Inspection on 20/12/05 for Western Park View

This inspection was carried out on 20th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Western Park View 26/07/07

Western Park View 25/07/06

Western Park View 20/07/05

Western Park View 02/12/04

Western Park View 15/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Western Park View 390 Hinckley Road Leicester Leicestershire LE3 0WA Lead Inspector Mrs Gillian Adkin Unannounced Inspection Tuesday, 20th December 2005 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 Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 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. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Western Park View Address 390 Hinckley Road Leicester Leicestershire LE3 0WA 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) 0116 2470032 0116 2470032 Western Park (Leicester) Limited Vacant Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (60), Physical disability of places over 65 years of age (60) Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person under 55 years of age who falls within category PD may be admitted to the home. To be able to accommodate the named person of category DE as identified in correspondence in variation application number V18512 dated 15/03/05 20th July 2005 Date of last inspection Brief Description of the Service: Western park view Nursing and Residential home is owned by a limited company Western Park (Leicester) limited. The home provides accommodation for sixty service users who fall within the categories of Old Age, and Physical Disability over sixty years of age. The home is purpose built and is set in secluded grounds in a residential area close to Western Park and Leicester City Centre. The home has fifty-four single bedrooms and two double all of which are en-suite situated on two floors which are accessed by two passenger lifts There are four lounges and a large conservatory. There are attractive garden areas to sit outside and ample parking is available. The home is managed by a qualified nurse manager and employs both trained and care staff. The home is a non-smoking home, however provision is made for residents who smoke in a separate area. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was inspected against the Regulations as in the Care Standards Act 2000. This was an unannounced inspection, which took place over one day and commenced at 9.30 am on 20/12/05.The inspection took 7.30 hours. The acting manager facilitated the inspection, as the registered manager post is currently vacant. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting four service users’ and tracking the care they received. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. During this inspection the inspector was notified of an anonymous complaint received through the Commission for Social Care Inspection duty officer in relation to: 1. 2. 3. 4. Management of service users continence and toileting needs. Staffing levels falling/less staff stability. Standards of care decreasing. Staff not answering call bells when required by service users’ Issues were investigated as part of the usual inspection methodology and through case tracking of four service users’. Complaint outcomes were as follows: 1. 2. 3. 4. Upheld (see main body of report for evidence) Not upheld (see main body of report for evidence) Partially upheld (see main body of report for evidence) Partially upheld (see main body of report for evidence) During this inspection a tour of the accommodation occupied by those case tracked took place and the inspector viewed internal records, and care plans. The inspector spoke to service users’, nurses, care and ancillary staff working Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 6 in the home. Several relatives were available during this inspection for comments. There were 54 residents accommodated at the time of this inspection of which over 50 were described as having medium /high dependency needs. Conversation with all of the service users tracked was possible although in one instance limited due to communication difficulties, however supporting comments were received from other service users and relatives as detailed below. Typical service user /relative comments included: “I have raised concerns recently regarding the number of baths my relative has been having” “Staff do not respond to requests for help in a timely way we are kept waiting for long periods of time between 10 minutes and an hour, sometimes they don’t come at all” “My relative has been in the home for a long time so I have seen some things change but overall the standard of care has been acceptable until recently” “I have never had to complain since I have been here” “There is never seems to be enough staff on duty” “Rooms are very comfortable and warm, I am very happy here” “It is not acceptable to be kept waiting for long periods of time when you need the bathroom” “The staff do there best and are very kind” “The meals are excellent” “Staff always maintain the dignity of my relative” “I am always made very welcome” “Communication can be very poor” “ Staff do not always leave the call bell within easy reach and as I cannot see have to feel around for it, if I cant find it I have to just sit and wait until staff come into the lounge then I shout for attention” “I’ve seen the notice board which has a notice on about notifying the owner about concerns but I have not been formally told what the procedure is” Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 7 Typical staff comments included: “There are five care staff on duty in the morning one does the breakfasts and the other four get people up, so when a call bell goes off we have to leave the resident we are attending to answer call bells, sometimes this is