Inspection on 16/08/07 for Parkview

This inspection was carried out on 16th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Parkview 29/08/06

Parkview 21/02/06

Parkview 23/08/05

Parkview 21/02/05

Parkview 09/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Parkview 105 Woolwich Road Bexleyheath Kent DA7 4LP Lead Inspector Lorraine Pumford Unannounced Inspection 16th August 2007 9.30 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 Parkview DS0000006794.V343334.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. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Parkview Address 105 Woolwich Road Bexleyheath Kent DA7 4LP 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) 020 8303 7889 020 8304 8017 jane.kingsmill@kcht.org.uk www.kcht.org Kent Community Housing Trust Mrs Jane Louise Kingsmill Care Home 69 Category(ies) of Dementia - over 65 years of age (69) registration, with number of places Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th August 2006 Brief Description of the Service: Park View is a purpose built care home providing accommodation to 69 older people who have dementia care needs. The home has 69 en-suite bedrooms, arranged in four units over two floors, 31 rooms on the ground floor and 38 on the first floor; the first floor is served by two passenger lifts. Each of the four units has their own lounge/dining areas. The home is located in a residential area in Bexleyheath in the London Borough of Bexley, and has good road, rail and bus links with access to local shopping and leisure facilities. The home is part of the Kent Community Housing Trust. The home has a day centre on site, which offers care to elderly people with specialist dementia care needs. The home has car parking to the front of the building and two attractive, well equipped integral garden areas accessible to the residents and their visitors. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken by two inspectors who spent one day in the home. The manager and a number of staff and residents were spoken with and parts of the premises and documents inspected. Five relatives completed CSCI surveys and additionally two relatives were spoken with and their views have been incorporated into this report. The fees are currently £478.45 to £498.72 What the service does well: What has improved since the last inspection? Photographs have been attached to Residents MAR sheet to reduce the risk of error. Action has been taken to relocate a number of residents who were assessed as needing nursing care to a more appropriate placement. At the time of the last inspection a recommendation was made that sluice rooms should be kept clear at all times to reduce the risk of the spread of infection; it was apparent that action had been taken to address this. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 6 A requirement was made at the time of the last inspection that copies of reports written following the providers audits should be forwarded to the CSCI and action has now been taken to address this issue. Additional staff have been recruited to reduce the number of bank and agency staff working in the home. What they could do better: 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. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 7 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 Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 8 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): 3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are only admitted to the home following an assessment of care needs. EVIDENCE: At the time of the last inspection a small number of residents had been assessed as requiring nursing care however an appropriate placement had not yet been found by the placing authority. A requirement was made and the manager was asked to liaise with the appropriate agency to ensure that residents were found an appropriate placement where their increased needs could be met. The manager stated that action had been taken in the timescale set. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 9 Residents representatives who completed CSCI surveys stated they had been provided with sufficient information regarding the home and the care and services provided at the time of admission. The organisation has a full time assessment officer who completes most of the pre-admission assessments. A total of four initial assessments were examined. All the care records viewed included a pre-admission assessment of need completed by the assessment officer; there was also evidence that information had been collated from residents relevant social care and health departments. Records seen indicate that residents representatives are provided with written confirmation that the home can meet their needs following the initial assessment. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 10 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. Residents care plans need to contain more guidance for staff on how to meet their individual needs. Residents can be assured that their privacy and dignity will be respected. Medication procedures need to be improved to protect the health and well being of residents. EVIDENCE: Four care plans were viewed in full and one specifically in relation to the management of challenging behaviour. Two others were examined in relation to specific aspects of residents health and care. Care plans included assessments such as moving & handling, nutrition and continence. Documentation also included a record of the resident’s daily routine, including times for getting up and going to bed, social preferences and resident’s ability in relation to maintaining their independence. