CARE HOMES FOR OLDER PEOPLE
Parkview Nursing Home 1 - 3 Eversley Road London SE19 3PY Lead Inspector
Alison Ford Key Unannounced Inspection 16th January 2007 09:30 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 Nursing Home DS0000019037.V327047.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 Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Parkview Nursing Home Address 1 - 3 Eversley Road London SE19 3PY 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 8771 5234 020 8653 6493 Planshore Limited Patricia Mary Fyfe Care Home 65 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (53) of places Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Parkview is a large home, in Upper Norwood, registered with The Commission for Social Care Inspection, to provide nursing care for up to sixty-four residents over the age of sixty-five. Since its registration the top floor has been adapted to provide accommodation for people with dementia. The home is located in a residential road opposite a large park and there is off street parking to the front. It is near to local amenities and well served by public transport. Accommodation is provided over three floors in a mixture of single and shared rooms some of which have en-suite facilities. There are a variety of communal areas; a large well maintained rear garden and an attractive small courtyard garden. At the time of this inspection fees range from £550-£700 according to the assessed healthcare needs of the resident. Additional charges may be payable for services such as hairdressing and private chiropody and these would be discussed prior to admission. Information regarding fees, the services that are provided and the latest report from The Commission are detailed in the Service User Guide, which is available from the home. Inspection reports are also available from the Commission for Social Care Inspection and may be downloaded from the internet. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report reflects the unannounced visit to Parkview Nursing Home undertaken as a part of the inspection process for the home for the year 2006/2007. Consideration has also been given to information and comments received during the year including complaints and the reporting of accidents and to conversations held with residents and staff and visitors during the visit. The Registered Manager and her deputy were available throughout the time of the visit and they welcoming and receptive to the inspection process. A tour of the premises was undertaken; a sample of care plans were assessed and a selection of records relating to the health and safety of residents and recruitment and training of staff were examined. Several residents, visitors to the home and staff members were spoken with in order to gain their views of life in the home. During the preceding year one concern had been received by The Commission regarding noise at night, which was preventing a resident from being able to sleep. This has now been resolved to the satisfaction of all of those involved. Discussions were also held with the Registered Manager and Registered Provider following a period where there appeared to be an increased number of falls in the home. This too has now improved and The Commission has received no notification of any serious falls for the last six months. What the service does well:
This home continues to provide a consistently high standard of care within a well-managed environment. The atmosphere within the home is friendly and welcoming and residents looked comfortable and well cared for. All of those residents able to express an opinion, relatives and other representatives that were spoken to, were appreciative of the care that is delivered in the home and of the manager and her staff team. Many of them commented positively about the approachability of the manager and the kindness of the staff. One resident particularly enjoyed the way a member of staff comforted her when she was “feeling a bit down and fed up because she couldn’t care for herself anymore” Others commented that “staff couldn’t do enough for you”. The home is well maintained and in good decorative order. Aids and adaptations have been provided to ensure the safety of both residents and staff and consideration has been given to the needs of those with dementia on the top floor. The surrounding area is pleasant and there is a large park opposite which is enjoyed by residents in the summer. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 6 One relative explained that one reason she had chosen the home was because the area in which it was situated was quite flat and it was easy to manoeuvre a wheelchair and go outside. Many residents living in the home are very frail however a range of activities which suits their remaining capabilities are arranged for them and others, who are more able, are taken out on organised trips and excursions. Several residents praised the enthusiasm of the activities organiser who works in the home for three days a week. A comprehensive pre-admission assessment process is in place to ensure that the healthcare needs of potential residents will be met and they would be encouraged to visit the home if they were able to and make sure it will suit them before they decide to move in. A plan of care is then put in place that outlines how they wish to be cared for and supported, so that all staff members are made aware of their preferences and the interventions that are required. Advice is gained from other healthcare professionals as needed and the care plans are reviewed regularly so that they remain up to date. Residents expressed their satisfaction with the food served in the home and alternative choices would always be made available if they wanted them. The chef is closely involved with residents, monitoring both their satisfaction with the food and their body weights to ensure that they are receiving a nutritional and balanced diet and their dietary preferences are discussed with them and recorded. The provision of staff training has a high priority in the home and all of the staff are able to access training appropriate to the work that they undertake. Two of the senior nurses in the home are trained assessors and one member of staff is a manual handling trainer. The majority of carers have gained an NVQ level 2 qualification and several have now progressed to level 3. Most of the staff are currently undertaking training in dementia awareness so that they can improve their understanding of the needs of the residents. Safety practices in the home were generally of a good standard and with the exception of procedures relating to recruitment, measures are in place to ensure the protection, health and safety of both residents and staff. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
This home generally provides a high standard of care with due regard for the safety and welfare of both residents and staff and any requirements are complied with promptly. However, the overall judgement for this inspection was influenced by poor recruitment procedures for new staff members. There was evidence to suggest that new staff are allowed to start work prior to satisfactory clearance being obtained from The Criminal Records Bureau. One staff member was still without any confirmation of satisfactory clearance from the Criminal Records Bureau or the Protection Of Vulnerable Adults register and the Registered Manager was required to obtain confirmation of their suitability within fortyeight hours. Without this information residents cannot be sure that they are
Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 8 safe and being cared for by staff that are suitable to be working with vulnerable adults. 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 Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 10 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): Standards 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive pre-admission assessment ensures that the home can meet the healthcare needs of potential residents who are also encouraged to visit the home to see if it will suit them. Facilities offered to those admitted for intermediate care mean that they are supported to return home as soon as possible. EVIDENCE: A sample of care plans were viewed, these contained evidence that thorough and thoughtful pre-admission assessments had been done to ensure that the healthcare needs of potential residents could be met. These then formed the basis for subsequent care planning. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 11 A senior member of the nursing team undertakes the assessment and some residents explained that they had been offered the opportunity to visit the home to see if they liked it before they made their choice. A Service User Guide, which reflects the philosophy of the home and services that residents can expect, is in their bedroom and this has recently been updated to comply with new regulations. Some residents knew what it was however; others did not understand it and one said she would not be able to read it anyway. It was recommended that staff should take the time to explain what was in the book. The existing key worker system has now been updated and reviewed. As a result pictures of the staff members allocated to residents are on the wardrobe doors. Several of the residents that were spoken to understood how the system worked and the “special relationship “ they had with their carers. Intermediate care facilities are currently provided on the second floor of the home in conjunction with other members of the multidisciplinary health care team. These include physiotherapists and occupational therapists. At the time of the inspection there were two residents in this category, one of whom was spoken with. They were very happy with the care that they were receiving although they were looking forward to going home. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9,10 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The residents in this home are treated in a way, which maintains their dignity and respect. Their healthcare needs are identified, and an individual care plan, reviewed regularly, ensures that they continue to be met. Medication policies and procedures are in place to ensure the protection of residents EVIDENCE: All residents have an individual care plan and six of these were assessed during the inspection. There was evidence that these were reviewed regularly to ensure that they reflected the care and support currently being delivered. And they showed that other members of the multidisciplinary healthcare team are involved in residents care as required.
Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 13 There is regular monitoring to identify those at risk from developing pressure sores, appropriate equipment is provided where necessary and risk assessments have been done for any activity that may possibly compromise the safety of residents. Work has been undertaken with residents and their families to compile life histories so that staff can relate to them and begin to understand them and their behaviour more. Several residents knew what their care plans were and there was evidence that they and their families had been involved and been able to contribute to them The medication storage and records were seen; they were all in order and the supplying pharmacist carries out regular audits in the home. Currently no resident are able to control their own medication. Personal care is delivered in resident’s own rooms and all those spoken with agreed that staff were kind and treated them well. Comments were received that “it’s a lovely home “ “the people here couldn’t do more for you “ and “staff are very kind”. During the inspection, staff were seen to be approaching residents with kindness and interacting well with them. Parkview Nursing Home DS0000019037.V327047.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): Standards 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 in this home are able to participate in an activities programme, which suits their expectations and preferences, provides interest and adds variation to their day. They are able to make choices within their daily lives, which enable them to maintain their independence for as long as possible and they are encouraged to continue their relationships with their friends and relatives. Residents receive a well balanced diet, which suits them and supports their nutritional needs. EVIDENCE: Residents confirmed that they are able to choose the time that they got up in the morning, the clothes that they wear, the activities that they participate in and the meals that they eat. Several residents were in their rooms, watching
Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 15 television or reading however they said that this was their preference. One resident commented, “you can always do what you want here “ Previous inspections had always praised the extensive activities programme in the home. Since the last visit the activities organiser has changed however residents were extremely complimentary about the new member of staff. Several said how much they enjoyed the current programme especially the quizzes and word games. Various excursions are planned for the forthcoming year and there is an intention to provide a more specialist programme for those residents with dementia. The activities organiser is currently undertaking Dementia Awareness training to help her do this. The lunchtime meal was served during the inspection and looked appetising, choices were available, and all of the residents praised the food served in the home. Drinks were served with the meal and the process was unhurried and pleasant. The cook visits residents in the morning to discuss the menu and dietary preferences are recorded. He also monitors the bodyweights of residents to ensure that the meals served are meeting their nutritional needs. Any special requirements are catered for. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The residents in this home can feel confident that any concerns or complaints would be dealt with promptly and sensitively however they are not always protected by robust recruitment procedures. EVIDENCE: One complaint made since the last inspection has now been dealt with to the satisfaction of all of those concerned. All the residents that were spoken with agreed that they were confident that any concerns would be dealt with promptly and they would not worry about having to raise them. A copy of the complete complaints procedures is available to them in the Service User Guide, which is in their bedrooms. Staff have all received up to date training in the protection of vulnerable adults however, as detailed under Standard 29, recruitment policies do not always ensure residents safety. Therefore the quality rating of this standard is affected by the failure of the home to always carry out satisfactory pre-employment checks on new staff. There was evidence to suggest that staff begin work prior to the appropriate clearance being completed from the POVA register and in
Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 17 one case satisfactory confirmation had still not been gained. An immediate requirement was issued against Standard 29 citing regulation 19. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19,26 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents live in a clean, well-maintained home, which meet their needs in a comfortable and homely way. EVIDENCE: The home is situated in a residential road, opposite a park, and is keeping with other properties in the area. It is attractively presented and well maintained in line with health and safety guidelines. Bedrooms and communal areas are comfortable and well designed and residents have been able to personalise their rooms with possessions from home.
Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 19 Adaptations are in place to meet the needs of the residents and all parts of the home are accessible to them except the top floor. This area is designated for residents with dementia and appropriate keypad security has been fitted. Colour co-ordination and pictorial help has also been used here to help with reality orientation. All areas of the home were clean and free from odour and there was evidence that control of infection measures are in place. Protective aprons and gloves are also available for staff as required. Bedroom doors have now been fitted with automatic closers, which operate in the event of a fire, to ensure the safety of those residents wishing to keep their doors open. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents in this home are cared for by well-trained and competent staff who are able to meet their assessed needs, however recruitment procedures are not robust enough to ensure that they will always be protected. EVIDENCE: On the day of the inspection there were sufficient numbers of care staff on duty to ensure that residents were well cared for. They were supported by a range of catering and domestic staff. Staff training is given an extremely high priority in the home, the majority of carers have completed an NVQ level 2 qualification and several are now undertaking level 3. Two of the senior nurses are A1 assessors and there is an in-house manual-handling trainer. The majority of staff are enrolled on the dementia awareness course and there have been additional staff trained in first-aid. A training needs analysis is available to highlight any future training requirements. The quality rating of this outcome is affected by the lack of appropriate preemployment information available for newly appointed staff. It was evident that some staff members had been allowed to start work prior to the return of satisfactory clearance from the POVA register and the records of one were still not complete. An immediate requirement was issued to obtain the necessary documentation within 48 hours citing regulation 19.
Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 21 An assurance was given that the member of staff would not work until such time as this had been received. Residents had expressed a desire to be a part of the interview and selection process for new staff and they are now able to meet any potential staff prior to their appointment. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 22 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): Standards 31,33,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is managed by a person that is fit to be in charge and will run the home in their best interests. An effective quality assurance system measures the satisfaction of residents and their relatives and health and safety procedures are in place, which ensure their protection EVIDENCE: The Registered Managers Award completed June 2006. She has many years experience in working with this client group. She is supported by two senior nurses who have worked in the home for some years and together they provide stable and strong leadership. Residents commented that they appreciated the manager’s approachability and the fact that “she got things done “.
Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 23 A resident’s questionnaire is completed yearly and the results were available for inspection these are also all collated and sent out to everyone. Services provided by the home and the care that is provided are also subject to regular audit. Regular residents and relatives meetings are held every two months and these give an opportunity for users of the service to air their views and influence the running of the home. Staff explained that they also had regular meetings and that the minutes were made available and would also be discussed during supervision sessions. Various documentation relating to the health and safety of residents and staff was seen and was generally in order. Staff confirmed that regular fire drills took place and that all mandatory training had occurred. Certificates of worthiness were seen and appeared to be in order although there was no date available to show when gas installations needed to be rechecked. It was recommended that this should be verified. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 24 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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 25 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 OP29 Regulation 19 Requirement The Responsible Person must ensure that, in order to ensure the protection of residents, staff are not employed before full and satisfactory checks have been made on them. Immediate requirement issued Timescale for action 18/01/07 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 OP1 Good Practice Recommendations It is recommended that some work should be undertaken to ensure that residents are aware of the existence and content of the Service User Guide, so that they can understand the philosophy of the home and the services that they can expect to receive. It is recommended that the validity of the gas installation certificate should be checked so that the Responsible Person can be sure that the safety residents and staff will
DS0000019037.V327047.R01.S.doc Version 5.2 Page 26 2 OP38 Parkview Nursing Home be protected. Parkview Nursing Home DS0000019037.V327047.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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
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