Care Home: Park View

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What the care home does well People completing the surveys returned to us said that they had received sufficient information about the home before moving in. Pre-admission assessments gave sufficient information before a person came to live in the home to ensure that the home could meet the person`s needs. Residents on going health care needs were being met with evidence of visits to or visits by other health care professionals identified in the care files looked at. Surveys returned to us included positive comments about the medical support that they received. Comments made by people completing the surveys in response to, "Do you receive the care and support you need?" included, "Staff and management very caring." "I do not think it could be any better." "Very pleased with the personal care and caring." Medication practices and procedures safeguard the health and well being of the people living at the home. Residents were cared for in a respectful manner ensuring that their dignity and self esteem were maintained. A relative of a resident said in one of the surveys returned to us, "My (relative) is always treated with dignity and respect." There was evidence in records, and from discussion with residents, to support that they had sufficient activity and occupation to stimulate them. A relative also said that there was an open invitation to all functions. Observations made and discussion with residents showed that people living at the home have the opportunity to make choices in their daily lives. Those residents spoken with said that they enjoyed the meals and that the homemade cakes were always good. The menus were varied and nutritious with residents saying that they could make choices of what to eat. The home has appropriate policies and procedures about safeguarding to protect residents and takes complaints seriously. Residents knew who to speak to if they had any concerns and how to make a complaint. Financial policies, procedures and practices safeguard residents` financial interests. Park View provides comfortable, clean surroundings, which were mainly well decorated and furnished. The residents benefit from smaller group living units rather than all residents living in one large area. Specific team of staff allocated to these units provide continuity and familiarity The bedrooms viewed were clean, comfortable and free of any offensive odour. They had been personalised by the occupant`s own possessions such as plants, ornaments, pictures and photographs. Responses in the surveys returned to us said "Yes" to the question about if the home was fresh and clean and positive comments were made. What has improved since the last inspection? Records related to falls were available in each care file. A chart was kept for monitoring any falls sustained by residents. Systems for monitoring the administration and recording of medication had been implemented and the system was much safer than previously. All creams, ointments and eye drops were dated on opening and disposed of appropriately. All recruitment practices safeguarded residents from the employment of unsuitable people, with appropriate disclosures in place. All lifting equipment had been appropriately serviced and maintained in order to safeguard residents and staff from injury. Stained and aged carpet in the restaurant (dining room) had been replaced by non-slip and attractive safety floor covering that gave the appearance of wooden flooring. Night staff numbers were increased from two to three if there were any residents presenting with increased care needs. Some staff had attended training related to specialist needs including strokes, physical disability, mental health bad dementia. CARE HOMES FOR OLDER PEOPLE Park View Park View Priory Road Warwick Warwickshire CV34 4ND Lead Inspector Lesley Beadsworth Unannounced Inspection 21st August 2008 11:40 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 Park View DS0000042008.V371921.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. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park View Address Park View Priory Road Warwick Warwickshire CV34 4ND 01926 493883 01926 491134 annistombs@warwickshire.gov.uk 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) Warwickshire County Council, Social Services Department Mrs Annis Irene Tombs Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2007 Brief Description of the Service: Park View is a Local Authority home for elderly people, with thirty-five beds. It provides 28 permanent care places, 7 short stay/respite care places and 12 day care places. It is situated amongst largely sheltered housing on the edge of Warwick town centre. There are local shops within easy walking distance, but quite a steep hill into the town, making walking or pushing a wheelchair strenuous. There is car parking to the front and rear of the home. The home is within walking distance of the train station and ‘bus routes. Accommodation is provided on three floors. The ground floor is used for people on short stays and those coming in for day care, and has a restaurant, a conservatory, a lounge/diner, a hairdressing salon and the short stay bedrooms as well as the laundry, kitchen and domestic and staff offices. On each of the first and second floors are a lounge, a dining room and fourteen bedrooms, all with en-suite facilities. Each floor also has two bathrooms and a communal WC, and a very small office. The home is staffed over twenty-four hours. It has a management team of a registered manager, two assistant managers and two care officers, all full time, plus a clerical officer who works twenty hours a week. In addition the full staffing complement includes care assistants, domestic staff, a laundress and cooks. The home also has a small bank of staff to call on when needed. The home does not provide nursing care. Residents who require nursing attention receive this from the community nursing service, as they would in their own homes. The fees for permanent residents are social service rates and are exclusive of hairdressing, chiropody, newspapers and toiletries. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star.This means the people who use this service experience good quality outcomes. The inspection included a visit to Park View. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Ten surveys were sent to service users. Eight were completed and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the assistant, staff, visitors and residents. The registered manager was absent at the time of the visit and the assistant manager and/or care officers were present throughout the visit, which took place between 11:40am and 08:30pm. What the service does well: People completing the surveys returned to us said that they had received sufficient information about the home before moving in. Pre-admission assessments gave sufficient information before a person came to live in the home to ensure that the home could meet the person’s needs. Residents on going health care needs were being met with evidence of visits to or visits by other health care professionals identified in the care files looked at. Surveys returned to us included positive comments about the medical support that they received. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 6 Comments made by people completing the surveys in response to, “Do you receive the care and support you need?” included, “Staff and management very caring.” “I do not think it could be any better.” “Very pleased with the personal care and caring.” Medication practices and procedures safeguard the health and well being of the people living at the home. Residents were cared for in a respectful manner ensuring that their dignity and self esteem were maintained. A relative of a resident said in one of the surveys returned to us, “My (relative) is always treated with dignity and respect.” There was evidence in records, and from discussion with residents, to support that they had sufficient activity and occupation to stimulate them. A relative also said that there was an open invitation to all functions. Observations made and discussion with residents showed that people living at the home have the opportunity to make choices in their daily lives. Those residents spoken with said that they enjoyed the meals and that the homemade cakes were always good. The menus were varied and nutritious with residents saying that they could make choices of what to eat. The home has appropriate policies and procedures about safeguarding to protect residents and takes complaints seriously. Residents knew who to speak to if they had any concerns and how to make a complaint. Financial policies, procedures and practices safeguard residents’ financial interests. Park View provides comfortable, clean surroundings, which were mainly well decorated and furnished. The residents benefit from smaller group living units rather than all residents living in one large area. Specific team of staff allocated to these units provide continuity and familiarity The bedrooms viewed were clean, comfortable and free of any offensive odour. They had been personalised by the occupant’s own possessions such as plants, ornaments, pictures and photographs. Responses in the surveys returned to us said “Yes” to the question about if the home was fresh and clean and positive comments were made. What has improved since the last inspection? Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 7 Records related to falls were available in each care file. A chart was kept for monitoring any falls sustained by residents. Systems for monitoring the administration and recording of medication had been implemented and the system was much safer than previously. All creams, ointments and eye drops were dated on opening and disposed of appropriately. All recruitment practices safeguarded residents from the employment of unsuitable people, with appropriate disclosures in place. All lifting equipment had been appropriately serviced and maintained in order to safeguard residents and staff from injury. Stained and aged carpet in the restaurant (dining room) had been replaced by non-slip and attractive safety floor covering that gave the appearance of wooden flooring. Night staff numbers were increased from two to three if there were any residents presenting with increased care needs. Some staff had attended training related to specialist needs including strokes, physical disability, mental health bad dementia. What they could do better: Whilst the majority of the necessary information for care provision was contained within the care file it was not always where someone unfamiliar with the care files would expect to find it. The monitoring of pressure sore guidelines did not provide sufficient information to be able to assess the risk of each resident developing pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). A risk assessment tool needs to be in place to minimise this risk. There are no domestic staff at the weekend and any domestic tasks have to fall to care staff, as commented upon by a resident’s representative in a survey, these tasks would “.. individual floors appear to suffer at weekend when I assume cleaners don’t come in. Also for staff on duty it is a balance of supporting the residents or cleaning.” Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 9 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 Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. Information required to make a decision about choice of home is available. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Statement of Purpose and Service User Guide were available in the home, with each resident receiving a copy to inform them of the services provided. Everyone answered “Yes” in surveys returned to us in response to the question, “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” Several positive comments were made “We thought it was the best place for (relative) being so close as well.” Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 11 “I visited the home and saw the manager. Viewed the room which was very pleasing.” “Very well handled – clear – and warm welcome.” “As a family we did our homework.” Three care files were looked as part of the case tracking process. Preadmission assessments compiled by staff at the home were not in the care files looked at. However each one had an assessment that had been completed by the social work team from which the home was able to make a decision about whether they could the person’s needs or not. Further assessments take place after the person comes to live in the home and all assessments are used to formulate a care plan. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Care instructions are included in the care plans but there are shortfalls in locating the information. Risk assessments for the development of pressure sores are not available. Residents have access to health care professionals and are cared for in a respectful manner. Residents are safeguarded by the medication procedures and practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked as part of the case tracking process. Each included a care plan to inform staff of the care required by each individual. The majority of the care plans viewed contained the appropriate information and instructions that staff would need to be able to provide appropriate care. However this was not always where someone not familiar with the care files would look. Care instructions were frequently in the column of the plans related to strengths needs, and problems and absent either from the column entitled ‘care instructions’. For example, in the ‘needs’ column of one resident’s plan there was recorded information regarding the use of pressure sore (a break in the skin due to pressure, which reduces the blood supply to the area) prevention Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 13 equipment, the use of continence aids and the need for maintaining family links with an elderly relative who was unable to visit. However there was no information or guidance in the care instructions advising care staff how to manage any of these needs. The plans were typed although some handwritten updated information had been added following reviews. These too had been put in an inappropriate column. Some care guidance could only be found in risk assessments, which were in a separate part of the care file. These shortfalls in recording could lead to the residents’ needs not being met or result in a great deal of time being spent looking for relevant information. The files viewed included procedures of how to monitor tissue viability but did not include a tool for assessing the risk of pressure sores developing that would minimise the risk of pressure sores developing. Preventative measures such as pressure relieving mattresses and cushions were seen in use for the people living at the home. Residents on going health care needs were being met with evidence in the care files and in discussion of visits to or visits by the GP, District Nurse, optician and chiropodist being identified in the care files looked at. Residents spoken to confirm they could see the doctor if they wished and that they had visits from the chiropodist, optician, district nurses and other health care professionals when necessary. Comments made in the surveys, returned to us, in response to the question, “Do you receive the medical support that you need?” included the following, “The medical attention is good. I have asked for GP visits, he knows me well. I have had to make an appointment to go to the surgery with help from the manager.” “Staff always very proactive in ensuring appropriate care.” Records related to the incidence of falls, weight charts and personal care were in place within the files looked at. Completed risk assessments for nutritional risk screening and manual handling risk assessments were also in place. This would help to minimise risk of poor nutrition and of injury occurring to staff or residents when transfers take place. In completed surveys residents responded as follows to the question, “Do you receive the care and support you need?” Always – 7; Usually – 0; Sometimes – 0; Never – 0. One person did not answer. Comments made in the survey with regard to this question included, “Staff and management very caring.” “I do not think it could be any better.” Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 14 “Very pleased with the personal care and caring.” The medication procedures and practices were assessed. A medication policy is in place but this is in the process of being updated by the Local Authority. The homely remedies policy still does not enable the home to have a supply of ‘over the counter’ medication to give to residents with minor ailments, in a safe way. The home uses a multi dose blister pack system that is dispensed by the pharmacist. Some tablets and all liquids cannot be dispensed in this way and so are received by the home in their original packets or bottles. The assistant manager was in the process of auditing the medication when we arrived at the home. The current procedure was that the person responsible for medication each shift checks the actual balance of the tablets in two of the original packs against the calculated balance on each floor after each medicine round. A table is kept to ensure that the checks rotate and each pack is checked in turn. Once a week the balances of all medication in original packs are checked. Whilst these checks will show if any errors occur they do not indicate which member of staff made the errors. The assistant manager said that audits that check staff competence is planned for the near future. Action will then be able to be taken to address the reasons of the errors being made. A random audit of balances of medication was carried out. The majority were correct but one