not always possible and we have to keep people waiting, we could do with another member of staff to float particularly on the morning shift” “We do not have enough hoists to attend to residents who are in the lounges and need the toilet in the morning particularly when we are getting people up using the other 3 hoists, they have to wait until someone has finished with it” “We have recently had first aid and moving and handling training; we use the same sling for all service users who have had a stroke. “I have not had any adult protection training for three years” “We have a handover at the beginning of each shift” “We look at the care plans for information” What the service does well: What has improved since the last inspection? What they could do better: The care home would be more homely if it was kept free from offensive odours. Robust procedures must be in place for the management of allegations of abuse. Notice must be given to the Commission without delay of any occurrence which affects the safety or well being of a service user Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 8 Adult protection training must be provided to the acting care manager and other senior staff within two months. Management of service users continence needs must be improved. An appropriate professional must assess the continence needs of service users admitted to the home. Assessments in care plans should be reviewed regularly and should be reflective of actions provided by staff in order to achieve satisfactory continence care. The registered provider must make suitable arrangements to ensure the care home is conducted in a manner which respects the privacy and dignity of service users accommodated this is particularly in reference to meeting the toileting needs of each individual. The registered provider must make suitable arrangements to ensure the care home is conducted in a manner, which respects the privacy and dignity of service users, accommodated. This is particularly in reference to meeting the personal care needs of each individual with specific continence needs such as use of pads. Suitable arrangements must be made to ensure that physically disabled service users and those with sensory impairment are provided with an appropriate method of communicating with staff, this should include positioning of call bells. Service users and their relatives must be provided with a copy of the complaints procedure on admission. Complaints records should be inclusive of an outcome /resolution. Where a written copy is inappropriate due to sensory impairment a different format must be provided or arrangements made to ensure the service user is fully aware of how to complain. Service users identified at risk of choking must have risk assessments put in place in consultation with an appropriate professional i.e. SALT, General Practitioner etc which are reviewed at least monthly. Where a service users weight is declining without obvious cause a professional opinion must be sought without delay. The dependency needs of service users’ accommodated must be regularly assessed to ensure that appropriate numbers of staff are on duty on each shift and in order to meet the individual needs of service users. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 9 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. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 10 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 Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 11 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): 3 Core standard 6 is not applicable Service users’ have their needs assessed prior to moving into the home, this ensures that residents’ needs can be met. EVIDENCE: Four service users were selected for case tracking. Three out of four care plans included a relevant assessment and most included risk assessments. Where applicable social worker assessments were in place. None of the four-service users case tracked could not remember being assessed prior to admission (due to their medical condition) Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10. Care plans provided insufficient detail and lacked an outcome-based approach to meeting individual needs. Lack of attention to meeting service users basic care needs will lead to them being disempowered and dissatisfied with the service provided. Lack of essential risk assessments increases the potential for harm occurring and assessed needs not being fully met. EVIDENCE: Four care plans were case tracked including three service users with moving and handling needs and one with continence needs. A further service user tracked was selected due to concerns over current placement. Discussion with the acting care manager and case tracking of a service user indicated that although the service user had been identified with a potential mental health condition no referral had been pursued by the home through the General Practitioner for diagnosis. The impact of the service users behaviour on other people accommodated was described by staff as distressing. Agreements were made with the registered provider to address this with the General Practitioner and funding authority. Care plans had been developed by trained or suitably competent persons. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 13 Care plans and risk assessments had mostly been evaluated but were not all reflective of the outcomes of care provided or risk managed. Care plans tracked on this occasion identified a number of shortfalls. For example the care plan of a service user identified as at risk of tissue breakdown did not include the type of equipment required, it was apparent that the service user required a pressure relieving cushion and mattress yet only had a mattress but no cushion in place whist seated in an armchair thus increasing the risk. Another service user tracked was found to have significant nutritional issues yet no evidence was found of a care plan to address this. The same service user was described by a relative as “being treated as a diabetic”, however no evidence was found to certify the status of this person and erratic records were kept regarding monitoring of weight. No evidence was found in records to suggest that any concerns had been raised by the home or investigations been undertaken to establish diagnosis. The acting care manager confirmed that no investigations had been undertaken. Evidence was found to demonstrate that some risks had been assessed however in two instances where service users had identified choke risks, no risk assessment was in place. Some evidence was found to support that service users’ had been consulted with regarding their care plan. Service users and relatives were however unable to confirm the extent of their involvement. It was not clear if care plans had been audited recently. One relative knew the care plan had been updated but did not know to what extent. Concerns had been raised with the Commission for Social Care Inspection by a Social Work review officer prior to this inspection about staffs’ ability to manage the toileting and continence needs of service users accommodated. Further concerns were raised by an anonymous complainant on the day of inspection about this matter and staffs’ response to call bells when service users’ required the toilet. On the day of inspection observations of staff and discussion with service users confirmed that complaints/concerns made were justified. Staff described how toileting was conducted at frequent intervals during the day however no obvious routine was seen.Staff further indicated that due to the deployment of staff requests to use the toilet mid morning are not always Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 14 possible as staff are otherwise engaged in getting service users up usually until approximately 11.00am. At least two service users in the conservatory were kept waiting for excessive periods of time after calling for staff assistance and four service users in the main lounge were noted to be kept waiting to use the toilet after lunch, the reason given for this was that staff were receiving a handover. One service user said she had been waiting for approximately half an hour after buzzing for assistance. One service user said he found this to be “totally unacceptable”. Another service user who had a sensory impairment said sometimes staff do not come at all” Concerns previously raised by a relative regarding meeting the personal care and continence needs (use of pads) of two service users had recently been addressed at a review. Records implemented after this review were noted to be unsatisfactorily maintained and staff spoken with said the toileting regimes were not always recorded. No evidence was available to suggest that monitoring of call bell response times currently take place. Dependency monitoring was evident in care plans tracked however discussion with senior staff identified that dependency scores did not accurately reflect the dependency levels. Discussion took place regarding the appropriateness of the current tool used. Medication systems were inspected in relation to those residents tracked and was found to be satisfactorily maintained. Controlled drugs were not inspected as none of the service users’ tracked were in need of them. The systems of ordering, storage and administration were appropriate and safe although it was apparent that the system for returning drugs to pharmacy was unclear on the residential floor of the home. Trained nurses administer medication to nursing residents and trained senior care staff administer drugs to residential residents. Staff were questioned regarding policy and procedure and were aware of how to report errors. Care staff responsible for drug administration have completed recent training to ensure competence. None of the resident’s case tracked were responsible for their own drug administration Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 15 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): 12.13.14 Service users are mostly satisfied with the routines of the home and food provided. A better activities programme and an increase in planned activities at times, which are flexible and suitable to them would improve outcomes for individuals. EVIDENCE: Discussions with service users and relatives identified that that routines in the home are usually fairly rigid for example set meal times, however some examples were given of service users having the flexibility to get up and go to bed when they choose. It was apparent from discussion with staff that night staff are responsible for completing certain tasks before their shift ends. Two residents spoken with stated that they were very happy with the current routines, which met their individual preferences. Discussions with relatives in the home indicated that they were always made welcome and were not restricted when visiting their r family. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 16 A relative described how she had made arrangements for a service user to have an early lunch before a hospital appointment. Concerns and complaints from service users mostly were about the lack of response to their requests to be taken to the toilet All comments made by service users about the quality of food were very positive. A number of residents stated that they regularly attended the church services, which are held each month. An activities organiser provides activities one and a half days per week No activities were in place during the inspection and staff said that they considered they did not have time currently to provide any extra activities. During this inspection the activities organiser was on his days off and no arrangements were in place to ensure that residents were suitably occupied other than some music being on in the lounge. A number of residents said they were bored when the activities person was not there. Staff said that the activities organiser starts work at 9.30am, which was considered by most to be too early and not an effective use of time. Activities records were not inspected on this occasion. Social diaries were seen in one out of four care plans tracked but this was in need of updating. A carol service and raffle were displayed as this weeks events on the notice board in the home. No other routine programme of activities was seen. It was not possible to establish if a programme was in place, as the activities organiser was not working during this inspection. The inspector was unable to clarify how those service users’ with sensory impairment or who were immobile were informed of the events planned. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 17 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 Investigation and recording of complaints is not sufficiently robust and therefore service users’ are not confidant in the homes complaints procedure. EVIDENCE: Discussions took place with service users’, staff and relatives about the complaints system in place. One relative stated she had “seen the notice on the notice board about contacting the owner about complaints” however two service users said they had not received a copy of the procedure and would normally complain to the manager or nurses. One service user tracked said he was not aware of how to complain. Discussion with the acting care manager indicated that she had been managing current complaints but had not had any formal training. Four complaints were recorded in the records and only one was reflective of an outcome although it was indicated that they had been concluded. One complaint, which had recently been investigated, had no supporting documentation in place to confirm any formal investigation having taking place. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22.24.26 Facilities, which maximise independence, are not always provided this has the potential to disempower those with disabilities. The home is not sufficiently clean and hygienic to provide a pleasant living environment. EVIDENCE: All of the four service users’ case tracked required specialist equipment to help them maintain independence or safety. This included bedrails, hoists, and pressure relieving mattresses, cushions and wheelchairs. All of the equipment required was in place however in one instance was not detailed in the care plan. Discussion with staff indicated that a high number of service users require a hoist especially in the mornings, occasionally they were unable to respond to service users requests for the bathroom in an acceptable time due to all three hoists being in use. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 19 A service user was tracked with a specific sensory impairment. When spoken with it was evident that a call bell was required to attract the attention of staff. A service user and relative stated that “on occasions the call bell was not positioned within easy reach and on an odd occasion the call bell was not given or was on the floor” thereby restricting access to staff. Several service users were unable to use call bells and it was noted that they relied on other people to call for staff to attend to them. Several service users stated that they had to wait excessively long times for staff to attend to them. This had been raised with the home prior to the inspection and was confirmed by most individuals spoken with. A service user tracked who was identified with pressure area risks was found to have appropriate pressure relieving equipment on their bed but no cushion in place in their chair in the lounge. No reasonable explanation was given for this omission. The home (including bedrooms) overall were found to be clean and well maintained however the ground floor corridor and main lounge and entrance from the dining room had strong urine odours present. It was noted that de-odorisers were fitted in the corridor however they were not effective in reducing the odours present. Discussion with ancillary staff indicated that the carpet shampooer had been broken and spot cleaning undertaken where required. It was evident from odours present that more thorough cleaning of the areas identified was required. Maintenance records were not inspected on this occasion however records supplied indicated that all routine maintenance was up to date. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27.30 Service users’ needs are not fully met by the current levels of staff provided. Training provided does not ensure that staff are fully able to meet individual needs or protect them from potential harm. EVIDENCE: During this inspection four service users’ were selected for case tracking. All of the four service users were identified with high dependency needs including moving and handling and continence needs. Discussion with service users’ and a relative indicated that very often call bells are not answered in an acceptable time and on occasions not at all. Staff spoken with indicated that many service users required a hoist for mobility and that when the three hoists were in use for getting service users up that any individuals waiting to use the toilet had to wait for staff to finish their current job to be able to have use of a hoist. Discussion with staff indicated that despite night staff having set morning routines that morning staff struggled to get the remaining service users up in a reasonable time as most required two staff to tend to them. It was indicated that although a member of care staff worked in the dining room in the morning (giving out breakfasts) they were often distracted from getting people up as this person could not take people to the bathroom whilst being responsible for serving breakfast and assisting service users to eat. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 21 The home had fifty-four people accommodated during this inspection of which approximately 35 were described as having medium –high dependency needs and usually required two staff for care tasks. Care hours provided were calculated at 1183 per week plus the acting care manager hours, which are supernumerary. This numbers of hours despite being within the Department of Health Residential Forum recommended guidelines appeared to be insufficient based on evidence collected from service users, staff, relatives and by observation of routines during this inspection also based on ongoing complaints regarding response times for attention when requested by service users. The inspector noted long periods of time when lounges were unattended and a number of service users who were distressed at having to wait for attention whilst staff were receiving a handover of shift in the afternoon. No monitoring of call bell response times was being undertaken at the time of this inspection. Training records were inspected and evidence supplied indicated that most staff had received basic training and induction including moving and handling. Concerns were however raised with the provider over the lack of continence and abuse training. This was particularly relevant in relation to the management of the continence needs of those people case tracked and concerns raised in recent complaints. Further concerns were raised with the provider, as records provided indicated that staff had not received any fire training during 2005. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.36.38 A system of risk assessment, management and recording is in place but evidence indicated weaknesses in completion of essential high-risk issues, evaluation and review. This puts residents at risk of their needs not being met, and has the potential to increase the risk of harm occurring. EVIDENCE: The home is currently being managed by an acting care manager following the resignation of the registered manager. A residential manager is employed to oversee care for residential clients. Supervision records were not inspected on this occasion however staff spoken with considered they were well supported by the acting care manager and senior staff. This standard will be fully inspected at the next inspection. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 23 An external authority prior to this inspection raised concerns over the moving and handling needs of specific service users. Observation of staff at work and questioning of them in relation to handling clients indicated that they were knowledgeable and performed procedures safely and according to the moving and handling assessment contained in care plans. Appropriate equipment was in use for procedures performed. Records of training demonstrated that all staff were up to date with MH training. Case tracking of one service user indicated that although a choke risk had been identified, a risk assessment had not been put in place and discussion with the service user indicated that her condition and posture placed her at risk of choking whilst eating. Accident records were inspected and it was evident that they were being managed appropriately. It was noted however that an incident, which required formal reporting under Regulation 37 of the care Standards Act 2000, had not been done. It was also noted that generic risk assessments completed in 2004 had not been updated since then. Evidence supplied by the provider indicated that fire training had not been provided for staff during 2005 and arrangements must be made to ensure that staff receive fire training at least annually. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 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 “ ” 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 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 X X X 2 3 3 3 1 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 2 X X X X X X 1 Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 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 2. Standard OP26 OP18 Regulation 12(2) k Requirement Timescale for action The care home must be kept free 20/12/05 from offensive odours. 17(2) Sch Robust procedures must be put 20/12/05 (4) 12 in place for the management of allegations of abuse. 37 Notice must be given to the 20/12/05 Commission without delay of any occurrence which affects the safety or well being of a service user Adult protection training must be 20/12/05 provided to the acting care manager and other senior staff within two months. Management of service users 31/01/06 continence needs must be improved. An appropriate professional must assess the continence needs of service users admitted to the home. Assessments must be reviewed regularly and care plans must be reflective of actions required to achieve satisfactory continence care. 3 OP38 4 OP18 13(6) 5 OP8 13 Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 26 6 OP10 12(4) The registered provider must 31/01/06 make suitable arrangements to ensure the care home is conducted in a manner which respects the privacy and dignity of service users accommodated this is particularly in reference to meeting the toileting needs of each individual. A senior company representative must monitor procedures put in place. 