Care Home: Parc Vro

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What the care home does well New people to the home confirmed that their introduction to the home was positive, the majority attending for day care initially which led to a permanent placement, and felt that staff listened to them and understood what care they needed. People who use the service commented this was done in a sensitive and informative manner and did not feel this area could be improved upon. From inspection of case records it was evident that the registered provider undertakes their own assessment plus gains the views and opinions of any specialist workers involved with the individual. From this an individual plan of care that identifies the persons needs is implemented. The care plan forms the basis of the care and support provided. The registered provider stated that the plans are regularly reviewed to make sure the persons needs are met at all times but this needs to be evidenced more clearly. Each person admitted to the care home is provided with a contract or terms and conditions of residency. People who use the service were positive about the care and support provided by the staff and said the staff was flexible and responsive to their needs. Some comments include `I get personal help from kind staff` and `staff are so helpful`. People who use the service also stated they were `always` treated with dignity and respect. Good arrangements are in place to meet individuals health needs and people who use the service were confident that medical services are promptly accessed when required, which was also observed during the inspection. Flexible visiting arrangements are in place. People who use the service are positive about the varied and nutritional menu that reflects their preferences and choices. Some saying the food is `good`, `excellent` and `we get plenty of it`. The kitchen is suitably equipped and good standards of cleanliness are maintained. People who use the service said they felt there was `enough to do` in the home and that it was their choice if they joined in the activities or not. No one felt improvements to this area were needed. People who use the service said that if they had any concerns they felt able to discuss them with their family, or with any member of staff and in particular the registered provider. They felt confident that the registered provider would listen to them and act upon any issues raised. The environment is homely, clean and comfortable and the people who use the service said they were satisfied with the accommodation provided. There is a lounge and dining area on the ground floor, which people who use the service were seen to be socialising in. All said they were satisfied with their bedrooms, cleanliness, presentation and the furnishings of the home. People who use the service said they were satisfied with the care provided and that staff `are marvellous`, `nothing is too much trouble for them`, `staff are kind, supportive and helpful`. It is clear that positive and trusting relationships have been establishedbetween the staff and people who use the service. The care home is well managed by an experienced, qualified, registered provider who has the confidence of the people who use the service, relatives and staff. The home is maintained to a good standard ensuring that all health and safety and fire checks are carried out as per legislation. What has improved since the last inspection? The registered provider has complied with all the previous requirements identified at the last inspection. The registerd provider has purchased medication training for all staff to attend, some have completed training already. Records confirm that the administration of medication is more robust and less open to medication errors. The registered provider has downloaded the latest safeguarding policy, which covers what staff need to do if an allegation of abuse is made. However it is recommended that the policy is made more specific to Parc Vro so that staff have immediate contact details to hand. No new staff have been recruited since the last inspection. However on inspecting staff files it was evident that relevant information and checks have been carried out to ensure that staff have all necessary employment checks prior to commencing work. Access to staff training has improved so that all staff have attended or are booked to attend mandatory training. The registered provider has employed a fire company to test all fire equipment and to review the homes fire risk assessment, which are deemed as satisfactory. They also provide advise on health and safety matters in the home. There have been improvements to the homes environment for example redecoration and new carpets in communal areas. What the care home could do better: The home is managed to a good standard but there are some recommendations to further improve the standards in the home. These are it needs to be evidenced more clearly that care plans are regularly reviewed to make sure they are up to date and appropriately reflect the individual`s needs, preferences and choices. Risk assessments in respect of mobility are completed when an issue of mobility has arisen and identify what equipment if any, is needed to assist in the moving of an individual. The registered provider agreed that it would be beneficial to commence a monthly audit of falls in the home so that she has a clearer overview of any mobility issues for individual people. The homes medication policy and procedure is detailed and the registered provider agreed that she needs to review it to ensure that all parts of the policy and procedure are relevant to the homes actual practice. The home uses the Monitored Dose System of medication. However medication had not been entered onto the MAR sheet when received at the home and therefore for `as andwhen` required medication and tablets that can not be blister packed, a audit of these medicines was not possible and did not tally with the medication held in stock. In addition, two staff members to ensure that the entry is written accurately should witness medication that has been handwritten on to MAR sheets. One tablet is stored in a locked tin in the fridge it is recommended that a risk assessment be undertaken as to its storage there. Ideally the home should purchase a separate fridge and the registered provider said she would consider this. As the registered provider agreed to address these issues immediately and has since confirmed this verbally a recommendation has been identified at this time. It is recommended that the registered provider complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. The registered provider acknowledged that she has not been recording formal supervision of staff. This must occur so that there is a record of staff accountability and that issues such as care practice or training needs are identified and addressed accordingly. The inspector would like to thank people who use the service, relatives, staff and the registered provider for their kind assistance and cooperation during this inspection process. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Parc Vro Mawgan-in-Meneage Helston Cornwall TR12 6AY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynda Kirtland     Date: 1 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Parc Vro Mawgan-in-Meneage Helston Cornwall TR12 6AY 01326221275 01326221275 parc.vro@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Alison Stevenson Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service users to include up to 15 adults of old age (OP) Service users to include up to 3 adults over 65 with a mental ilness (MD) Service users to include up to 3 adults over 65 with dementia (DE) To accommodate a named service user with Dementia aged over 65 years Total number of service users not to exceed a maximum of 15 Date of last inspection Brief description of the care home Parc Vro provides care for up to 15 fifteen older people some of who may have dementia or mental health difficulties. The home is situated in a rural location outside Care Homes for Older People Page 4 of 31 Over 65 3 3 15 0 0 0 Brief description of the care home the village of Mawgan, near Helston. The registered provider is Mrs A. Stevenson. The home also provides day care for up to five people during weekdays. The home is wheelchair accessible, and has a lift to the first floor. The home has gardens which are accessible to people who use the service. There is suitable parking for staff, people who use the service and visitors. A copy of the inspection report is available in the hallway, and it is suggested a copy is requested from management if required. The fees at the time of the inspection are from three hundred pounds per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A key inspection took place on 12 December 2008 and lasted for approximately nine hours. The purpose of the inspection was to ensure that people who use the service needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that peoples placements in the home result in good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the people living there. The inspection included meeting with some of the people currently living at Parc Vro plus taking into account the seven surveys completed by them. On the day of inspection fifteen people were resident in the home. Members of staff were interviewed Care Homes for Older People Page 6 of 31 plus there were opportunities to directly observe aspects of peoples daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the registered provider. The principle method of inspection was case tracking. This involves interviews with a select number of people who use the service, staff caring for them and examination of records relating to their care. This provides a useful impression of how the home is working for people who use the service overall. Three people were case tracked in detail at this inspection. In discussion with people who use the service they were all complimentary about the care that they receive. On asking them if there was anything the home could do to improve the service further, they replied, they couldnt do better, you couldnt find better and they couldnt improve on a first class service. The registered provider acknowledged that some of her paperwork systems are not robust however what was evident in this inspection is that the care people who use the service are being provided with is to a high standard and hence the rating of good outcomes has been achieved. However work on improving paperwork systems must remain ongoing. The Annual Quality Assurance Assessment, which is a questionnaire that the registered provider completes, has not yet been received, due to specific reasons, and the registered provider agreed to complete this as soon as possible. What the care home does well: New people to the home confirmed that their introduction to the home was positive, the majority attending for day care initially which led to a permanent placement, and felt that staff listened to them and understood what care they needed. People who use the service commented this was done in a sensitive and informative manner and did not feel this area could be improved upon. From inspection of case records it was evident that the registered provider undertakes their own assessment plus gains the views and opinions of any specialist workers involved with the individual. From this an individual plan of care that identifies the persons needs is implemented. The care plan forms the basis of the care and support provided. The registered provider stated that the plans are regularly reviewed to make sure the persons needs are met at all times but this needs to be evidenced more clearly. Each person admitted to the care home is provided with a contract or terms and conditions of residency. People who use the service were positive about the care and support provided by the staff and said the staff was flexible and responsive to their needs. Some comments include I get personal help from kind staff and staff are so helpful. People who use the service also stated they were always treated with dignity and respect. Good arrangements are in place to meet individuals health needs and people who use the service were confident that medical services are promptly accessed when required, which was also observed during the inspection. Flexible visiting arrangements are in place. People who use the service are positive about the varied and nutritional menu that reflects their preferences and choices. Some saying the food is good, excellent and we get plenty of it. The kitchen is suitably equipped and good standards of cleanliness are maintained. People who use the service said they felt there was enough to do in the home and that it was their choice if they joined in the activities or not. No one felt improvements to this area were needed. People who use the service said that if they had any concerns they felt able to discuss them with their family, or with any member of staff and in