Care Home: Park View

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What the care home does well We undertook a tour of the home on arrival, and found the home to be clean, hygienic with no offensive odours. The laundry area was very clean and tidy with dirty laundry being appropriately stored pending washing, and clean laundry was kept separately. Comprehensive and detailed assessment are undertaken by people trained to do so prior to a resident being admitted to the home. All prospective residents and their families are invited to visit the home before making a decision to move in. On all units staff were seen working as teams, and this included nurses, care staff and housekeeping staff. It was evident on all of the units that residents were being treated with care and consideration and that staff had a good rapport with them. Nothing appeared to be too much trouble, and when a Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 7resident asked for a cup of tea, then the member of staff went and got one. Another resident said her trousers were wet, and the member of staff gently took her to her bedroom to help change her clothes, and this was at a busy time for nurses and care staff engaged in assisting residents to get up. Residents were well dressed and groomed and appeared generally content. On all units the care plans were very person centred and gave a real feel as to the person, and in discussions with staff they were very aware of the needs and wishes of the individuals. Equality and diversity issues were being addressed in the care plans, and these included issues around religion, ethnicity, gender care, diet, culture and sexuality. There are two units specialising in the care of younger adults who have differing types of dementia and/or severe cognitive impairment, and we were very impressed with the level of care being given to these residents. Feedback from relatives was that they felt the care was excellent and had seen improvements in their relative since admission, generally from long stay hospitals. The staff on these units are very committed to improving the lives of these younger adults who have very complex, and often challenging, needs. Medication on all of the units was inspected and was found to be in good order with regular audit systems in place. This is in spite of some current difficulties being experienced with the local health centre in the prescribing of medications. We were able to observe breakfast being served on one of the units, and lunch being served on two units. In all instances we were pleased to see that residents were being given assistance as needed by staff who were generally very sensitive to the individual needs. Dining tables were nicely laid and the atmosphere was one of calm. Meals were well presented and there was a choice offered to residents at both meals. There are two activity co-ordinators and they have designed a weekly programme of activities for residents, and these include large group, small group and individual sessions. Entertainment is organised within the home, and there are also trips arranged outside of the home for shopping and leisure. On the day of the inspection we saw residents enjoying an activities session in the garden, and later on during the morning a small group were discussing a name for a new pet bird which had recently been acquired by the home. Training is of a good standard and this was evidenced from training records and from talking to various members of staff. All safeguarding issues are taken very seriously by the registered manager and the appropriate procedures are always followed with the necessary referral being made to the local authority and to the Commission. Feedback from the local safeguarding team was that the manager is proactive, and very sound in judgements and investigations with the interests of the residents foremost. What has improved since the last inspection? Memory Lane has now been introduced at Park View and the activity coordinators are using this in sessions with the residents who are living with dementia. The issue of storage of equipment has now been resolved as during the inspection we did not see any equipment being stored inappropriately in corridors or bathrooms. All residents now have either a contract or a statement of terms and conditions. What the care home could do better: Although Memory Lane has been introduced at the home, care staff could be more interactive in the use of this equipment. Much of the equipment is along the corridors, but it was felt that if some of this was more accessible in the lounges, then care staff would be more inclined to use this with residents. This would certainly be of benefit to the residents living with dementia as it would give them more stimulation. Additional items such as magazines, newspapers and cushions should be available to residents in the lounges, and again this would give people items to touch, feel and look at. This was discussed with the clinical development nurse during the inspection visit. For some residents who would be unable to use the emergency call system, the use of assistive technology may be beneficial when they are in their bedrooms or even sitting in lounge chairs where they may have a tendency to fall forward. The use of assistive technology will often obviate the need to use a lap or other form of restraint. Again this was discussed with the clinical development nurse during the inspection. We did observe that some bedroom doors had been wedged open contrary to the home`s fire policy and this was addressed during the inspection and the appropriate action taken by the staff. From information contained in the annual quality assurance assessment (AQAA), and from comments received there does appear to be a high turnover of staff at the home. The AQAA does not give any explanation for this and perhaps this is an area which can be addressed by the service for the future benefit of residents. CARE HOMES FOR OLDER PEOPLE Park View 1-2 Morland Road Dagenham Essex RM10 9HW Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 16th June 2008 08:00 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 DS0000069386.V366194.