CARE HOMES FOR OLDER PEOPLE
Purley View Nursing Home 20 Brighton Road Purley Surrey CR8 3AB Lead Inspector
Alison Ford Key Unannounced Inspection 27th March 2007 11:00a 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 Purley View Nursing Home DS0000019039.V332289.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. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Purley View Nursing Home Address 20 Brighton Road Purley Surrey CR8 3AB 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 8645 0174 020 8763 2456 Glancestyle Care Homes Limited Mrs Anna Marie Cunningham Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow one specified service user in the Dementia - over 65 (DE(E)) and Terminally Ill - over 65 (TI(E)) categories to be accommodated. 15th December 2005 Date of last inspection Brief Description of the Service: Purley View is a care home registered with The Commission for Social Care Inspection to provide nursing care for up to thirty-nine older people. It is situated in Purley with easy access to both road and rail links and close to the centre of town. The rear of the property offers off street parking for up to eight cars and there is metered space around the home. The home offers accommodation over three floors, in twenty-seven single bedrooms and three shared rooms all of which have en-suite facilities. A passenger lift ensures accessibility to all parts of the home. There is a large communal lounge, on the ground floor, which also provides a dining area and a pleasant rear garden where residents can sit in the fine weather. Fees at the time of this inspection ranged from £524 - £720 per week and these and any extra charges payable would be discussed prior to admission. Copies of The Statement of Purpose for the home and the latest inspection report can be obtained from the home. Inspection reports can also be downloaded from the Commission for Social Care Inspection website via the internet. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken as a part of the inspection process for the year 2006/2007. In writing the report consideration has also been given to information received throughout the year such as comments from people who use the service, reports of incidents and complaints. A partial tour of the premises was undertaken; many of the thirty-three residents currently living in the home were spoken to, also three relatives that were visiting and several members of staff. Various records that the home is required to keep, as evidence of its commitment to the protection and health and safety of its residents, were seen and also a sample of care plans which identify the help and support that residents need and show how their assessed health care needs are met. What the service does well:
Although bedroom areas with their long corridors have an institutional appearance and room sizes would not meet current standards the home is pleasantly decorated and residents have personalised them with possessions they have bought from home. It is clean and warm and specialist adaptations ensure that all areas are accessible. Assisted baths and toilets suitable for wheelchair users are throughout the home and there is a small garden where residents can sit in the summer month. The home has a comprehensive Statement of Purpose and a Service User Guide, which are available in the front hall with the complaints procedure and the latest inspection report. These are also given to residents or their representatives at the time of admission. This ensures that they have all of the information that they need to decide whether the home will be suitable for them. Those relatives that were spoken with at the time of the inspection agreed that they had appreciated being able to have this and that staff had been very helpful to them during this time. Prior to admission, all new residents would be visited by a senior member of the nursing team and a very comprehensive assessment of their physical needs is undertaken. Care plans are then compiled to identify how these needs will be met. Relatives and residents, if they are able, are encouraged to contribute to this process. These plans are reviewed regularly to ensure that changing needs are identified and that all of the staff are helping the resident in the way that they prefer. The provision of staff training is given a high priority in the home and is designed to make sure that all staff have the skills that are needed to deliver this care.
Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 6 All of the residents agreed that they are treated kindly and relatives that were visiting were very complimentary about the attitudes of staff members describing them as “lovely” and “so caring” Several staff members have worked in the home for some years and residents appreciate the continuity of care and say that they feel safe and protected from harm. The home is participating in The Liverpool Care Pathway for the Dying. This is part of the End of Life Care Initiative which aims to give those who are nearing the end of their life access to high quality palliative care and decrease the numbers of elderly people who are transferred into hospital in the last week of their life. The Commission has received several complimentary letters from relatives of residents who have died recently in the home, praising the skills and compassion of the staff and others are displayed in the home. Some organised activities are held in the home, for those who wish to join in, including bingo and exercise sessions. Birthdays and other occasions are celebrated and relatives and friends are encouraged to visit. Residents were complimentary about the meals served in the home and the chef has worked there for many years. The kitchen has been given the Gold Standard Award and Food Standards Agency inspection results are always very good. Complaints about the home are few and are always managed appropriately and with sensitivity and all staff have received training in issues around the recognition of adult abuse. Health and safety practices with in the home are good, comply with current legislation and provide evidence of the homes commitment to the protection and wellbeing of residents and staff. What has improved since the last inspection? What they could do better:
Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 7 All of those standards considered, by The Commission, to be key to the inspection process remain met and the staff of this home continue to provide a high standard of care to its residents in an environment, which suits their needs and abilities. 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. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards1, 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, undertaken by a senior staff member, ensures that potential resident’s physical, healthcare needs can be met in an environment, which will promote their independence and wellbeing. Residents can be assured that they will be able to access all of the information that they need to help them decide if the home will suit them. This home does not offer intermediate care; this standard does not apply. EVIDENCE: The care plans of four residents were seen, including one who had recently been admitted, and all of them contained full and very comprehensive assessments of their physical needs. These assessments then form the basis for subsequent care planning. Staff training is planned to ensure that these needs will be met.
Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 10 Copies of the homes Statement of Purpose and a Service User Guide are available in the front hall with the complaints procedure and the latest inspection report. They are given to residents or their representatives at the time of admission. The relatives that were spoken with all agreed that they were given lots of help when they were deciding whether the home would be suitable, one commented that “the staff had been very positive about what they felt they could or could not provide “. However, during what they agreed had been quite a difficult time, none of them could remember being given a copy of the Service User Guide. This provides a useful reference tool for residents and their families as a guide to the things that they might expect from the home and it was recommended therefore that a copy of this should be put into each resident’s room. This was done the following day. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10,11 Quality in this outcome area is excellent, This judgement has been made using available evidence including a visit to this service. Each resident has a clear and comprehensive care plan, regularly updated, to ensure that the support currently required is documented. Residents can be confident that they will be treated with respect and that measures are in place so that their privacy and dignity will be maintained including in the event of their death. Medication procedures are robust in order to protect them and maintain their safety. EVIDENCE: The care plans of four residents were seen. They were comprehensive and showed that residents healthcare needs are carefully considered and appropriate interventions are introduced. Residents, or more often their relatives are consulted about the care plans and they are discussed with them on a regular basis although it was recommended that there should be a place in the care plan for relatives to sign to show that this had been done.
Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 12 All of the care plans contained evidence that they are regularly reviewed and updated. On the day of the inspection, a domiciliary optician was visiting the home and residents also benefit from dental and chiropody services. Staff have been trained to support residents in caring for their feet and have also had training sessions in oral health care. Residents confirmed that they are treated kindly and in an appropriate manner and staff were observed interacting well with them. All personal care is delivered in resident own rooms. Relatives that were visiting were very complimentary about the attitudes of staff members describing them as “lovely” and “so caring” Several staff members have worked in the home for some years and residents appreciate the continuity of care and say that they feel safe and protected from harm. Medication storage and administration procedures were all in order and are randomly audited on a weekly basis. A signature sheet identifies staff members however it was recommended that this should be updated as some staff are no longer working in the home. The home is participating in The Liverpool Care Pathway for the Dying. This is part of the End of Life Care Initiative which aims to give those who are nearing the end of their life access to high quality palliative care and decrease the numbers of elderly people who are transferred into hospital in the last week of their life. The Commission has received three complimentary letters from relatives of residents who have died recently in the home, praising the skills and compassion of the staff. Several more letters and cards are displayed in the home. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 13 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 would be supported to exercise choices in their lives, as far as they are able, so that they can maintain their independence and they would be encouraged to maintain contact with their families and friends. Meals are well prepared and varied to ensure that nutritional needs are met and choices are always available. EVIDENCE: Residents confirmed that they are able to choose what they wear, when they get up and go to bed and whether or not they wish to join in any activities. Some organised activities are held including bingo and exercise sessions. Birthdays and other occasions are celebrated. Relatives and friends are encouraged to visit without any restrictions and those spoken with said that they were always made to feel welcome. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 14 The menus were seen and were varied and nutritious. Choices are always made available and care is taken to ensure that meals that have to be prepared for those who have difficulty chewing or swallowing are attractively presented. Lunch was served during the visit and residents agreed that they were always happy with the food that they had. The chef has worked in the home for many years and spends time talking with the residents so that he can be sure that their preferences are being catered for. The kitchen has been given the Gold Standard Award and Food Standards Agency inspection results are always very good. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 15 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 good This judgement has been made using available evidence including a visit to this service. Residents in this home are confident that any concerns or complaints that they might raise would be dealt with promptly and they can be reassured that measures are in place to protect them from abuse and neglect. EVIDENCE: There is a simple and clear complaints procedure and a copy was seen in the entrance hall. The complaints book was seen and two entries detailed minor complaints that had been dealt with appropriately. No complaints had been received by The Commission. Relatives that were spoken with said that they were confident that any concerns that they raised would be dealt with promptly. There is a vulnerable adults procedure in place and all staff members have received training. Those that were spoken with were able to demonstrate an understanding of the relevant issues. All staff that are working in the home have received satisfactory Criminal Records Bureau Clearance. Staff files reflected the homes commitment to appropriate information being obtained prior to employment. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 16 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): Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home provides a clean and comfortable environment with specialist adaptations, which suits the needs of its residents. EVIDENCE: The home provides clean comfortable accommodation for its residents, which is in keeping with the surrounding area and since the last inspection redecoration has been undertaken inside the home. The exterior had been painted not long before that. Unfortunately the bedroom areas with their long corridors have an institutional appearance and room sizes would not meet current standards however they are pleasantly decorated and residents have personalised them with possessions they have bought from home. Specialist adaptations ensure that all areas of the home are accessible to residents and assisted baths and toilets suitable for wheelchair users are
Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 17 throughout the home. There is a small garden where residents can sit in the summer month. On previous visits wedges were seen keeping bedroom doors open. At this visit all but one bedroom door, of a newly admitted resident, was closed and an assurance was given that this is always the situation. The registered manager was reminded that if residents wish their doors to remain open they must be fitted with an automatic closer, which operates in the event of a fire. It is recommended that potential residents preferences in this matter should be ascertained and documented prior to admission so that appropriate steps can be taken. All areas of the home were clean and free from odour on the day of the inspection. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 18 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 excellent This judgement has been made using available evidence including a visit to this service. Residents in this home can be confident that there will always be enough welltrained and qualified staff on duty so that their healthcare needs will be met and that robust recruitment procedures will help to support and protect them. EVIDENCE: Off duty rotas show that there are always sufficient staff, both trained nurses and carers, on duty in the home, supported by domestic and ancillary staff. Training is given a high priority and a training needs analysis outlines all the recent training that has been undertaken. Recent sessions have included nutrition, infection control, food hygiene, diversity, violence and aggression and wound care. Training has also been delivered by a dental hygienist to help staff care for the oral health of their residents. The deputy manager has recently undertaken a 5-day course in adult protection and has been cascading this down to all the staff. Any new staff members undergo comprehensive induction training when they come to the home working under close supervision until deemed competent. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 19 There has also been an emphasis on training concerned with care of the dying and palliative care. Complimentary letters from relatives of residents who have recently died reflect the skills and expertise that staff have in this area. The majority of care staff have attained an NVQ level 2 qualification and are now gradually undertaking level3. Both matron and her deputy have completed the Registered Managers Award. Personnel files of three new members of staff were seen and all contained all of the requirements of the Minimum Standards. Criminal Records Bureau clearance is always completed prior to employment. There is a very low staff turnover in the home giving a continuity of care for residents, which allows them to feel safe and protected from harm. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 20 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 31,33,35,36,38 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Residents can be sure that the home is managed by someone who is competent to do so, that is run in their best interests and that their views will be taken into consideration. Safe working practices employed by the home ensure that the health and safety of staff and residents is protected. EVIDENCE: The Registered Manager has been in post for several years and has a wealth of experience in working with this client group, demonstrating a clear understanding of the problems that they and their families experience. Both she and her deputy have gained The Registered Managers Award and lead a
Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 21 strong team of well-trained and committed staff. Staff meetings are held regularly so that everyone is aware of what is happening in the home. To allow residents and their families the opportunity to contribute to the running of the home there are residents meetings monthly. Minutes of these are available to be seen in the home. There is also a quality assurance monitoring system in place. Audits are undertaken that are in line with The National Minimum Standards, results are collated and letters are sent to relatives highlighting the issues raised and how they will be addressed. The Registered Provider visits frequently and visits are recorded in line with standard 26. The home does not take responsibility for the finances of any of the residents. Staff supervision and appraisal is undertaken regularly and records are available to support this. Certificates of worthiness for equipment and services were seen and were in order. Kitchen records were seen and were all appropriately kept. Staff attend monthly fire drills and fire safety inspections have not resulted in any requirements being issued. It was recommended that the Fire Safety Officer should be contacted regarding the new legislation for fire risk assessments for the home. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 3 X 3 Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP7 OP9 OP19 Good Practice Recommendations It is recommended that there should be evidence that residents or their relatives have been consulted when compiling or reviewing the care plans It is recommended that the signature sheet identifying staff members who administer medication should be updated, It is recommended that there should be evidence to show that the need to keep bedroom doors closed has been explained to newly admitted residents. If they do not wish this to happen it must be documented and appropriate door closers fitted. Purley View Nursing Home DS0000019039.V332289.R01.S.doc Version 5.2 Page 24 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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