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 11 Staff stated that team leaders had the responsibility of implementing an initial care plan. Care plans seen generally reflected the resident’s needs and how these would be met, however the care plan for a resident with challenging behaviour did not include guidance for staff on how to manage this and there was no evidence that the resident had been assessed by a Psychiatrist. The care plan for another resident highlighted staff had been keeping a monthly record of the persons weight from April 2007 although this indicated the residents weight was decreasing the monitoring appeared to have stopped and there were no further entries for July or August. There was no evidence to indicate this matter had been brought to the attention of the GP. Staff had introduced a fluid and diet record for another resident there was no indication on the care plan as to why this had been introduced and the care plan had not been amended to reflect any change in the residents needs. Those who completed CSCI comment cards stated they were kept informed and consulted about the care and important matters affecting their relative or friend living in the home. Relatives said they had seen or had care plans discussed with them and overall were satisfied with the quality of care provided to residents. Staff were seen to address service users by their preferred name, and spoke with them in a respectful manner. All residents are registered with a GP and records seen included residents appointments with their GP. A visiting district nurse was spoken with and stated she visited the home daily to provide diabetic care to named residents and visited one day a week to give advice, assess residents and carry any wound dressings required. The nurse said that staff worked well with her, followed advice given and referred residents appropriately to the service. One persons notes indicated they had only received two baths and shower during the months of May and June and a number of female residents seen had long dirty fingernails. The manager stated that some residents refused to let staff help them with personal care and discussion took place regarding the need to include this in peoples care plans. A number of issues arose in relation to medication. Staff had used a hole punch to secure MAR sheets; this meant it was not possible to see the names of some medications recorded. Eye drops prescribed for one resident indicated that once open the bottle should be discarded after 28 days, however they had not been signed when opened so it was not possible to know the date the 28 days commenced from. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 12 Some residents had been prescribed medication to be administered as directed the manager was advised to discuss this matter with the GP to seek more specific clarification. Records seen for one resident indicated that the medication had not been administered for nine days. Staff stated that this was because the medication was out of stock and it had not been possible to reorder the medication from the pharmacist. This matter was raised with the manager who established the medication was no longer available. The GP had subsequently issued a new prescription and although the replacement was in the home it was not being administered. A member of staff responsible for administering medication said that task took approximately 2 hours to perform each morning. The person undertaking the task on the other floor reiterated this. Medication was still being administered at 10:30 a.m. and discussion took place with the manager regarding the fact that residents requiring lunchtime medication may only have an approximate two-hour gap between medication being administered which may have an adverse effect over a period of time. Records are kept for receipt, administration and disposal of medicines and these records seen were well maintained and up to date. Adequate medicine storage areas are provided. A recommendation was made following the last inspection that staff should regularly record temperatures of the room. To date this is not taking place. Domestic fridges had been provided to store medicines requiring refrigeration, however Records showed that the temperature of this fridge often reached 10C degrees. Discussion took place with the manager regarding the need to purchase fridges specifically designed for the purpose. Medicine records were checked for four residents on one unit and an error was noted in one of these. The number of doses remaining for one medicine did not tally with the amount dispensed and administered. Another issue noted was that when a resident was prescribed one or two doses of ‘as required’ pain relief this was recorded twice on the administration chart. The administration charts ended up with three entries for one prescription. The supplying pharmacist printed the instruction; staff added two further sets of instruction, one for the administration of two doses and a second for the administration of one dose. This was not considered safe practice and staff must ensure they follow the guidance provided by the supplying pharmacist and not make any alterations to this. Homely remedies were provided for residents and a list of medicines agreed with the GP. The list was agreed some time ago and requires review. Some of Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 13 the homely remedies in stock and administered to residents were not included on the list agreed by the GP. Other issues discussed with manger were the need to have a medicine profile for each resident with evidence of regular medicine reviews. The need to have protocols in place for administration of ‘as required’ medicines such as pain relief for residents with poor or no communication skills. The need to evidence that staff responsible for medicine management are assessed annually as being competent to do so. Residents requiring help with personal care were seen to be assisted by staff in a calm and appropriate manner. Residents appeared relaxed and comfortable in their surroundings. Comments made included “I am happy here”, “I am quite independent and my time is my own”, “staff are good” and “the home is what you make it”. Staff had also recorded when residents had requested their preference for a male or female carer. A number of residents said they enjoyed having their hair done weekly by the visiting hairdresser. Parkview DS0000006794.V343334.