7 OP10 12(4) The registered provider must 31/01/06 make suitable arrangements to ensure the care home is conducted in a manner, which respects the privacy and dignity of service users, accommodated. This is particularly in reference to meeting the personal care needs of each individual with specific continence needs such as use of pads. A senior company representative must monitor procedures put in place. 8 OP22 23(2) n Suitable arrangements must be 31/01/06 made to ensure that physically disabled service users and those with sensory impairment are provided with an appropriate method of communicating with staff Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 27 9 OP16 22 Service users and their relatives 31/01/06 must be provided with a copy of the complaints procedure on admission. Where a written copy is inappropriate due to sensory impairment a different format must be provided or arrangements made to ensure the service user is fully aware of how to complain. 10 OP38 13(4) c Service users identified at risk of 31/01/06 choking must have risk assessments put in place in consultation with an appropriate professional i.e. SALT, General Practitioner etc which are reviewed at least monthly. Where a service users weight is 31/01/06 declining without obvious cause a professional opinion must be sought without delay. Appropriate numbers of staff 31/01/06 must be on duty at all times to meet assessed needs and having regard to the Statement of Purpose and categories of registration. Care plans must be drawn up to 31/01/06 reflect all assessed or new needs as they arise. Care plans must be drawn up and reviewed in consultation with the service user and /or relative or significant person 11 OP8 12.13 12 OP27 18 13 OP7 15 14 OP7 12 Where identified as at risk of 31/01/06 tissue viability issues such as` pressure sores, care plans should be fully reflective of equipment required. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 28 15 OP31 9(2)b(i) Suitable arrangements must be 31/01/06 made to ensure that the acting care manager is fully supporting in the interim period and to ensure that any gaps in knowledge regarding managing the home are addressed appropriately. Suitable arrangements must be 31/01/06 made to ensure that the activities programme provided meets the individual needs of service users accommodated and that service users are consulted about the activities provided. Suitable arrangements must be 28/02/06 made to ensure that staff receive fire training. 16 OP12 16(2) m.n 17 OP38 23(4) d 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 OP3 Good Practice Recommendations It is recommended that a social history be completed during assessment of residents and kept in their care plan. This recommendation had not been addressed in care plans tracked. 2. OP12 It is recommended that appropriate arrangements be made to provide activities for residents when the activities organiser is on leave. It is further recommended that an orientation board be provided to ensure residents remain fully orientated to date and day. This recommendation had not been addressed. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 29 3. OP25 It is recommended that ventilation and temperatures in the conservatory are monitored and appropriate action taken to ensure the environment is ambient and comfortable. This recommendation had not been addressed. 4. OP38 It is recommended that generic risk assessments are completed in full and are evaluated at least quarterly or more often as required dependant on individual risk. It is further recommended that a nominated person be given this responsibility to ensure reviews take place regularly. This recommendation had not been addressed. 5. OP27 It is recommended that staff do not work excessive numbers of shifts which may result in them being overtired and unable to work efficiently. This recommendation had not been addressed. 6 OP15 It is recommended that suitable arrangements are put in place to ensure that those service users who are immobile have access to cold drinks left in lounges. This is particularly relevant to those service users who are immobile and who require additional fluids. 7 OP3 It is recommended that where service users are identified with nutritional needs that robust records of monthly weight monitoring are maintained. It is recommended that staff be provided with training updates related to management of diabetes. It is recommended that the current dependencymonitoring tool used in care plans is reviewed and a more research-based tool is put in place to accurately reflect dependency levels in the home. It is recommended that staff deployment on each shift (including that of both registered nurses and care staff) be reviewed to ensure that all staff on duty assist in meeting the toileting needs of service users and responding to call bells requests. 8 9 OP30 OP27 10 OP27 Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 30 11 OP4 It is recommended that the timing and process of the staff handover is reviewed and arrangements put in place to cover call bells during handovers. It is recommended that the registered provider reviews the current provision of activities (time allocated) and times that the activity organiser works to ensure that current provision is adequate and suitable to meet service users needs. It is further recommended that where the activities organiser is not working in the home that a member of staff be allocated a one-two hour period each day to provide stimulatory activities. 12 OP12 13 OP22 It is recommended that the registered provider assess the current provision of hoists in order to establish if there are adequate numbers to meet the needs of those service users’ reliant on them. Western Park View DS0000001932.V271755.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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