particular the registered provider. They felt confident that the registered provider would listen to them and act upon any issues raised. The environment is homely, clean and comfortable and the people who use the service said they were satisfied with the accommodation provided. There is a lounge and dining area on the ground floor, which people who use the service were seen to be socialising in. All said they were satisfied with their bedrooms, cleanliness, presentation and the furnishings of the home. People who use the service said they were satisfied with the care provided and that staff are marvellous, nothing is too much trouble for them, staff are kind, supportive and helpful. It is clear that positive and trusting relationships have been established Care Homes for Older People Page 8 of 31 between the staff and people who use the service. The care home is well managed by an experienced, qualified, registered provider who has the confidence of the people who use the service, relatives and staff. The home is maintained to a good standard ensuring that all health and safety and fire checks are carried out as per legislation. What has improved since the last inspection? What they could do better: The home is managed to a good standard but there are some recommendations to further improve the standards in the home. These are it needs to be evidenced more clearly that care plans are regularly reviewed to make sure they are up to date and appropriately reflect the individuals needs, preferences and choices. Risk assessments in respect of mobility are completed when an issue of mobility has arisen and identify what equipment if any, is needed to assist in the moving of an individual. The registered provider agreed that it would be beneficial to commence a monthly audit of falls in the home so that she has a clearer overview of any mobility issues for individual people. The homes medication policy and procedure is detailed and the registered provider agreed that she needs to review it to ensure that all parts of the policy and procedure are relevant to the homes actual practice. The home uses the Monitored Dose System of medication. However medication had not been entered onto the MAR sheet when received at the home and therefore for as and Care Homes for Older People Page 9 of 31 when required medication and tablets that can not be blister packed, a audit of these medicines was not possible and did not tally with the medication held in stock. In addition, two staff members to ensure that the entry is written accurately should witness medication that has been handwritten on to MAR sheets. One tablet is stored in a locked tin in the fridge it is recommended that a risk assessment be undertaken as to its storage there. Ideally the home should purchase a separate fridge and the registered provider said she would consider this. As the registered provider agreed to address these issues immediately and has since confirmed this verbally a recommendation has been identified at this time. It is recommended that the registered provider complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. The registered provider acknowledged that she has not been recording formal supervision of staff. This must occur so that there is a record of staff accountability and that issues such as care practice or training needs are identified and addressed accordingly. The inspector would like to thank people who use the service, relatives, staff and the registered provider for their kind assistance and cooperation during this inspection process. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of prospective residents are assessed so that they can be assured that the home can provide adequate care to meet thier indvidual needs. Evidence: Parc Vro has a Statement of Purpose which oulines the services and facilities that it provides for those thinking about or are currently living at Parc Vro and thier relatives. This is accessible at all times. From discussions with people who have recently come to live at Parc Vro they said that they were welcomed to the home by staff and were emotionally supported as they settled into their new surroundings. The registered provider stated that if the person has not attended the home for day care, which occurs in the majority of placements, then they will meet with prospective Care Homes for Older People Page 12 of 31 Evidence: residents prior to admission to discuss their care needs. Documentation evidenced an assessment had occurred taking into account prospective residents physical, emotional, social and diverse needs. The homes assessment does not make clear who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. People who use the service however, feel that the home involved them in their care arrangements. The persons contract or a statement regarding the terms and conditions of residency was present on individuals files and specifies what cost if any the individual person is responsible for. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written care plans direct and inform staff about peoples health and personal care needs so that these can be consistently met. The healthcare needs of people are monitored and addressed so that their needs are met. Action must be taken to ensure that all medication is accounted for so that the risk of medication errors is minimised. People who use the service stated they are treated respectfully at all times so that they retain their dignity and enjoy a good quality of life in the home Evidence: Each person who uses the service has a care plan that covers the individuals physical, emotional, and diverse care needs. The care plans in the main guide and inform staff in specifying what caring interventions are needed, this then allows consistent care to be provided. It needs to be evidenced more clearly that care plans are regularly reviewed to make sure they are up to date and appropriately reflect the individuals needs, preferences and choices. People who use the service were satisfied with the care and support they receive and many were positive about the manner in which the staff undertakes their duties and responsibilities. Care Homes for Older People Page 14 of 31 Evidence: Risk assessments in respect of mobility are completed when an issue of mobility has arisen and identify what equipment if any, is needed to assist in the moving of an individual. The registered provider agreed that it would be beneficial to commence a monthly audit of falls in the home so that she has a clearer