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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to maintain links with family, friends, and the local community. Residents are provided with a varied balanced nutritional diet and have opportunities to participate in appropriate activities. EVIDENCE: Residents benefit from two activity coordinator being employed. There are two designated activity/craft rooms unfortunately the room on the first floor is situated away from the general communal area and the activity coordinator felt more residents would want to participate if they could see other people participating. This issue was discussed with the manager in light of observations about the use of space (see standard re environment). Residents spoke with were satisfied with the activities provided. Some residents said they were supported to participate in organised activities if they wished. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 15 A number of residents were seen in the activity room enjoying music, a cup of tea and some were involved in art work or making jigsaw puzzles. Activities were also arranged on Cedar unit during the after noon. Relatives spoken with said that residents had the opportunity to take part in activities such as bingo and music entertainers. The activity coordinators keep detailed records of all activities that take place in and outside the home. Three relatives who completed surveys stated they thought more activities should be provided. The manager was advised to provide information regarding activities taking place at resident/relative meetings. The activity coordinator spoken with stated that she endeavours to meet with new residents and talk to them about their hobbies and interests and care plans seen included resident’s preferred activities. From discussion with staff and record seen it is apparent that residents are able to participate in local community events. The manager stated that they also endeavour to arrange activities for the local community and they had recently hosted a summer fete which had proved to be very popular. Some residents spoken with said they enjoyed going out with their family and staff assist residents who are able on shopping trips to enable them to purchase clothing and other personal items. Care records seen included the resident’s daily routine and showed how staff supported resident independence and choice. For example care plans indicated when residents had chosen to have a lay in and their routines in terms of rising and going to bed. One resident said your time is your own here ”. Residents bedrooms were individually personalised and staff stated residents were encouraged to bring in personal effects from their home when moving in. Lunch was observed on two units. Each unit has a lounge/diner with a kitchenette area. Meals were brought to the unit in heated trolleys. Tables were nicely laid for lunch with place mats; cutlery and drinks were readily available. The daily menu was not displayed and staff said that residents selected their meal choice the previous day. It was evident that a choice of meal was provided and one resident was provided with finger food as this was their preference. Residents were observed enjoying their meal and those spoken with confirmed this view. However comments made by some residents regarding the food included “passable”, “food is very samey” a relative spoken with said their resident “enjoyed their meals”. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 16 Staff assisted residents appropriately to have their meal and sat down with residents when assisting with eating. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must keep a detailed record of any complaint received and the action taken by them to address this. Adult Protection training provided to staff helps safeguard residents living in the home. EVIDENCE: Policy and procedure documentation was seen in relation to complaint management. Residents spoken with said if they had a concern they would speak to a member of staff or the person in charge. Relatives seen said they knew how to make a complaint. Two relatives said they had made a complaint and were satisfied with how this was managed. This was also confirmed by relatives who completed surveys. Complaint records are kept and these show that since the last inspection 6 complaints had been made, however the records seen were incomplete and it was not possible to see what the details of the complaint were and how this had been managed. The manager stated that most of the complaints had occurred in relation to the laundry and as a consequence she had employed another member of staff which appeared to have addressed the issue satisfactory. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 18 The CSCI have not received any complaints regarding the care or service provided in the home. The providers Safeguarding Adults Policy was seen. No incidents have occurred in the home that required referral to the local authority. Staff spoken with had a good understanding of safeguarding adults and how they would handle such a situation should it arise. However some staff were not fully aware of the term ‘whistle blowing’ and how it operated. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 19 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. The home is well maintained and decorated. Residents must be provided with appropriate seating. EVIDENCE: Residents and relatives spoken with were satisfied with the environment. Areas seen were generally clean and tidy. A small minority of bedrooms were malodorous and the manager stated that they were looking at more appropriate flooring and when necessary carpets would be replaced. One relative raised concerns about the lack of toilets near the lounge on Cedar unit. The manager stated that an additional toilet was due to be provided close to the lounge. Bedrooms were personalised and residents said they liked their bedrooms. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 20 Holly unit is designed to accommodate up to twenty residents. The communal area is a lounge diner. Although there are a sufficient number of dining chairs there was only space for fourteen armchairs and an additional four chairs were positioned in the corridor just outside the lounge area. The manager was asked to undertake a review of communal space around the home i.e. the possibility of utilising other communal areas in the home such as the activity room to ensure that all residents are provided with comfortable and appropriate seating. A visitor’s room appropriately furnished for the purpose is situated on the ground floor and available for service users who wish to meet with relatives in a room other than their bedroom. The home has an emergency call system in all areas used by residents. There are handrails in communal areas and grab rails in bathrooms and toilets. Baths are provided with appropriate aids to assist service users with bathing. There is a central courtyard, which has a garden and seating areas and is well maintained. Staff spoken with stated that the laundry equipment provided meets the needs of the current service users accommodated. All Bathrooms were clean and tidy, however it was noted they did not have any hand washing facilities. The provider needs to look at the possibility of locating wash hand basins in all bathrooms to reduce the risk of the spread of infection. At time of the last inspection recommendation was made that sluice room should be kept clear at all times to reduce the risk of the spread of infection it was apparent that action had been taken to address this. Staff stated they had access to adequate supplies of protective clothing. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The homes recruitment procedures protect residents living in the home. Staff must be provided with appropriate training to enable them to meet the needs of people who have dementia. EVIDENCE: At the time of the last inspection a requirement was made in relation to staffing. At the time a number of staff working in the home were either bank or agency staff and it was evident that they had limited knowledge in relation to meeting the needs of the residents. The manager stated that since then a sustained programme of recruitment has taken place. A sample of five files were examined in relation to the homes recruitment procedure. This indicated that staff had completed application forms and provided the names of referees, although two people only had one reference on file. There was evidence that the provider had checked peoples ID and had undertaken health, CRB/POVA checks. There were no photographs on file for any of the sample seen. The manager stated that the organisation would be routinely updating employees CRB checks three yearly. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 22 A designated member of staff has responsibility for monitoring staff training and a matrix is kept in relation to this. This indicated that some of the staff most recently employed have not yet undertaken any training in relation to meeting the needs of residents who have dementia and action needs to be taken to address this particularly as some people have no previous experience of working with people who have dementia. Discussion also took place about extending basic training to domestic staff to help them to understand and communicate with people living in the home. The manager stated that all of the care staff working in the home now hold an NVQ 2 or above qualification in care. Records seen indicated that staff have regular supervision and staff responsible for undertaking this stated they had received appropriate training. All of the relatives who completed surveys felt care staff have the right skills and experience to look after people properly. Parkview DS0000006794.V343334.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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a system in place for reviewing and improving the quality of care provided. Health and safety practises need to improve to protect people living in the home. EVIDENCE: The manager has a number year of years experience working with older people and holds The Registered Managers award and a Certificate in Management qualification. The manager stated that the home receives regular monthly audits from KCHT in accordance with regulation 26 of the Care Standards Act 2000. A requirement was made at the time of the last inspection that copies of reports Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 24 written following the audits should be forwarded to the CSCI and action has now been taken to address this issue. The provider also arranges for an independent body to undertake a comprehensive assessment in relation to the quality of care and service they provide every three years. The manager stated that within the