CARE HOMES FOR OLDER PEOPLE
Valley View Residential Nursing Home Maidstone Road Rochester Kent ME1 3LT Lead Inspector
Lucy Ansell Announced Inspection 1st February 2006 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 Valley View Residential Nursing Home DS0000026211.V273761.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 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. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Valley View Residential Nursing Home Address Maidstone Road Rochester Kent ME1 3LT 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) 01634 409797 Dr Prathap Padmanabhan Jana Mrs Jyothi P Jana Mrs Hazel Beattie-Burrows Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (5), Terminally ill (4) of places Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st August 2005 Brief Description of the Service: The home is purpose built. Service user accommodation is located on the ground and the first floor. There are 27 single bedrooms and three double rooms and all have en suite toilet facilities. The communal lounge and dining area is on the ground floor and there is also a pleasant conservatory. On the first floor there is a small lounge and on the lower ground floor there is a visitors room. There is a passenger lift. The home is accessible for wheelchairs and there are aids and adaptations to support those with mobility problems. The accommodation is built in a square around an enclosed courtyard garden. There are further gardens around the property at the front and rear and ample parking space is provided. The home is managed by a registered nurse and employs a further 5 trained nurses. In addition the home employs care, domestic, catering, maintenance staff and an activity organiser. Valley View is privately owned and the registered providers have two other homes in the area. The home is located in a residential area of Rochester close to local amenities and a bus route. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Announced Inspection took place on the 1st February 2006 by one inspector Lucy Ansell. The Inspector agreed and explained the inspection process with the Registered Owner and the manager. Documentation and records were read, including care plans. Time was spent reviewing a sample of written policies and procedures, looking at care plans and records kept within the home. A tour of premises was undertaken. The focus of the inspection was to assess the Home in accordance to the National Minimum Standards for older persons and to seek resident’s and representatives views of the home. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Some Standards were not inspected in full and the last report should be read in conjunction to obtain a full picture. What the service does well:
The plans of care indicated in detail the care required to meet the individual needs of the residents. The care plans seen were of a high quality and exceeded the required standard. It was noted that staff regularly review all aspects of the care plan recording outcomes and making changes, as required, daily logs were informative and comprehensive. On inspecting the home it was apparent that staff maintain a high level of cleanliness and a high level of decorative order was maintained throughout the home. The home have shown a high commitment to giving the staff sufficient skills and knowledge to ensure the service users are well cared for. The home has achieved 65 of their staff having gained the NVQ level 2 in care or above. The home provides a comprehensive induction package for all new staff. The home has a comprehensive and robust policy and procedure on recruitment that they follow meticulously. The information retained by the home on staff files is kept well maintained. The levels of activities and outings provided for the residents by an enthusiastic and committed member of staff exceeds the minimum standards. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 6 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. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 Prospective service users and their relatives have access to the information they require to make an informed choice about the home. Service users benefit from a comprehensive assessment of their needs prior to moving into the home that ensures their assessed needs can be met. EVIDENCE: The home’s statement of purpose and service users guide has recently been revamped and reviewed. They were clear and concise with all relevant information included. They are used for their correct purpose of informing residents prior to choosing a home and as a source of reference after moving into the home. These are reviewed annually and updated as required. Residents are provided with a statement of terms and conditions when moving into the home. Evidence was seen of the homes contracts, which were very detailed and signed by the resident or their representative. The Local Authority contracts with the home were also seen, these all appeared to cover overall care provided and fees payable. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 9 The pre-assessment paperwork seen was very detailed and had been updated to include the date, signature, care manager details and the place where the interview was conducted. A good practice recommendation was made to ensure it was clear that the home is strictly non smoking for future residents. The home does not offer intermediate care. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,11 Residents benefit from a high standard of care planning and are treated with respect and dignity. All residents benefit from being consulted, regarding their wishes concerning terminal care and arrangements after death. EVIDENCE: Residents care plans were looked at; these have all been rewritten and are now detailed records that contained good personal and health care recording. The care plans were well written and contained good scope of information with depth and precise details of how the care is to be provided. The health needs of residents are well met with evidence of good multi-disciplinary working taking place on a regular basis. The risk assessments were clear and concise and evidence was seen they are reviewed regularly. A good practice recommendation was made to ensure all moving and handling assessments are also made into risk assessments. The home has asked all residents sharing a room whether they are happy with this agreement and this is now recorded on their care plan. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 11 Evidence was seen that reviews of the care plans are taking place regularly. The manager has in place a system to monitor all care plans after the staff have completed their reviews. The home operates a key worker system where residents have an identified staff member. The staff are now recording enough detail in the daily report, it was also noted that when events and care delivery occurs throughout the day a detailed and comprehensive record is kept with good use of times. The home promotes and maintains residents health through supporting and facilitating medical appointments as required. The home is well able to manage residents with pressure areas with treatment and has a tissue viability link nurse. The home has good links with other professionals and the home can offer a choice of G.Ps from the many surgeries situated locally. The staff on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents. Most residents gave positive feedback during the inspection about the approach of the staff team, comments included “nothing is too much trouble for the girls” and “they show great care and kindness”, it should also be noted that comments were received about how rushed they sometimes felt and how the girls always seem busy. In the residents shared rooms it was noted that privacy curtains were in place that ensured privacy and dignity for the occupier. Residents are consulted regarding their wishes concerning terminal care and arrangements after death and this is recorded on their care plans, allowing them a dignified and compassionate end to their life. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed. EVIDENCE: Standards 12 and 13 were exceeded on the last inspection and this still appears to be the case. No change to the chefs, mealtime observed all residents complimented the food. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents have access to a clear complaints procedure, which is acted upon by the home when necessary. The resident’s benefit from all staff knowing how to report appropriately any possible abuse, and what immediate action to be taken to protect residents. EVIDENCE: The home has a clear step-by-step procedure that meets the requirement of the regulations. The complaints procedure had recently been rewritten to include time scales and was displayed within the home. All residents and family and staff had been given two revised copies one of which was signed and put on file. Further evidence was also seen of it included in the statement of purpose and in the service user guide. The home has received three complaints since the last inspection; all three have been dealt with to a satisfactory level, evidence was seen of a copy of these in the complaints folder. The home now ensures the residents are safeguarded from any abuse, neglect or harm by having a policy for the home as well as the Local Authority Guidelines. The owner is a trainer and gives training for all staff at induction, then they attend courses in the Local Authorities protocols on Adult Protection. The home has a whistle blowing policy. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 14 Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Residents benefit from living in a safe, well maintained, clean and homely environment in which there are high standards of décor, furnishings and fittings. EVIDENCE: The home’s location and layout is suitable for its stated purpose; it has been visited recently by the fire officer and environmental health and had met all their requirements. The home has a routine maintenance and renewal programme and normally when a room is vacated it will be redecorated, four over the last couple of months. All corridors and the office and kitchen had been deep cleaned and redecorated since my last visit. Bedrooms seen had all been personalised by the service users. The rooms were all clean and well decorated with matching bedspreads and curtains. Bedrooms have sufficient space to accommodate the required furniture. The home has very high standards of cleanliness and now all cleaning staff have rotas of which rooms to deep clean daily and no odours were detected
Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 16 anywhere in the house. All double rooms had privacy screens provided to ensure their need for privacy for personal care. The home has a separate laundry room, which met infection control requirements. The kitchen was viewed and this was well maintained. The home has two sluice rooms and a large basement which doubles as a storage space and a staff room. Hand washing facilities are prominently sited and the provision of protective clothing was clearly seen. The home has also recently added antibac gel dispensers by the front door following a request from relatives. All the staff are up to date on infection control training and the kitchen staff are due to go on a twelve week course on food hygiene and safety. The home has a 6 monthly contract for servicing for the hoists and parker baths. The maintenance man checks and services all the wheel chairs and recorded evidence is kept of this. Call systems were seen in all the rooms and provided in communal areas. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,30 Whilst residents are assured their need will be met, the home needs to ensure this is timely and enough staff are on duty to meet their needs. The residents are cared for by competent staff that receive regular, on-going training. EVIDENCE: The evidence on the day showed high levels of staff however from staff rotas and questionnaires and comments received back from relatives and residents it would appear that staffing levels are still an ongoing issue. The home is only down by one member of staff and so perhaps it is the staff routines that make residents and families feel that there is not enough staff on the floor. There is a general feeling that the staff are too busy to help them and many small tasks like emptying bedpans or clearing away crockery are not attended to as swiftly as would be required. This needs to be looked at thoroughly by the management. The home is to be commended on its active role in securing training, with good numbers of staff having completed NVQ’s level 2 and 3. This includes kitchen and cleaning staff. All new staff members are also encouraged to enroll on the course. The home gives good support in all aspects of training. The home has a very robust and inclusive induction programme carried out in-house. Overall a good standard of training with all mandatory course completed last year. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 18 Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Whilst the residents benefit from having a well supported and well led staff team run in their best interests, they need to ensure the staff team are appropriately supervised. The resident’s finances are safeguarded by the home, and the policies and procedure ensure their health, safety and welfare are promoted and protected. EVIDENCE: The manager was seen to communicate a clear sense of leadership and direction to her staff. She has thirty years experience in the field of nursing and has been manager at the home for the last six years. In 2005 she completed her NVQ4 in management and updates her practice with training on a regular basis. The home has annual house meetings with just residents to ensure their views are heard and monitor the home is being run to their satisfaction with a chance for all complaints to be aired. A recommendation was made to increase this to
Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 20 twice yearly. It was also felt that the expectations of the relatives was different from the reality of a large busy home and it was agreed for anonymous questionnaires to go out to relatives followed by a meeting to ensure any questions were answered. The home does carry out twice yearly effective monitoring with views of staff, relatives and residents regularly sought. The results of the last survey are produced and displayed in the hallway. The home does not act as appointee for handling financial affairs for their residents, families or solicitors deal with this responsibility. The homes accountant audits the resident’s personal record of expenditure monthly and the home gives receipt for any monies spent on their behalf e.g. hairdresser or chiropodist. The home receives bank statements with separate interest for each resident. The manager must ensure supervision is carried out at least six times a year and this will be split between herself and her deputies to complete this after they have received supervision training. The manager needs to ensure she is receiving clinical supervision and she carries out unobserved supervision of the staff while they are working. The home’s record keeping is effective and efficient with reviews of policies and procedures happening yearly, good record keeping for the residents, which safeguard their rights and best interests. Individual records and home records are kept secure up to date, in good order and used in accordance with the Data Protection Act. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 21 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 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 3 x Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 22 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 OP36 Regulation 23 Requirement Timescale for action 30/06/06 2. OP27 18 The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. The registered person shall, 30/06/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users(a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 23 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 Refer to Standard 7 33 Good Practice Recommendations To ensure Risk assessments are completed for all moving and transfers. To ensure Quality assurance in the home is carried out for residents and relatives on a regular basis. Valley View Residential Nursing Home DS0000026211.V273761.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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