Inspection on 25/07/06 for Western Park View

This inspection was carried out on 25th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Western Park View 26/07/07

Western Park View 20/12/05

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 25th July 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 Western Park View DS0000001932.V302265.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. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 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 Mrs Rose Anna Goddin 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.V302265.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To specify the minimum age: No person under 55 years of age who falls within category PD may be admitted into Western Park View To admit a named person: To be able to accommodate in Western Park View, the named person of category DE as identified in correspondence Variation Application No. V18512 dated 15th March 2005 Service user Numbers: No person to be admitted into Western Park View in categories PD, PD (E) or OP when 60 persons in total of these categories/combined categories are already accommodated in Western Park View Service User Numbers: No one falling within category OP may be admitted into Western Park View where there are 60 persons of category OP already accommodated within Western Park View The maximum number of persons to be accommodated within Western Park View is 60 3. 4. 5. 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. A qualified nurse manager manages the home 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. Current fees are £320-500 per week or as agreed after assessment. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The service was inspected against the Regulations as in the Care Standards Act 2000.This was an unannounced inspection, which took place over 8.75 hours and commenced at 09.15 am on 25/07/06. The registered manager assisted at the inspection. The focus of inspections is on outcomes for residents living at the home and obtaining their views of the service provided. This process considers whether the home meets the National Minimum Standards and highlights areas, which might need further development or improvement. The method of inspection used is called “case tracking’ which involved selecting two residents and tracking the care they received this was achieved by discussion with them, their relatives and associated staff. Residents were selected randomly. Staff were observed at work and providing care. During this inspection a tour of the rooms (occupied by those case tracked) and associated communal and external areas took place and the inspector viewed internal records, and care plans. The Commission had received a number of notifications before this inspection relating to falls and use of moving and handling equipment, these issuesare addressed within the inspection report and relate to standard 38. Concerns raised at the previous inspection relating to management personal care needs are addressed in standards 7-11.Improvements had been made to meeting personal care needs but it was evident during this inspection that further improvement was required. Nine residents completed comment cards during this inspection, comments made were mostly positive. Residents were assisted to complete comment cards with the assistance of visitors. Five relatives were available for discussion during the inspection. Typical resident/ staff /visitors comments included: “Staff usually listen to what we say” “ Staffing levels and morale have improved since the new manager came” “I know who to speak to if I’m not happy about something” “We have seen residents calling for attention in lounges for long periods of time, we have had to go and find staff to take them to the toilet” “The meals are always good” “The home is usually clean and fresh” “The new manager is a hands on manager, she works on the floor in the mornings and when needed” “Staff have told me they haven’t got time to bath me” “I have rung the bell for assistance and once had to wait three quarters of an hour for attention” “I have had no involvement in my care plan” Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 6 “There is more leadership now” “ I have not been here very long but have been told about wearing gloves and aprons for personal care” What the service does well: What has improved since the last inspection? What they could do better: The ventilation in the home is poor, these areas include the lounge, conservatory and dining room, despite having ceiling fans, which were largely ineffective, and some pillar type fans the temperature in all three areas was uncomfortable for residents and staff alike. Temperatures were recorded at one stage in the conservatory at 91degrees F. Many residents commented about how uncomfortable they felt. Furthermore there is inadequate ventilation in the downstairs treatment room where medicines are stored. Training should be provided in relation to adult protection, managing difficult behaviours and diversional techniques. The recruitment process should be strengthened to ensure that all documentation required is in place before a person starts work in the home. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 7 The privacy and dignity of residents’ and protection of their valuables would be improved by locking of bedroom doors when they are in hospital or away from the home. End of life decisions should be discussed at the earliest opportunity and specific or diverse needs recorded. 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.V302265.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 Western Park View DS0000001932.V302265.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3.6 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. A qualified person assesses residents before admission; this process involves residents/relatives and other professionals. Residents are assured that their needs can be met in the home. EVIDENCE: Four care plans were case tracked. Evidence was found during inspection of care records to demonstrate that a robust assessment of needs is undertaken before admission and where required additional assessments for nursing care are conducted. Two residents were case tracked who had recently been admitted to the home, one was unavailable to give comments about their assessment, the other was unable to remember. Discussions with the registered manager at the last inspection indicated that the home did not provide intermediate care services. A relative informed the inspector that they had taken an active part in a pre admission assessment conducted by the registered manager over the telephone. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 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): 7.8.9.10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Resident’s needs are set out in a plan of care, residents do not consider that their personal needs or medication requirements are always met in a manner, which is respectful and appropriate to them. EVIDENCE: All of the four persons case tracked had a plan of care in place (a care plan describes how residents needs are to be met) Care plans detailed preferences and specific choices. End of life decisions (such as where someone may wish to be when they die) were not however detailed, this was considered to be particularly important when considering the needs of people with cultural or diverse wishes / requirements such as that of a resident who was case tracked from a black minority ethnic background. All residents have a named nurse who have specific responsibilities in meeting these needs and are responsible for the updating and general up keep of records. All residents are registered with a local General Practitioner practice. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 11 Residents tracked were unaware of their care plan mostly due to communication issues but comment cards completed by others indicated that usually their care needs were met. Care records inspected had been completed and were reflective of the initial assessment of needs and included essential risk assessments. Most care plans had been reviewed regularly. However one resident informed the inspector that that they had not seen their plan of care nor had they been consulted with regarding any reviews, this person had a number of issues relating to personal care (including meeting his specific continence needs and bathing) these issues were discussed with the registered manager. The service user was not case tracked during this inspection however the registered manager produced care plans following the inspection which indicated that the service user had been involved the continence care plan was not however dated and it could not therefore be clarified when the involvement commenced. Daily records provided indicated that the service user was toileted 2-3 hrly or on request. Agreements were reached between both parties that the care plan would be reviewed together at least six monthly or as required, further concerns about bathing and personal care were to be addressed in an internal review including all staff involved. A new member of staff informed the inspector that they had been given information about individuals at handovers and was aware of the care plans and where to locate them. Information received from a domiciliary dentist demonstrated that the home were pro-active in obtaining visits when required for treatment. Staff spoken with indicated that care plans had improved tremendously and were easier to use, however discussion with a resident and staff identified that vital information about communication (where the residents first language was not English) was not detailed in their care plan. Personal or specific issues or behaviour management and any factors, which might affect the resident and how staff provide care, such as bed rest should be documented. Staff observed during the inspection demonstrated a good understanding of care needs and requirements. It was recommended that where this type of information is considered necessary that care plans include the information required by staff to manage these needs. The manager stated that she had addressed the issue of handwriting variances (different styles and quality) by putting in place pre printed care plans. None of the residents’ case tracked administered their own medication. The medicines policy provided was current and met with current legislation and Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 12 recommended guidelines. The registered manager informed the inspector that all policies including the medicines policy were due for review next year. The registered manager provided evidence of weekly audits demonstrating a commitment to ensuring medication is managed appropriately. Medication procedures including blister packs, records, storage, and disposal were checked and were appropriate to meeting recommended guidelines. Medicines are ordered by registered nurses and are administered by both nurses and senior care staff who have been trained. Evidence of this training was seen in staff records. A registered nurse stated that the pharmacist who supplied their medicines visited the home regularly and on the last visit made no recommendations about the systems in place. Observation of a medicines round at lunchtime took place and registered nurses were observed assisting where required. Concerns were raised with the inspector about the manner in which certain staff left medicines with residents before they had taken them, it was stated that it was “not unusual to find tablets on the floor when visiting” No evidence of this was seen on the day of inspection however the matter was discussed with the manager who agreed to investigate and take appropriate action. Further concerns were raised by a resident who complained that they were not getting the prescribed cream they required for a skin condition as residential staff informed him they “didn’t have the keys for the fridge” REQ The registered nurse on duty had defrosted the drugs fridge on the day of inspection, this is a weekly occurrence, it was noted that insulin was being stored on a shelf in the treatment room, which was extremely warm temperature (gauge read 28 degrees) on checking the manufacturers instructions it was noted that it should be stored at a much lower temperature. No explanation was given regarding the reason it had not been stored in a more appropriate place. This was discussed with the manager. It is recommended that all staff receive appropriate information about the correct temperatures to store medicines whilst cleaning of fridges takes place. Observation of staff at work indicated that their approach was appropriate and comments received during inspection indicated that most residents’ considered their privacy and dignity was respected, this included two relatives of a person tracked. Another relative said, “We have no complaints and are very happy” Some concerns were raised by residents and some relatives at the last inspection regarding meeting toileting, although toileting arrangements appeared to have improved and new systems had been put in place one resident stated that they can still wait from a few minutes up to three quarters of an hour to be taken to the toilet or were told by staff they “had to wait” these matters were discussed with the registered manager who agreed to address with individuals concerned and to put in additional monitoring. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 13 Discussions were held between the manager and relatives about their specific concerns re toileting of their relative. All parties were satisfied with the outcome of the discussion. Specific issues relating to frequency of bathing were discussed with a resident and it was apparent from discussion that current arrangements were unsatisfactory, no reasonable explanation was given regarding the reasons for the lack of baths provided. The registered manager was invited to take part in this discussion and was not aware of the difficulties the resident was having in trying to get a regular bath and meeting his continence needs. The resident said, “ I should not have to argue for my basic care needs to be met” It is was further stated that the resident had not complained as they “didn’t want to be a nuisance” It was agreed with the registered manager that a full review of care must take place with all staff involved. It was also agreed between the manager and resident that any concerns must be directed to her in the first instance. REQ Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The lifestyle experienced in the home does not always promote choice or control; residents’ do however receive a wholesome diet and are able to maintain family and community links. EVIDENCE: Discussions with residents took place about their views of the lifestyle they experienced in the home. Views were also included on comment cards completed by residents. Residents’ said that they are given a choice of routines and that staff were reasonably flexible. Observation of routines confirmed this. Observation of staff at work identified that mostly residents’ were given choices and assisted to make decisions where possible, although some residents did not confirm this spoken with. One resident stated they had rung their call bell for a long time on one occasion and had been informed that “staff were busy” after waiting for about ¾ of an hour the resident had been forced to seek out two senior staff who when found were doing paper work. No reasonable explanation was given for this and the resident had not made the manager aware. It was agreed that an investigation would take place and action take to address. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 15 Discussion with residents during and after the meal and observation of food supplied at breakfast and lunchtime indicated that most residents were happy with the meals provided. Menus seen described the alternatives available. Staff were observed assisting with meals and residents tracked one of whom had specific requirements had appropriate meals. Alternatives were offered if required. The registered manager has worked hard since appointment to improve the overall outcomes for residents who are nutritionally at risk by ensuring that good risk assessments are in place and that she personally takes responsibility for observing the amount of food taken. Records seen indicated that all appropriate measures are taken to improve or maintain good nutritional status (average weight for height and BMI) particular attention was being paid to those persons with pressure sores and good evidence was seen of supplements being provided and enrichment of food (adding extra cream, sugar, milk, butter to add extra calories). Residents’ and staff said, ”Jane is an excellent cook” The manager stated that the owner is fully supportive of any increase in budget relating to provision of food. Discussions with the cook indicated that she was fully aware of the nutritional needs associated with a service user case tracked. She stated that cultural issues had been addressed with the family and previous manager and that the resident was now happy to eat a full English diet with treats brought in by the family. The cook said she no longer needed to maintain food audits as there had been no complaints about food recently and that food was always discussed at resident meetings. An excellent example was given by the manager regarding how staff had encouraged a resident to eat and maintain weight whilst on chemotherapy (treatment for cancer) Most residents and relatives spoken with at lunchtime said that food was of good standard and offered enough choices. Comments received on comment cards indicated that most service users were very happy with food provided. Cold drinks were freely available throughout the day and the manager stated that she had put an extra member of staff on duty to provide an on going drinks service throughout the day, hot drinks are available at regular intervals. Evidence seen in the home indicated that religious and spiritual requirements were met in the home and that usually residents were involved in the planning of activities. A hand massage was given to residents during the inspection by the new activities organiser. Some evidence was seen of a plan of activities but this had not been fully implemented by the new activities organiser. Social histories were recorded in residents’ care plans and the registered manager stated she fully intended to ensure that the new organiser received training and was made familiar with the backgrounds of residents living in the home. Regular visitors to the home included local school children, hairdressers and the local church. Relatives informed the inspector that visiting was not restricted. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 16 Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 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): 16.18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service The home has a clear and accessible complaints and adult protection procedure, which promotes an open and positive approach to problem solving and ensures the protection of service users. EVIDENCE: Complaint records seen indicated that there were no outstanding complaints being dealt with. A previous safeguarding adults process had been investigated by the funding authority (social services department) and no further action taken. Discussion took place with residents; relatives and the registered manager about the way complaints are handled. Residents and their relatives receive a copy of the policy on admission a relative confirmed this. Most relatives appeared to be aware of the process and stated they would refer any concerns or complaints to the manager or deputy, as those residents tracked were unable to make complaints themselves. Eight comment cards from residents’ were received and all indicated they knew how to make a complaint. The complaints policy had not been updated recently. A new member of staff informed the inspector that although she was new she would report any incidents considered abusive to the manager. Staff training records seen indicated that no recent abuse training had taken place, however the manager stated that this had been arranged and was Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 18 taking place in July 2006. It was further confirmed in documentation received that over half of the staff employed had NVQ level 2 (recognised training programme in care) which includes adult