organisation a quality circle focuses on specific areas such as food and activities. Records seen indicate that the manager meets regularly with residents and their relatives, and all staff working in the home. Relatives who competed CSCI comment cards stated they were satisfied with the overall care provided. A policy and procedure was provided in relation to management of resident’s finances. The administrator keeps individual records for residents on the computer and makes these available to residents and relatives. Support is given to residents to manage personal allowances. Records for three residents were viewed and found to be accurate and up to date. Residents pay privately for personal items such as toiletries and clothing and for newspapers, chiropody care and hairdressing. There is a safe to store residents money and a second safe for storage of residents valuables. A list of items stored in the second safe was kept but this was not up to date and did not include all items held. Staff said that efforts were made to return jewellery and other valuables to residents or relatives however over time the number of items unclaimed had grown. The manager was advised to seek legal advice regarding unclaimed items to reduce the amount of items held. Systems were in place to ensure a safe environment is provided. Safety records viewed included service of assisted baths and hoists, lift, gas, and fire safety. All records seen were up to date. A fire risk assessment was completed on the premises and weekly fire alarm tests are undertaken and fire drills monthly. Fire drill records included the drill times and staff response. There was no evidence to show that fire drills were held at times to include night staff and they should be included in this. Accident records were viewed, the manager audits these monthly. The system to record accidents is quite complex with two different forms used when a person sustained an injury and another form used for a ‘near miss’. Staff also recorded the event in the resident’s daily care notes. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 25 Some staff spoken with were not aware of the homes policy on a ‘near miss’. Therefore there is a strong possibility that different staff members interpret the procedure in different ways. There was no evidence seen to show that unexplained injuries sustained by residents were followed up on and action taken to prevent a recurrence. Records seen indicated one resident sustained a skin tear on the leg and this was only recorded on a body map. The resident’s injury had a dressing applied but had not been assessed by the district nurse. The body map on an other file indicated staff had observed bruising to the top of the residents arms on two separate occasions however, no further action was recorded although this could be an indicator of poor moving and handling practice. Body maps used to record injuries were confusing and action must be taken to address this. Records seen indicate staff have received Moving and Handling training and food hygiene training .All team leaders hold first aid certificates. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement The registered person must ensure that care plans are in place that address residents assessed needs and these are reviewed and updated to reflect any changes. The registered person must ensure that residents receive appropriate health care support in this instance for the resident who is exhibiting challenging behaviour and the resident who has continued to lose weight over a number of months. The registered person must ensure accurate records are kept for all accidents. A system must be in place to follow up unexplained injuries sustained by residents. The registered person must ensure that medicines are safely managed and that: All prescribed medicines are available at the home so that resident’s health conditions are not compromised by missed doses of medication. Timescale for action 01/10/07 2 OP8 13 28/09/07 3 OP8 17 31/10/07 4 OP9 13 28/09/07 Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 28 5 OP9 13 6 OP16 22 7 OP19 23 8 9 OP29 OP30 Sch 2 of the CHR 18 The registered person must ensure that all medication is stored, recorded and administered in line with the Royal Pharmaceutical Society guidelines. The responsible person must ensure that a register of complaints is kept and the action taken to address these. The registered person must ensue that there is appropriate and adequate seating in the home. The responsible person must ensure that photographs of employee are help on their files The registered person must ensure that all persons working in the home receive appropriate training in this instance understanding and working with people who have dementia. 28/09/07 28/09/07 30/11/07 28/09/07 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The registered person should ensure a medicine profile is prepared for each resident, that there is evidence to show that residents medicines are regularly reviewed, that a protocol is prepared for the administration of ‘as required’ such as pain relief to residents with poor communication skills and evidence that staff responsible for medicine management have their competency assessed annually. The registered person should ensure that all staff are aware of the correct procedure to report and record accidents and incidents to residents using the correct paperwork. It is recommended that wash hand basins be installed in bathrooms. DS0000006794.V343334.R01.S.doc Version 5.2 Page 29 2 OP9 3 OP19 Parkview 4 OP19 Residents would benefit from a review of seating areas in the home. Parkview DS0000006794.V343334.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. 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