CARE HOME ADULTS 18-65
Parkview 113 Sussex Road Watford Hertfordshire WD24 5HR Lead Inspector
Louise Bushell Unannounced Inspection 13th October 2005 10:30 Parkview DS0000019491.V259074.R01.S.doc Version 5.0 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 DS0000019491.V259074.R01.S.doc Version 5.0 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 Adults 18-65. 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 DS0000019491.V259074.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Parkview Address 113 Sussex Road Watford Hertfordshire WD24 5HR 01923 230586 01923 230586 viv.fenmore@turning-point.co.uk 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) Turning Point Southern Area Office Vivienne Inara Fenemore Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6), Mental disorder, excluding of places learning disability or dementia (6) Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th June 2005 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. 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 DS0000019491.V259074.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection of the year, taking place in the morning to mid afternoon. This inspection, reflects that the home is making some positive progress with newly introduced systems. Comments made by both service users and staff were positive. Time was spent with a senior member of staff and one service user who were present throughout the inspection. The information that has remained the same following the last report has been transferred to this report. This inspection focused on the core standards that were not inspected at the last visit. 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 are well maintained and promote an extremely pleasant homely environment to reside in. A monthly audit occurs in all areas of the home and identifies the works that are required. Once recorded this forms and action plan that the home then works towards getting completed. Staff encourage service users to join in small gardening tasks that encourages them to engage in different activities. All bedrooms in 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. 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 staff are actively able to support this need whilst respecting and dignifying the service user. There are 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. Positive relationships are maintained with the local GP and consent to administer medication forms are held on file. The home has a sound management and monitoring system in place that ensures that all areas regarding health and safety are monitored and system checked. Currently the management, staff and service users are adapting all care planning systems to ensure and develop a person centred approach to all work. Daily management of the home appears to be offered in a realistic, flexible manner, with the systems in operation encouraging a homely environment to reside in. There is a clear positive relationship between both service users and staff that is based on mutual respect. Medication systems are well managed using a Monitored Dosage System for administration. A positive working relationship is maintained with the pharmacy and regular inspections take place. The home has introduced a new
Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 6 medication breakdown information sheet, which is applicable and individual to each service user. What has improved since the last inspection? 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.
Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 8 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 the following 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 within the their lives 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 Statement contains information for the service user to make an informed choice about where to live. 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 for 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. Detailed assessments remain on all service users files and include a medical and a social history. At the inspection one service user was currently being supported through a trial period at the home. He was able to provide information that he was happy with the process and that the staff were very supportive. The assessment completed by the manager, was accurate, precise and well recorded.
Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 6, 8, 9 & 10 Individual needs and choices are reflected in the service user care plan ensuring changing need and goals are reviewed, met 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: Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 10 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 seen . 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 of the home ensures that the care plans of each individual are owned by the individual. Currently the management, staff and service users are adapting all care planning systems to ensure and develop a person centred approach to all work. The system appears to be an effective working document and focuses on service users individual goals and aspirations. There is a need for the home to ensure that a structured care plan is implemented for service users on a trial visit to ensure that staff are able to provide specific care and support to meet individual need. Service users meetings are currently not taking place. Following discussion with the senior member of staff on duty, it was determined that they would recommence once the vacant beds had been occupied. The home is linked to an external advocacy group and referrals have been made. Work has commenced with a number of service users. The home has currently two vacancies for occupancy. Referrals have been received from prospective service users. All information in the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 11, 12, 13, 14, 15, 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. There are also opportunities for engagement in activities within the home. 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. Discussion with a service user with support from staff determined that he accesses a variety of day activities. 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
Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 12 encouragement of the service users in a variety of tasks was seen throughout the inspection. The home is centrally located, and is within a short distance from shops and the local community amenities. The staff at the home value and seek to reflect racial and cultural diversity of service users through celebration 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 the last inspection an activities board has been erected to display the activity plan for the day, however this was not completed on the day of the inspection. It is recommended that the board be accurately completed at all times and that staff invest some time in gaining pictorial images and symbols of reference to display the events of the day. Once implemented this will further develop and support all service users to participate in leisure activities. Staff support and encourage service users to maintain links inside and outside the home. Service users are supported appropriately to individual need. One service user is currently being supported via Consent. Meal choices are provided within the home although there is an need for the system introduced to be further developed to further empower service user choices. Staff on duty confirmed that work is currently taking place to increase the photo library available. 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 DS0000019491.V259074.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 18, 19 & 20 Service users physical and health needs are met, ensuring that their safety, wellbeing and health is promoted at all times. Medication systems are required to be monitored to ensure that service users are supported in the safe administration and management of their medication. EVIDENCE: The staff at the home are able to support specialist needs of service users. Currently one service user requires a specialist diet. Staff reported that they are seeking appropriate support from specialist dieticians but are successfully managing the need of the service user. Staff are 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. Service users health care needs are being met and staff encourage service users to visit relevant specialist care provides to ensure that their health is monitored. When a practitioner visits the service user in the home all consultations take place in private. A sound system has been recently
Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 14 introduced, providing information for all staff that support in the administration of medications for the service users. This system provides the details including side effects of the medication and describes the reasons for the person to be prescribed such a medicine. A Monitored Dosage System is used which provides a structured and safe administration process for the staff to follow. Full induction and training is provided for the staff before they are able to administer any medicines. Each service user has a file which contains information on the prescribed medication, a details profile of the service user including a photo, any administration guidelines required and behaviour plans that may effect the administration of such medications and a consent to medicate form which has been signed by the GP. There is a need for the medication fridge to be lockable and the stored medicines to be locked away in a cabinet that is securely fixed to the wall. All medicines that are opened from bottles, tubes and packets require a date opening so a shelf life can be determined. Parkview DS0000019491.V259074.R01.S.doc Version 5.0 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 the following standard(s): 22 & 23 The complaints procedure is sufficient and adequate for the service users to feel that their individual views are listened to. 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 states that all complaints are responded to within 28 days. A record is maintained within the home 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 being provided within the home. Staff are all subject to enhanced Criminal Records Bureau (CRB). Staff personnel files were unable to be inspected due to the manager not being on site. Parkview DS0000019491.V259074.R01.S.doc Version 5.0 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 the following standard(s): 24, 25, 26, 27, 28, 29 & 30 The environment is very well maintained, thus promoting a homely, comfortable and safe space for service users to live. All resources and equipment is provided within the home 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 upkeep and the maintenance of the garden area, which is well maintained. Staff encourage service users to take part 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. Toilet and bathing facilities ensuring that choices and preferences can be met, and specialist equipment is available as per individual service user need. The
Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 17 home was clean and hygienic throughout. The worktop in the kitchen is in need of replacing, as it is very stained and worn. The manager confirmed that a replacement had been ordered and that they were waiting a fitting date. Parkview DS0000019491.V259074.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 The home is suitably staffed with well-trained and supported individuals ensuring that at all times service users complex and changing needs can be met. 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. 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 appear well structured, with relevant checks occurring prior to employment. Detailed pre employment checks have occurred with a checklist 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. All staff spoken to at the inspection were clear about their roles and their individual responsibilities. Each member of staff has a defined additional area for responsibility. This system ensures that the sound management takes place with the manager overseeing all actions as required. Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 19 Monthly staff meetings are held and they were well recorded with clear actions detailed in the minutes. All staff are supervised and evidence was seen of the frequency of supervisions occurring. Annual appraisals are also undertaken. Parkview DS0000019491.V259074.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41 & 42 The management within the home 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 in 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 creates an open, positive and inclusive atmosphere. Staff and a service user spoken to commented that they feel extremely supported and that 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. A service user spoken to during the inspection appeared to be extremely happy with the home and appeared to be relaxed in their environment.
Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 21 The staff team and the manager of the home are adequately trained and experienced to ensure that service users needs are being met. Periodic training occurs within the home to ensure staff development is maintained. 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 ensure that the water temperatures are monitored and a clear record of action is maintained when the temperature is recorded to be above the required temperature. Actions for the staff to follow must be in the risk assessment and form a clear protocol of actions to be taken in the absence of the manager. Parkview DS0000019491.V259074.R01.S.doc Version 5.0 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 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 2 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Parkview Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 2 X DS0000019491.V259074.R01.S.doc Version 5.0 Page 23 Yes 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 YA6 Regulation 15 (1) Requirement Care plans to be completed in a person centred way to ensure current and changing needs are being met. (This requirement has been carried forward from the last report; failure to comply may result in enforcement action being taken). 2 YA39YA7 12 (2), 24 (3) 16 (2) (i) Service user meetings to commence to ensure that participation and consultation is promoted for all. Works commenced on the menu choice system must continue to ensure that service users are empowered and encouraged to make active choices. The medication fridge must be locked. The medication storage cabinet must be locked and securely attached to the wall in an approved manner. All medication opened in bottles, packets and tubes must have a
Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 24 Timescale for action 31/01/06 31/01/06 3 YA17 28/02/06 4 YA20 13 (2) 30/11/05 date opening added. 5 6 YA24 YA42 23 (2) (b) (c) 13 (4) (b) & (c) The kitchen worktop is to be replaced. Hot water temperatures must not exceed 43 °c. A clear protocol must be in place for staff to follow if such an occurrence occurs. 30/11/05 15/11/05 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 YA14 Good Practice Recommendations The activity board should be completed on a daily basis to encourage and empower service users awareness of activities being provided at specific times. Parkview DS0000019491.V259074.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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