error was noted. The actual balance of Codeine Phosphate tablets for one resident was one more than the balance calculated against the number signed for on the MARS. This indicated that a tablet had not been given when signed for. As the audit for this packet of tablets had not been carried out for several medication rounds it was not possible to identify who had done this. The medicines in use were stored in the trolleys, there being one on each floor. The trolleys were very organised and tidy, with each person’s tablets that were not in the MDS being in named containers. This facilitated easier access when medicines were being administered and minimised the risk of errors being made. All creams, ointments and eye drops were dated so that they could be disposed of at the appropriate times. Instructions giving these times were included in the Medication Administration Record Sheets records. Inhalers were also being disposed of every 28 days, which may not be necessary. The assistant manager showed a good knowledge of the uses of the medications in use. The administration practice was later observed and medicines were signed for correctly. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 15 Medication Administration Records (MARS) were examined. There were no gaps in the signature boxes. The reason for not giving medication was also written on the back of the MARS as well as the appropriate code used. The MARS were completed to show what had been given on specific dates, for example when the dose instructions said “one or two tablets” to be taken. The MARS showed the receipt of medicines and discharge of any were recorded separately and returned to the pharmacist. The pharmacist prints the MARS. As all medication administration time is printed for each medicine the person receiving the medication into the home highlights the specific time each one is to be given to minimise the risk of errors, although this is time consuming. Copies of prescriptions are kept so that the home is able to ensure that the medication ordered by the GP is received. Only staff who have undertaken validated medication training are allowed to be responsible for medication. A sample of signatures of their signatures/initials was kept in the office. The practices and procedures at the home safeguards the health and well being of the people living at the home. Terms of preferred address are on the residents care plan and heard to be used by staff. Residents are cared for in a respectful manner, which was confirmed by residents spoken with, and this ensures that their dignity and self esteem are maintained. Conversations between staff and residents were respectful whilst including a little jovial banter. A relative of a resident said in one of the surveys returned to us, “My (relative) is always treated with dignity and respect.” Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control, with limitations to leaving the building, over their daily lives. Residents enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities offered at the home included bingo twice a week, reminiscence session once a month, Motivation & Co (visiting entertainers) every two weeks, Pet-A –Dog visits (pet therapy), and specific activities every week which are decided on the day by the residents. Recent trips out included, a drive around the village for seven residents, a day trip for three residents and five days in Weston-Super-Mare for seven residents. People living at the home also participated in daily activities in the day centre. In completed surveys residents responded as follows to the question, “Are there activities arranged by the home that you can take part in?” Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 17 Always – 7; Usually – 1; Sometimes – 0; Never – 0. Comments made in the survey with regard to this question included, “I enjoy being involved with all the entertainment visiting day care. I especially enjoy holidays and outings with my friends from the home. I like very much having the rapport and security of having staff with me.” “Activities are arranged. My (relative) doesn’t want to take part always – her choice.” A relative said, “Open invitation to all functions”. Visiting continues to be at any reasonable time. No visitors were spoken with during the visit but residents that were asked the question said that their visitors were made welcome. Observations made and discussion with residents showed that people living at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. They have the opportunity to attend residents meeting and to affect the way in which the service s provided. This was shown in a comment from a resident in a survey returned to us. “I can discuss any problems or good ideas with my carer or management. I enjoy being part of the residents meetings or any discussions.” There is a large dining room known as the restaurant that caters for the day centre service users and people staying at the home for a short stay. This room has recently had new non-slip and attractive safety floor covering that gave the appearance of wooden flooring and new dining room furniture. The décor though is looking aged and in need of redecoration. There is also a small dining room/lounge on the ground floor where the short stay service users can have breakfast and their evening meal. The first and second floors have their own small dining rooms. Each looked bright, well furnished and decorated. The evening meal times were observed in these areas. There was friendly banter between residents and staff, and the mealtime was a social event that residents seemed to enjoy. The meal consisted of fish cakes and tomatoes or sandwiches and excellent home made coconut cake. Those residents spoken with said that they had enjoyed the meal. One resident offered the comment that they always did and that the cakes were always as good. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 18 The menus were varied and nutritious with residents saying that they could make choices of what to eat. In completed surveys residents responded as follows to the question, “Do you like the meals at the home?” Always – 4; Usually – 2; Sometimes – 1; Never – 0. Comments made in the survey with regard to this question included, “My (relative) eats all the meals without complaint.” “Meals can vary. Sometimes excellent, sometimes not so good. Choices are available if we do not like anything.” Assistance and support in eating was available to residents as required. This was individual, unhurried and sensitively given. The kitchen was clean and well managed, a record of fridge, freezer and high risk cooked food temperatures were kept. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home uses the Local Authority complaints procedure and a copy was displayed in the home for the benefit of residents and visitors and a copy included in the Statement of Purpose and Service User Guide, which were given to residents. A complaints record was maintained with evidence of timely and objective responses to complaints made. Four complaints had been recorded since the last key inspection. One was made by a short stay service user regarding the lack of a preferred type of bottled sauce, the attitude of staff and not being able to smoke in the home; a second was related to care issues; the third was because the complainant had waited a long time for the door bell to be answered; the fourth was related to the lack of domestic staff at weekends and a mistake made about the collection of belongings. These were managed appropriately by the manager and indicated that concerns would be taken seriously. There had been no complaints made directly to us. In completed surveys residents responded as follows to the question, “Do you know who to speak to if you are not happy ?” Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 20 All answered “Always” or “Usually” and the following comments made in the survey with regard to this question included, “Yes, but never had to.” “Yes, I will always speak to my carer and also the manager who will always see me and listen to me.” and as follows to the question, “Do you know how to make a complaint?” “Clearly signalled on notice board but staff are always willing to listen” “Yes. Discuss, speak up with things I do not agree with. These are soon looked into.” The home has the Local Authority policy for Protection of Vulnerable Adults (safeguarding). Staff spoken with were aware of safeguarding and the majority of all staff had attended relevant training. There had been no safeguarding issues. All recruitment practices safeguard residents from the employment of unsuitable people. Financial policies, procedures and practices safeguard residents’ financial interests. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26 Quality in this outcome area is good. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. There were some shortfalls in the décor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken including the bedrooms of those residents case tracked. Park View provides comfortable and clean surroundings, which are mainly well decorated and furnished, although some communal areas were in need of redecorating, as they looked aged and past their best. The only area visited that had any malodour was the lounge on the first floor that had a faint smell of urine throughout the visit. The ground floor caters for short stay residents who stay at the home for respite care or assessment. The first and second floors cater for’ permanent’ residents. The ground floor also housed the day care conservatory, which was Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 22 adjacent to the large dining room. The dining room (known as the restaurant) had recently been provided with new furniture and floor covering but the décor was shabby and in need of replacing. A small dining room/lounge was also located on the ground floor for the use of people staying for short stays. The laundry, kitchen, offices and staff rooms were also on the ground floor. The carpet and décor around the offices and staffrooms was badly in need of replacing as it was worn and stained. The assistant manager said that the manager had made a request for this. There were bedrooms located on all three floors. The bedrooms viewed were clean, comfortable and free of any offensive odour. They had been personalised by the occupant’s own possessions such as plants, ornaments, pictures and photographs. The first and second floors were identical in structure, both having a lounge and a separate dining room. Both lounges were adequately decorated and furnished, with armchairs, footstools and occasional tables. The dining room had been decorated and refurnished the previous year and each dining room and lounge had a kitchenette where beverages and snacks could be prepared. There were adequate assisted toilets and bathrooms on each floor to meet the needs of the people living at Park View. It was noted that the tiles above a radiator in an assisted toilet were very dirty. The residents benefit from smaller group living units rather than all residents living in one large area. Specific team of staff allocated to these units provide continuity and familiarity. Laundry facilities were inspected and found to be well organised, clean and hygienic. Disposable gloves and disposable aprons were readily available for staff in order to further maintain infection control whilst providing personal care. Disposable aprons of a different colour were worn when handling food. All communal areas where staff and residents were expected to wash their hands were provided with appropriate disposable towels and soap dispensers so that hand washing could effectively help to reduce cross infection. Some staff had undertaken Infection Control training to give them the relevant knowledge and skills. Everyone completing surveys said “Yes” in response to the question, “Is the home fresh and clean?” Respondents made the comments, “No smell of urine which is most important.” Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 23 “The housekeeper keeps my room nice.” “During the week no problems, entrance hall is always clean and inviting with fresh flowers.” “Kitchen always clean.” There are no domestic staff at the weekend and any domestic tasks have to fall to care staff, as commented upon by a resident’s representative in a survey, “.. individual floors appear to suffer at weekend when I assume cleaners don’t come in. Also for staff on duty it is a balance of supporting the residents or cleaning.” The home is a no smoking home. Anyone wishing to smoke would have to go outside the home to do so. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. There are sufficient care staff available to meet the needs of the residents but the lack of domestic staff at weekends may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each unit has it’s own staff team providing continuity and familiarity for the people living at the home. The rota showed that the usual number of care staff on duty were two in the mornings, two each evening on the first and second floor and one on both shifts on the ground floor for the short stay people; are two care staff on nights. These staffing levels were confirmed with the assistant manager. In addition to care staff there are catering staff and domestic assistants. There is always a senior member of staff in the home on each shift. There were sufficient staff to meet the needs of the current residents and to maintain standards of hygiene, food and safety at the home, apart from the lack of domestic staff at weekends. It is likely that care staff would need to carry out domestic tasks then, which would be time taken away from residents. Visitors as previously quoted had noted the affect of this on the home. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 25 The rotas showed the actual hours worked by all staff and their designation was clearly recorded. The assistant manager said that night staff numbers were increased from two to three if there were any residents presenting with increased care needs during the night. 68 of the care staff had achieved the National Vocational Qualification Level 2 showing that they were assessed as being competent in their role. Further to this one care assistant was a registered nurse and another care assistant had a Btec Diploma in Care. A member of the bank staff had a degree in Social Care. Three staff files were looked at and all records showed that recruitment practices safeguard residents from the employment of unsuitable people, with validated references and the required Criminal Records Bureau and Protection of Vulnerable Adults checks being evidenced. There was evidence that all new staff undertake appropriate induction training. Training records show that staff have undertaken mandatory training including, manual handing, the use of hoists, first aid, health and safety, Control of substances hazardous to health, food handling and fire prevention. Other training undertaken by all or the majority of them included that related to Protection of Vulnerable Adults, equality and diversity, oral health, physical disabilities, mental health, strokes, dementia and infection control. Staff responsible for medication had also undertaken relevant validated training. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. A person with the appropriate qualifications and who has established management experience manages the home. The monitoring and auditing of the service and practices ensures that all services operate in the best interests of residents. The health and safety practices in the home protect residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is registered with us and has the Diploma in Social Work (DipSW), the Registered Managers Award and National Vocational Qualification (NVQ) Level 4. She had also completed dementia mapping and holistic dementia care training. She has many years of experience in a management role in care homes. She was not on duty at the time of the visit and the newly Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 27 promoted assistant manager, who had achieved NVQ Level 3, was in charge for the first part of the visit with a care officer in charge in the evening. The home used the Local Authority’s Quality Assurance programme, which is extensive and covers all areas of the service. A representative of the Local Authority monitors this, making monthly unannounced visits to the home and provides a report for us and for the home. Some monies are held for safekeeping on behalf of residents. This is kept in a secure location and all transactions were recorded appropriately. A random sample of transactions and cash balances were audited and found to be accurate. Training records showed that staff had undertaken the required mandatory training related to health and safety. There was evidence from a random check of records, that equipment, including hoist equipment, was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. Training records showed that staff had attended the mandatory training related to health and safety issues. Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 2. Standard OP8 Regulation 12 Requirement There must be an up to date assessment carried out for each residents regarding the risk of the development of pressure sores. This will ensure that the risk to the residents is minimised. Timescale for action 15/10/08 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 Care plans should be devised in such a way that staff are able to easily locate the information they require to provide the appropriate care. Domestic staff should be available at weekends as on weekdays. 2. OP27 Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Park View DS0000042008.V371921.R01.S.doc Version 5.2 Page 31 - 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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