overview of any mobility issues for individual people. The daily records for people who use the service summarised if care had been provided that day and reflect for example when visitors or participation in activities occurred. People who use the service are registered with local GP practices. They felt that their health care needs were monitored and attention obtained promptly when needed, which was also observed during the inspection. This was also documented in the individuals care records. The homes medication policy and procedure is detailed and the registered provider agreed that she needs to review it to ensure that all parts of the policy and procedure are relevant to the homes actual practice. General and surplus medicines are stored in a secure facility. The Pharmacist safely disposes of any medicines that are no longer required. The registered provider has had difficulty getting appropriate medication training for staff and has now purchased the Mulberry House training pack to do this. Clear records of medication administered are maintained. From a tablet count it was clear that the records for the receipt, administration and disposal of controlled drugs are accurate. The home uses the Monitored Dose System of medication. However medication had not been entered onto the MAR sheet when received at the home and therefore for as and when required and medication that cannot be blister packed, an audit of medicines was not possible as a tablet count did not tally with records kept. After discussion with the registered provider she stated that this would be addressed immediately. In addition, two staff members to ensure that the entry is written accurately should witness medication that has been handwritten on to MAR sheets (transcribing). Due to the registered provider ensuring that all actions identified at the last inspection were addressed and as she has given a undertaking to address these issues immediately this section has been rated as good as previous experience has shown that she will address these issues, since which this has been confirmed by telephone. One tablet is stored in a locked tin in the fridge it is recommended that a risk assessment be undertaken as to its storage there. Ideally the home should purchase a separate fridge and the registered provider said she would consider this. We sent a copy of the most recent medication guidance to the registered provider for their Care Homes for Older People Page 15 of 31 Evidence: information. People who use the service made positive comments on the skills and caring qualities of staff. People who use the service felt well cared for and reported that staff delivered care sensitively, respected their privacy and dignity and listened to their concerns. People who use the service said that staff were lovely and kind. Examples of staff providing skilled and sensitive care were observed during the inspection. People who use the service found it difficult to identify any area where the home could improve. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported in a lifestyle, which accords as far as possible with their own expectations and preferences. A range of activities takes place that meets peoples social, religious and recreational interests. The diet provided is varied and nutritious with attention to individual preferences. Evidence: People who use the service felt that they had control over their daily lives and were supported to make choices about their routines and activities. Individual care plans detail their social and activity interests. The home provides a range of planned activities such as church services, music and movement classes that had recently been videoed and they were keen to play this to visitors. They also have a vegetable garden and raised flowerbeds so that people who use the service can be involved in gardening if they wish too. People who use the service spoke of a recent Christmas party that they all enjoyed and some were going on an outing to the Christmas lights. There is also a residents shop to purchase small items. People were observed to be socialising with each other, receive visitors, reading, knitting and some chose to be in their rooms watching TV or listening to music. People who use the service said there was enough to do and did not want it expanded further. People who use the service said that they Care Homes for Older People Page 17 of 31 Evidence: found the visiting arrangements open and flexible. They felt that visitors were made welcome and could choose where they meet their guests. One relative said that Parc Vro was her second home and was very positive about the care their relative received. People who use the service confirmed they have a lockable facility for small items of value or can ask the registered provider to look after items for them. They are able to bring possessions and furniture at admission by agreement with the provider. People who use the service were aware that they could lock their rooms if wished, but have chosen not too. People who use the service were complimentary about the quality and quantity of food provided, comments such as excellent, good, very tasty and plenty to eat were given. Some were aware of the meal to be provided for that day, and a menu was on display. Each persons preferences and choices of food are recorded. People who use the service are encouraged at the residents meeting to provide ideas for the menus. Breakfast can be taken in the dining area or in their own room. We were invited to join the people who use the service for dinner. The food was cooked well and was tasty and presented in a nice way. The mealtime was a relaxed and unrushed occasion with staff providing sensitive support in a pleasant manner. Staff knew residents likes and dislikes. Hot and cold drinks are served between meals. Catering staff are aware of individual dietary requirements and cater for this. They have relevant qualifications in food hygiene and the majority of care staff have attended a recent refresher food course, the remaining staff are booked to attend a course in January 2009. Between the cook and the registered provider they ensure that they cook the main meal every day plus the preparation of tea in the home. Care staff are responsible for the breakfasts and serving of the tea. They demonstrated an awareness of a persons likes, dislikes of food and any special dietary requirements. The environmental health inspection occurred in January 2008 and no issues were identified. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements are in pace to deal with any concerns or complaints positively. Staff are aware of the importance of ensuring that people who use the service are protected from abuse and have received training in this area. Evidence: The complaints procedure is appropriate, plus a summary of how complaints will be managed is included in the homes Statement Of Purpose. People who use the service and from their surveys, said that if they had any issues of concerns, or ideas for improving the service that they were able to approach the registered provider or staff and felt that they would be listened too and if action was needed they felt this would be acted on. They also have residents meetings where their ideas can be shared and are a time for expressions of concerns to be raised. A complaints log has been devised should the home receive an expression of concern, which would evidence how the concern was investigated, and any actions the home took to resolve the concern expressed. Parc Vro and us have not received any concerns since the last inspection. The registered provider has downloaded the latest safeguarding policy and procedure and was aware of what procedure needs to occur if there is a suspicion or allegation of abuse as was staff. The policy is lengthy and would benefit from a flowchart to summarise for staff what actions they need to take if an allegation of abuse is suspected for quick reference. The registered provider has attended the multi Care Homes for Older People Page 19 of 31 Evidence: disciplinary safeguarding course and all staff have attended some form of adult protection training, of which certificates were seen. Parc Vro has a whistle-blowing policy. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is accessible, well maintained and safe. A homely, clean and comfortable environment is provided that is maintained to the required standard. Evidence: The environment is furnished and maintained to a satisfactory standard. People who use the service describe the accommodation as comfortable and many have personalised their own bedrooms. People said they liked and were happy with their rooms. People who use the service could not identify any improvements that were needed to the environment. The lounge and dining room are on the ground floor along with some bedrooms. Bedrooms are then on the first and second floors, all have a washbasin. Thirteen bedrooms are for single occupancy and there is one double room of which the occupants are happy to share. Bedrooms are individualised and comfortable. A stair lift, passenger lift and if mobile banister rails are provided to assist people to go upstairs. Decorations are to a good standard. People who use the service were observed to use the lounge and this was a social, relaxed occasion with music playing. The dining room was used at lunchtime for the majority of people who use the service but some chose to have their main meal in the Care Homes for Older People Page 21 of 31 Evidence: lounge or in their bedrooms. Some people who use the service said they preferred to spend time in their rooms rather than use the lounge and this was respected. Bathroom and shower facilities are to a suitable standard and are distributed throughout the home that is within a reasonable distance from peoples bedrooms and the communal areas. A range of aids and adaptations are provided at the home to assist people to be as independent as possible. In additional individual people are provided with disability equipment when this is required and following a specialist assessment. The registered provider has completed her own internal audit of the home and is aware of the maintenance work and redecoration that is needed throughout the home. Some carpets have been replaced and areas redecorated. Good standards of health and hygiene are maintained at all times and people who use the service are very satisfied with the cleanliness of the environment. Staff were aware of the importance of cleanliness, promoting infection control and COSHH. Suitable kitchen and laundry facilities are provided. The home was clean and hygienic at the time of inspection. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient qualified, competent staff are on duty at all times to meet peoples needs safely. Staff are qualified and competent to work with the people who use the service. They are recruited on the basis of fair, safe and effective recruitment and selection policies and practices. They have good access to ongoing training to maintain their knowledge and skills. Evidence: From surveys completed plus discussion with people who use the service and staff it was noted that all felt that there were sufficient staff on duty at all times. People who use the service commented that staff respond quickly when they press their call bell, and some acknowledged that at times there is a little wait but that is because staff are dealing with someone else. No one found this to be an issue. Currently there is a minimum of two care staff on duty in the day and evening with one waking night staff and one person on call. At all times there is management support and during the day catering support. Maintenance support is provided as needed. People who use the service were very positive about the staff and it is clear that positive and trusting relationships have been established. People who use the service said they felt in control of the care and support provided which they viewed as sensitive, positive, reliable and flexible. Care Homes for Older People Page 23 of 31 Evidence: Over fifty percent of the staff team have achieved a minimum of NVQ level 2. The majority of staff have achieved the NVQ level 3 in care, so that residents can be confident of the competency of the people looking after them. There is always a first aider on duty. There has been no further recruiting of staff since the last inspection. From inspecting staff files it was evident that relevant recruitment checks are undertaken prior to a person commencing work and that no one starts work at the home until they have received their CRB clearance. Interview notes are kept. Staff records showed that they completed an induction and staff commented they felt their induction programme was appropriate to their work. Staff at the home said they were well supported and were clear about their roles and responsibilities. It is clear the staff group are committed to helping people maintain their independence as far as possible. Staff said they enjoyed working at the home