protection. (abuse training). Where any type of restraint is required the manager said that an appropriate risk assessment and care plan is put in place this included two of the four residents tracked who required bedrails, evidence seen demonstrated that residents and relatives were fully involved in this process. A resident was noted to have a bruise on her face the injury was discussed with the registered manager and incident records seen were conclusive, however the matter had not been reported to the Commission as required. It is recommended that senior staff are reminded about their responsibilities regarding reporting incidents affecting the health or wellbeing of residents. Staff approach and body language was observed during this inspection and all staff appeared to be pleasant and friendly. Most residents spoken with said that with the odd exception staff were “very nice” Discussions with the registered manager indicated that there had been a previous incident relating to visitors entering the unoccupied bedrooms of other residents. Satisfactory evidence was given of how this was managed, it was however recommended that the rooms of resident that are in hospital be locked to preserve dignity and privacy and protect valuables. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 19 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): 19.22.25.26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service The home is clean, hygienic and reasonably well maintained it would be more homely if attention was given to better ventilation and replacement of carpeting. Replacement of damaged or old fixtures would ensure resident safety is protected. EVIDENCE: A tour of the rooms occupied by those residents’ case tracked and other communal areas took place, overall the home appeared to be clean and hygienic. The home is reasonably maintained internally and no urgent decoration was needed. Carpeting in corridors and some bedrooms was noted to be worn and no longer cleanable. Consideration should be given to its replacement. Residents’ rooms are redecorated as required. Rooms inspected appeared to be appropriate to meeting resident’s needs, were appropriately situated and Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 20 contained some personal possessions and specific equipment such as nursing beds, pressure mats (to alert staff to resident who get out of bed unaided) etc. Rooms inspected were sufficiently large enough to accommodate the equipment and staff using it. A number of specialist nursing beds and chairs have been purchased by the home since the last inspection, these were seen in use with one resident tracked and was fully detailed in the care plan. Discussion with another resident confirmed their frustration at having to wait for their new wheelchair this resident said “it prevented her from sitting at the table for meals”. During this inspection the registered manager showed the inspector around the external part of the home including the gardens. Residents’ spoken with were observed sitting outside in a shaded part of the garden. Walkways and paths at the front of the home were flat and accessible to those in wheelchairs. Residents and relatives did raise concerns with the inspector about the temperature in the lounges, and conservatory. The dining area and treatment rooms were also noted to be very hot on the day of inspection. Although ceiling fans were in place and on during the inspection they were largely ineffective. Two tower fans were also in place in the conservatory but it was unable to maintain the temperature at a reasonable level. The temperature in the conservatory was recorded at 91 degrees F at one point during the day and the treatment room at 28 degrees C. During this inspection it was a very hot day, despite a number of requests being made by the inspector to try to adjust the fans this was not done. Residents’ appeared lethargic and at least six said it was very uncomfortable for them. Laundry facilities were not inspected on this occasion, however observation during the inspection indicated that infection control is treated with importance. Good evidence was provided by a new staff member of staff who said that she had only worked in the home for a short time but had been instructed on day one about wearing gloves and aprons and handwashing. Alcohol rub is freely available for staff and visitors to use when entering the home. Records provided indicated that infection control training is planned this year for all staff. Maintenance records provided by the registered provider indicated that all routine tests and maintenance are carried out. A number of bedside tables observed were in need of urgent replacement as they had sharp edges, which could result in skin tears. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 21 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): 27.28.29.30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home provides sufficient numbers of staff with the skills and training necessary to meet the needs of service users. Residents are not fully protected by the current recruitment process. EVIDENCE: Information provided by the registered manager demonstrated that currently the home are providing the numbers of hours recommended in guidance by the Department of Health Residential Forum which considers the levels of dependency of residents. The managers hours are supernumerary but she was observed assisting staff throughout this inspection. The manager said that she works from 07.30am-10.30am each day on the floor to observe and assist with feeding of residents who require help and support in meeting nutritional needs. Discussions with residents and observation of staff at work indicated that sufficient staff are employed to meet individual needs, no resident’s were kept waiting excessive lengths of time for attention. Comment cards completed seen indicated that usually that there was adequate staff available to meet their needs. The only concern raised by residents during this inspection was in relation to meeting toileting needs when it was stated that residents were left waiting for long periods of time, this was discussed with the manager and it was indicated that a new regime had been put in place to retrain some residents in their toileting needs and in order to try to improve continence management overall. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 22 A resident who had transferred from the nursing to the residential floor raised concerns with the inspector about the lack of baths they received and indicated that they only got a bath when certain staff were on duty. Certain staff were being performance managed to ensure they were able to fulfil their role and it was agreed with the registered manager that an internal investigation would take place to address the resident’s concerns and to re-establish a bathing routine suitable to the person concerned. Inspection of staff rosters and discussion with the registered manager indicated that there had been a high level of sickness in the last two months particularly on nights and with specific senior staff. Many of the shifts had been covered either internally or by agency staff. Certain staff were being performance managed to ensure they were able to fulfil their role and it was agreed that an internal investigation would take place to address the resident’s concerns and to re-establish a bathing routine suitable to the person concerned. Training files were inspected and observation during this inspection indicated that staff are provided with suitable training. Discussion with the manager and staff indicated that they were due to commence dementia training and that a number of staff had received training from the Intermediate Care team including fire training, and food hygiene. The manager is a moving and handling trained trainer who provides training and updates for staff. She is very proactive in seeking out and facilitating training for staff. Some training is internal and some provided by external trainers. It was recommended that consideration is given to providing equality and diversity training and information /training about the Mental Capacity Act 2007 The registered manager is responsible for the recruitment of staff. Staff files for staff associated with those residents case tracked were inspected. Two out of four contained all relevant information and references but two did not, one file contained only one reference and the other contained no references. A recently appointed member of staff had no evidence of either a CRB or POVA first check (police checks). The manager stated that the administrator was on holiday and could not locate these documents, it was agreed that these documents would be forwarded to the Commission for Social Care Inspection at the earliest opportunity.REQ Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 23 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): 31.33.36.38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. Standard 35 was not inspected. Residents benefit from the ethos, leadership and management of the home. More attention to staff supervision might improve communication and overall outcomes for residents. EVIDENCE: The manager and deputy manager are registered nurses. The registered manager has relevant previous experience working in and managing large care homes. The manager and deputy were able to demonstrate their commitment to updating skills and maintaining their professional registration. Information was supplied to the Commission for Social Care Inspection before this inspection relating to the general management of health and safety in the home. The information provided indicated that the home employs a full time Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 24 maintenance person and that Western Park View maintain accurate maintenance records and procedures. Maintenance records seen indicated that an environmental health visit was carried out in April 2006 and maintenance and servicing checks on hoists were completed in April 2006.Risk assessments were in place for those residents’ requiring them or requiring specialist equipment or handling. Moving and handling techniques were observed and were conducted safely. Staff appeared to know which piece of equipment to use and were aware of residents individual needs. Discussion took place with the registered manager regarding an incident resulting in a bruise to a residents face. Documentation was seen in place to demonstrate that this had been followed up appropriately and had not occurred as a result of poor practise. This was not reported to the Commission for Social Care Inspection as is required. REQ. It was recommended however that staff should reassure the resident concerned when undertaking moving and handling procedures to prevent a similar incident occurring. Accidents records seen were conclusive and included evidence of the manager’s involvement in auditing them. Overall reasonable measures were being taken to minimise risk and promote and protect resident’s best interests. Evidence was seen of residents and staff meetings taking place. Staff supervision has not been undertaken for all staff, the registered manager said that she had put together a programme of planned supervision and had concentrated on performance management issues with certain specific staff since her appointment. Staff spoken with praised the manager for her leadership style and support. One member of staff said, “Ros leads by example and is very supportive” No recent quality survey was seen on this occasion. Relatives did confirm that they were able to talk to the manager if they had any concerns. Evidence provided before the inspection indicated that fire alarm checks are undertaken regularly and staff provided with training and drills. Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 26 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP12 Regulation 13 12(2) 3 Requirement Arrangements must be made for the safe handling and administration of medicines Resident’s wishes and feelings must be considered in relation to meeting their needs. Staff must respond in an appropriate manner to requests for assistance. Arrangements must be made to improve the ventilation in the home. Arrangements must be made to ensure that care staff meet the personal care needs of residents. Requirement not met from last inspection. Staff files must contain all required documentation as described in Schedule 2 of the Regulations before employment commences. Timescale for action 25/07/06 25/07/06 3 4. OP25 OP10 23(2) 12(4) 25/07/06 25/07/06 5 OP29 19 Sch 2 25/07/06 Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations Information related to specific and individual need (communication, language diversity) should be included in care plans to assist staff to effectively manage these needs. Arrangements must be made to ensure that medicines are stored according to manufacturers instructions. It is recommended that staff deployment on each shift (including that of both registered nurses and senior care staff) be reviewed to ensure that staff on duty assist in meeting the toileting and bathing needs/ requirements of service users and responding to call bells requests appropriately. Notice must be given to the Commission without delay of any occurrence which affects the safety or well being of a resident (regulation 37) 2 3 OP9 OP27 4 OP38 Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 28 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. Extracts may not be used or reproduced without the express permission of CSCI Western Park View DS0000001932.V302265.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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