CARE HOME ADULTS 18-65
Parkview 113 Sussex Road Watford Hertfordshire WD24 5HR Lead Inspector
Louise Bushell Unannounced 28 June 2005 10:00 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Parkview Address 113 Sussex Road Watford Hertfordshire WD24 5HR 01923 230586 01923 230586 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Turning Point Southern Area Office Vivienne Inara Fenemore Care Home 6 Category(ies) of LD LD Learning Disability - 6 registration, with number LD(E) LD(E) Kearbubg Disability - over 65 - 6 of places MD MD Mental Disorder - 6 Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 30.11.04 Brief Description of the Service: Parkview is a single storey, purpose built home, providing care for six service users who may have a learning disability or mental disorder. The home is also registered to provide services to individuals in these categories who are over sixty-five years of age. The home is situated in a residential area of Watford, at the end of a cul-de-sac and directly opposite a large park. The home has its own vehicle to transport service users. The main town of Watford is a short drive away, and provides extensive shopping and transport facilities, as well as a wide range of social opportunities. Parkview is a Turning Point home Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of the year, taking place mid morning to mid afternoon. It was an extremely positive inspection, reflecting the positive comments made by both service users and staff at the home. Time was spent with the manager of the home, a number of service users who were present throughout the inspection and several staff members who were on duty. What the service does well:
The home is set in a residential area of Watford and is suitably located meeting all needs of the service users. It is opposite a large park area and the grounds within the home are well maintained and promote an extremely pleasant outlook for service users. Following the last inspection a number of environmental changes have occurred and this has included the total refit of the kitchen, periodic redecoration of service users bedrooms and all communal areas. The staff within the home are responsible for the up keep and the maintenance of the garden area, which currently is well maintained. Staff encourage service users to partake in small gardening tasks to encourage them to engage in different activities. All bedrooms within the home are extremely well maintained and decorated. All service users are supported and empowered to decorate their individual rooms to their own taste and personalities. Staff should be commended for their efforts. The home is able to support specialist needs within the home. Currently one service user requires a specialist diet. The home has reported that they are seeking appropriate support from specialist dieticians but are successfully managing the need of the service user. The home is actively able to support this need whilst respecting and dignifying the service user. The home has further systems in place to support specialist health needs such as epilepsy and appropriate monitoring of the service user, whilst maintaining their dignity and privacy. The home has a sound management and monitoring system in place that ensures that all area’s regarding health and safety are monitored and system checked. Currently the management, staff and service users within the home are adapting all care planning systems to ensure and develop a person centred approach to all work. The system appears to be effective as working document and focuses on service users individual goals and aspirations. Once fully operational this will be effective. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 6 Daily management of the home appears to be offered in a realistic, flexible manner, with the systems in operation encouraging a homely environment. There is a clear positive relationship between both service users and staff that is based on mutual respect. Staff reported that they are provided with regular supervision where training needs are identified. What has improved since the last inspection? What they could do better:
To ensure that the home is operating in a person centred manner there is a need for the further development of systems within the home surrounding the provision of meals and meal choices that the service users make. Following discussion with the manager it was felt that the home and the service users would benefit from a pictorial menu and choice system in place. There is a need for the home to ensure that information is user friendly to meet individual need. This also includes the appropriate use of advocates in order to ensure and empower service user self-determination. Included in providing a person centred environment it was raised that service users would possibly benefit
Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 7 from signs / symbols or pictures and or objects of reference within the home that empowers and enables them to distinguish their own private space. There is a need for the home to develop a detailed fire risk assessment to ensure that all area’s of the home are assessed and periodically reviewed. Information was provided for the manager. Training certificates are required to be held to confirm training attendance. Personnel records were well organised, advice was provided regarding the CRB disclosure forms and a recommendation made regarding the recording methods used. 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. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 5 The service users guide and statement of purpose are comprehensive and informative documents for service users to determine and make positives choices about where to live. There is a need for all documents relating to the choice of home to be appropriate and user friendly ensuring the opportunity for understanding has been promoted. EVIDENCE: A comprehensive Statement of Purpose is held within the home and all current and prospective service users are provided with a copy. The content of the Terms and Conditions of Tenancy is comprehensive, however does not meet service users individual needs. The home is currently working on systems within the home to present a greater person centred approach. In addition to holding the company documents that are required, the home must adapt internal documents ensuring equal opportunity of understanding has been promoted. The admissions procedure to the home includes trial visits for the service users to make an informed choice about where to live. There is a detailed referrals and admission procedure to the home. Due to the high complex needs of the service users within the home it is recommended that the home integrate the work of external advocates throughout the process to ensure that service users right and choices are supported as far as practically possible. Detailed assessments remain on service users files and include a medical and a social history.
Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 & 10 Individual needs and choices are reflected in the service user care plan ensuring changing need and goals are reviewed, meet and developed. Systems within the home are in need of developing to further ensure that service users have the tools and information to take decisions about their lives. EVIDENCE: All service users have an individual care plan and an allocated key worker to support them in the home. Individual daily notes and guidelines for the service users were observed. All service users are supported within the Care Management Framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that the care plans of each individual are owned by the individual. Currently the management, staff and service users within the home are adapting all care planning systems to ensure and develop a person centred approach to all work. The system appears to be effective as working document and focuses on service users individual goals and aspirations. Once fully operational this will be effective. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 11 The home holds service user meeting, however due to high complex needs of the service user group, at times, seeking views is mainly achieved through body language and facial expression. The home is linked to an external advocacy group and referrals have been made. The home has currently two vacancies. Referrals have been received from prospective service users. It is recommended that advocacy services are contacted to ensure that the rights and choices of the service users are supported and represented at all times. All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 16 & 17. Personal development opportunities are encouraged for all service users ensuring interactions within the local community and that individual rights and responsibilities are recognised and supported. An opportunity for engagement in activities within the home occurs. The methods used requires reviewing to ensure service users can be encouraged and empowered, as far as practically possible, to make individual choices. The home encourages inclusion into the local community thus enabling integration into community life. EVIDENCE: Service users attend a variety of different day centres and colleges accessing courses suitable to their individual needs and aspirations. Discussions with the service users with support from staff determined that they have a variety of day activities to be involved within. The home has a variety of activity and day structure notice boards within the home, ensuring that visually service users are able to anticipate planned events and activities.
Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 13 The home has access to a mini bus and allocated drivers. Staff support and encourage all service users to maintain and develop social, emotional, communication and independent living skills. The involvement and encouragement of the service users in a variety of tasks was observed throughout the inspection. The home is centrally located, and is within a short distance form shops and the local community amenities. It values and seeks to reflect racial and cultural diversity of service users through celebration of, and awareness of different cultures, religions and festivities. During the inspection staff and service users were observed to interact equally with one another. Service users are supported appropriately to take part in activities within the home. Individual needs, choices and preferences are always considered. A record of activities is maintained within the daily recording system. Service users access the local community services frequently and visit the local area, enjoying going out for lunch and shopping. Following discussion with the manager it is recommended that the system regarding the display of activities within the home be further developed to ensure that a person centred approach is achieved, encouraging and empowering service user self determination with the access to an appropriate level of opportunity for understanding. Once implemented this will further develop and support all service users to participate in leisure activities. Meal choices are provided although there is an need for a system to be introduced to further empower service user choices. A pictorial system was discussed in detail. The home would require a digital camera. Menus were available and the home has a fourweek rolling seasonal menu which appeared well balanced. Records are maintained of food consumed and offered. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Service users physical and health needs are met, ensuring that their safety, wellbeing and health is promoted at all times. EVIDENCE: The home is able to support specialist needs. Currently one service user requires a specialist diet. The home has reported that they are seeking appropriate support from specialist dieticians but are successfully managing the need of the service user. The home is actively able to support this need whilst respecting and dignifying the service user. The home has further systems in place to support specialist health needs such as epilepsy and appropriate monitoring of the service user, whilst maintaining their dignity and privacy. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23. The complaints procedure sufficient and adequate in order for the service users to feel that their individual views are listened too. Robust policies, procedures and training are in place to ensure service users are protected and safe. EVIDENCE: The home has a comprehensive complaints procedure in place, which details that all complaints are responded to within 28 days. A record is maintained of complaints made detailing actions and outcomes as necessary. All service users have been informed about the complaints procedure. This is also on display within the home. Robust procedures are in place to ensure that service users are protected from abuse and harm. Staff receive suitable and adequate Protection of Vulnerable Adults (POVA) training, which is currently occurring within the home. Staff employed are all subject to enhanced Criminal Records Bureau (CRB) disclosures. Staff personnel files were unable to be inspected due to not being held on site. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 & 30. The home’s environment is very well maintained, thus promoting a homely, comfortable safe space for service users to live. All resources and equipment is provided in abundance ensuring specialist and individual needs are promoted and changing needs met at all times. Shared space both compliments and supplements service users individual space ensuring that individual space is tailored to personal style and taste. EVIDENCE: Following the last inspection a number of environmental changes have occurred and this has included the total refit of the kitchen, periodic redecoration of service users bedrooms and all communal areas. The staff are responsible for the up keep and the maintenance of the garden area, which currently is well maintained. Staff encourage service users to partake in small gardening tasks to encourage them to engage in different activities. All bedrooms within the home are extremely well maintained and decorated. All service users are supported and empowered to decorate their individual rooms to their own taste and personalities. Staff should be commended for their efforts.
Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 17 Toilet and bathing facilities ensuring that choices and preferences can be met, and specialist equipment is available as per individual service user need. The home was clean and hygienic throughout. The home and service users would benefit from the purchasing of a digital camera, this would further develop systems within the home to promote service user independence and communication offering an opportunity for understanding. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36 The home is suitably staffed with well-trained individuals ensuring that at all times service users complex and changing needs can be met. Recruitment policies and all personnel records must be held on site and be available at all times in order to establish robust procedures have been followed in the protection and safety of the service users. EVIDENCE: All staff have received a series of mandatory training course in order for them to meet the complex needs of the service users. Training includes Protection of Vulnerable Adults, food hygiene, risk assessment, challenging behaviour and first aid. Training records are maintained within the home. Copies of certificated should be held on file to confirm training received and staffing individual qualifications. Following the last inspection the manager has introduced a detailed training matrix of all the staff highlighting training received and new identified training needs. A number of staff are completing their NVQ’s in care. Recruitment practices within the home appear well structured. With relevant checks occurring prior to employment. Detailed pre employment checks have occurred with a check list system in place reflecting the positive and pro active management style of the manager. All policies and procedures relevant to the home were appropriately held on site.
Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 19 All staff are supervised and evidence was seen of the frequency of supervisions occurring. Annual appraisals are also currently taking place. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 41, 42 & 43 The management is secure and effective ensuring that changing needs of service users are met and that the home is running meeting its aims and objectives. Systems for effective health and safety management are in place, works are still required within the home to ensure the safety is maintained. EVIDENCE: The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The ethos and management approach of the home creates an open, positive and inclusive atmosphere, staff and service users spoken to commented that they feel extremely supported and they feel the home is well managed. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. The service users appeared to benefit from this well structured and well run home. Service users Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 21 spoken to during the inspection appeared to be extremely happy with the home and appeared to be relaxed in their environment. All staff and managers within the home are adequately and suitably trained in order to meet the complex changing needs of the service users. The home has a vast range of policies and procedural guidelines in place. Staff are requested to read and sign risk assessments and polices. The home has a multitude of risk assessments in place. All records required by regulation were available and maintained. All records are secure within the home and were up to date and held in accordance with the Data Protection Act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. There is a need for the home to develop a detailed fire risk assessment to ensure that all area’s of the home are assessed and periodically reviewed. Information was provided for the manager. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 4 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 2 Standard No 31 32 33 34 35 36 Score x 2 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Parkview Score x 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 2 3 I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15 (1) Requirement Development of all service user care plans must ensure a person centred approach and service user involvement. Involvement of advocacy services within the home for those who have limited networks must occur. The development of a choice system for meals must occur to enable a flexible provision of suitable food which is varied. A detailed fire risk assessment must be held on site and periodiaclly reviewed. Timescale for action 1st September 2005. 15th September 2005. 2. 7 & 17 12 (2) & 16 (2) (i) 3. 42 13 (4) (b) (c) 1st September 2005 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. 2. 3.
Parkview Refer to Standard 1&5 29 32 Good Practice Recommendations It is recommended that the home ensures relevant documentation is avialble in formats suitable for the people whom the service is intended for. It is recommended that the home purchases a digital camera. It is recommended that copies of all staff training records
I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 24 be maintained within the home as evidence of suitable training. Parkview I52 s19491 Parkview v222304 280605 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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