and were proud to work at Parc Vro. Staff confirmed that there has been recent training for example in first aid, infection control, POVA, mental Capacity Act, manual handling, dementia and medication. The registered provider has booked future courses for staff to attend in the area of infection control, health and safety, and fire in January 2009. It is recommended that the registered provider complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced and qualified registered provider who has a sound understanding of their responsibilities. The home is well run and managed for the benefit of the residents. Quality assurance processes demonstrate that People who use the service their representatives, and staff are consulted about the service that the home provides. Records are maintained and handled in accordance with good practice, for the welfare and safety of the people who use the service. Evidence: The registered provider, Ms Alison Stephenson has managed the home for many years and ensures that her training in elder persons care is kept updated. She is a competent manager in the daily running of the home and is viewed positively by staff and people who use the service. Staff stated that they receive good support from the registered provider both on a work and private level and this they believe accounts largely for why staff remain working at the home for a long time plus sickness levels are very low. Care Homes for Older People Page 25 of 31 Evidence: The registered provider has an annual review to monitor the quality of the service and facilities that Parc Vro provides and has agreed to send these findings to the Commission. The surveys demonstrated that people who use the service plus discussion with them and staff all felt positively about the care that Parc Vro provide. In addition resident and staff meetings are held which is another avenue to express ideas on how to improve the service further. The registered provider does not manage any monies on behalf of people who use the service, this is done either by themselves or their family assist them. A range of measures has been put in place to promote safe working practices and the equipment and services to the care home are regularly maintained and serviced. The risk assessment and risk management arrangements for individual people are satisfactory and a monthly monitoring audit of falls in particular is recommended so that any issues can be highlighted and addressed quickly. The registered provider was advised when to notify the Commission under Regulation 37 of incidents that occur in the home. The registered provider has employed a fire contractor who has recently upgraded the fire devices in the home, plus reviews their fire risk assessment to ensure that it meets current legislation. They also monitor and advise on health and safety issues. They are currenetly advising on how to manage the monitoring of legionella so that all systems are safe in the home. They also provide training to staff, which is recorded. Documentation evidenced that equipment is regularly serviced and monitored. The registered provider acknowledged that she has not been recording formal supervision of staff. This must occur so that there is a record of staff accountability and that issues such as care practice or training needs are identified and addressed accordingly. Staff conformed that they meet with the registered provider and that she is available to meet with them when they need to discuss issues as they arise. But they confirmed this is not officially recorded and hence a recommendation to this effect has been identified at this time. The registerd provider wishes to attend a staff appraisal training course to ensure, she states, that she is completing this properly and will then complete this with staff. However on some staff files some evidence of staff annual appraisals were seen. Records reviewed at this inspection indicate that they are appropriately maintained and held, to ensure the welfare and safety of people who use the service. There are suitable storage facilities and records are kept in ways that protect their Care Homes for Older People Page 26 of 31 Evidence: confidentiality. The registered provider was reminded to ensure that all records such as the communication book and diary adhere to the Data protection Act guidance so that peoples confidentiality is assured at all times. She agreed to address this immediately. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 4 It is recommended that potential service users and thier representatives views should be recorded in the pre admission process so that the assessment process takes into account how they will be able to meet thier indiviual needs. Care plan reviews should be recorded, with who was present so that a record of how care needs are being met, or need to be amended are recorded to ensure that the persons individual and changing care needs are constantly being met. A audit of medicines, in particular as and when required medication should be undertaken so that all medication in the home is accounted for and tallies with the medicines stored in the home. two staff should witness handwritten entries (transcribing) medication to ensure that it is recorded acurately as per the doctors instructions. A risk assessment of medication stored in a locked container in the fridge should be undertaken in the absence of a seperate fridge. However it is higlhy recommended that a seperate fridge to store medicines in is purchased. 2 7 3 9 4 18 A flowchart for staff to understand what to do if there is a Page 29 of 31 Care Homes for Older People allegation or suspicion of abuse would be beneficial as a quick reference guide as to who staff should contact and what to do in these situations as the current policy is lengthy and takes time to glean the information from it. 5 30 A training overview/plan for all staff at the home should be maintained so that the registerd provider can ensure that she can identify any gaps in staff training and that it is kept up to date at all times. Formal recorded supervision should occur a minimum of six times a year as per the national minimum standards guidelines to ensure staff acountability in thier care practice and that any training needs are identified and addressed. All records should adhere to the Data protection Act to ensure that individuals confidentiality is maintained at all times. 6 36 7 37 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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