Registration Team of CSCI to ensure that she is registered again as manager of the home. The manager has established a very good system for personalised care planning in the home. The ethos of the home is that it is the home of the residents, and the staff support them to live their lives as they wish to and to make their own decisions about every aspect of their lives in the home. All the staff are positive and enthusiastic about their work and their support of the people who live in the home. There is a system in place for monitoring the quality of the care that the home provides. This will include questionnaires for the residents, relatives and other stakeholders, which are due to be sent out in January 2009. There is a robust system of weekly, monthly and annual audits in the home, and an action plan is put into place to ensure that any findings from the audits are acted on. There are regular staff meetings and residents’ meetings, so that everyone can give their views about any changes that are needed. The home’s policies and procedures are generally well written and provide relevant guidance so that the staff know what they should do. Some, such as the complaints policy and the procedures for safeguarding people from the risks of abuse, need revision to make sure that they comply with current guidelines and good practice (See Complaints and Protection). We looked at the arrangements for management of residents’ money, and these appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect the people who live in the home from financial abuse. The home maintains appropriate records for the health and safety of the residents and staff in the home, including monitoring hot water temperatures, checks of fire equipment and regular fire drills. However the staff have not had appropriate training so that they can maintain the health and safety of the people in the home (see Staffing). Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 25 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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 X 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 12(1)(a) Requirement Timescale for action 30/11/08 2. OP8 13(5) 3. OP15 16(2)(i) The manager must ensure that appropriate care plans and recording are in place for all the residents’ health care needs, and in particular for skin care, so that the risk of pressure sores is reduced. All staff must have a certificated 31/12/08 training in moving and handling. This will make sure that the staff practice good techniques so that there is no risk of injury for the staff or for the people they support. Measures must be put in place to 31/12/08 make sure that people are provide with a wholesome and nutritionally balanced diet. This will help them to maintain good health. Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 27 4. OP18 13(6) 5. OP26 16(2)(j) 6. OP27 18(1)(a) The procedures and practices in the home must ensure that people are protected from the risks of abuse, and that any incidents are referred and investigated appropriately. The procedures for prevention of abuse should be amended to make reference to the HCC procedures. Measures must be put in place to enable staff to clean their hands effectively when providing personal care, in order to ensure that there is no risk of spread of infection. The staffing rotas show that some staff work very long hours. This means that staff may be too tired to provide a good quality of care for the people who live in the home, and there is a risk of errors due to poor concentration. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. A training programme must be put in place so that all the staff have appropriate training to provide a good quality of care and support for the people who live in the home, and to make sure that they are protected from any risk of infection. In particular, all staff must have a certificated training in food hygiene, and appropriate training in understanding mental health needs. 30/11/08 30/11/08 31/12/08 7. OP30 18(1)(c) (i) 31/12/08 Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should clarify the services that the home provides to meet people’s needs, so that people who plan to move into the home can be sure that it is the right place for them. The complaints procedure should be amended to refer people who are not satisfied with the outcome of their complaint to the local authority so that they can investigate it further. 2. OP16 Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Park View Residential Home DS0000065952.V371333.R01.S.doc Version 5.2 Page 30 - 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!