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 DS0000069386.V366194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park View Address 1-2 Morland Road Dagenham Essex RM10 9HW 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) 020 8593 7755 020 8592 7710 alexis.wood@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Alexis Josephine Sally Wood Care Home 108 Category(ies) of Dementia (40), Dementia - over 65 years of age registration, with number (32), Old age, not falling within any other of places category (36) Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 36) Dementia - Code DE (maximum number of places: 40) 2. Dementia - Code DE(E) (maximum number of places: 32) The maximum number of service users who can be accommodated is: 108 4th May 2006 Date of last inspection Brief Description of the Service: Park View is a purpose built care home with nursing that provides accommodation and support for younger adults with varying types of dementia, and for older people with dementia or who require nursing care. There are 108 beds divided into four units, each unit has its own team of nurses and care assistants. One unit specialises in the care of older people with a diagnosis of dementia, one unit specialises in nursing care for older people and two units specialise in the care of younger adults with varying types of dementia and cognitive impairment. This modern building is well designed for the purpose, including access for wheel chair users and specialist bathrooms. All but one of the bedrooms are singles, most having en-suite toilets. It is situated at the end of a cul de sac, bordering parkland within the London Borough of Barking and Dagenham. There is generous parking space and landscaped grounds. There is a local parade of shops, with the Heathway shopping centre and tube station about half a mile away. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 5 Fee levels range from £575. to £1500 per week. However, where residents are supported by a local authority or a primary care trust fee levels will be negotiated separately depending upon the needs of the individual. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use the service experience excellent quality outcomes. This was an unannounced inspection undertaken by two inspectors, namely the lead inspector Mrs. Sandra Parnell-Hopkinson and Mrs. Julie Legg. The inspection took place on the 16th June 2008 between the hours of 08.00 hours and 16.45 hours. Unfortunately the registered manager was away from the home on a conference, but another manager, Ms. Sian Mitchell, who is a clinical development nurse employed by the organisation, was available throughout the inspection. The inspection process included information contained in the annual quality assurance assessment (AQAA), previous regulation 37 notifications and regulation 26 reports, a tour of the home, questionnaires returned from residents, relatives and staff. We were also able to talk with many of the residents, visiting relatives and staff during the visit. We case tracked 20 people who use the service, together with viewing maintenance records, complaints staff rotas, training schedules, activity programmes, accident records and menus. We also spoke to social care professionals. We have been told previously by people at the home that they would prefer to be called ‘residents’ and, therefore, this term is used in this report. What the service does well: We undertook a tour of the home on arrival, and found the home to be clean, hygienic with no offensive odours. The laundry area was very clean and tidy with dirty laundry being appropriately stored pending washing, and clean laundry was kept separately. Comprehensive and detailed assessment are undertaken by people trained to do so prior to a resident being admitted to the home. All prospective residents and their families are invited to visit the home before making a decision to move in. On all units staff were seen working as teams, and this included nurses, care staff and housekeeping staff. It was evident on all of the units that residents were being treated with care and consideration and that staff had a good rapport with them. Nothing appeared to be too much trouble, and when a Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 7 resident asked for a cup of tea, then the member of staff went and got one. Another resident said her trousers were wet, and the member of staff gently took her to her bedroom to help change her clothes, and this was at a busy time for nurses and care staff engaged in assisting residents to get up. Residents were well dressed and groomed and appeared generally content. On all units the care plans were very person centred and gave a real feel as to the person, and in discussions with staff they were very aware of the needs and wishes of the individuals. Equality and diversity issues were being addressed in the care plans, and these included issues around religion, ethnicity, gender care, diet, culture and sexuality. There are two units specialising in the care of younger adults who have differing types of dementia and/or severe cognitive impairment, and we were very impressed with the level of care being given to these residents. Feedback from relatives was that they felt the care was excellent and had seen improvements in their relative since admission, generally from long stay hospitals. The staff on these units are very committed to improving the lives of these younger adults who have very complex, and often challenging, needs. Medication on all of the units was inspected and was found to be in good order with regular audit systems in place. This is in spite of some current difficulties being experienced with the local health centre in the prescribing of medications. We were able to observe breakfast being served on one of the units, and lunch being served on two units. In all instances we were pleased to see that residents were being given assistance as needed by staff who were generally very sensitive to the individual needs. Dining tables were nicely laid and the atmosphere was one of calm. Meals were well presented and there was a choice offered to residents at both meals. There are two activity co-ordinators and they have designed a weekly programme of activities for residents, and these include large group, small group and individual sessions. Entertainment is organised within the home, and there are also trips arranged outside of the home for shopping and leisure. On the day of the inspection we saw residents enjoying an activities session in the garden, and later on during the morning a small group were discussing a name for a new pet bird which had recently been acquired by the home. Training is of a good standard and this was evidenced from training records and from talking to various members of staff. All safeguarding issues are taken very seriously by the registered manager and the appropriate procedures are always followed with the necessary referral being made to the local authority and to the Commission. Feedback from the local safeguarding team was that the manager is proactive, and very sound in judgements and investigations with the interests of the residents foremost. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Although Memory Lane has been introduced at the home, care staff could be more interactive in the use of this equipment. Much of the equipment is along the corridors, but it was felt that if some of this was more accessible in the lounges, then care staff would be more inclined to use this with residents. This would certainly be of benefit to the residents living with dementia as it would give them more stimulation. Additional items such as magazines, newspapers and cushions should be available to residents in the lounges, and again this would give people items to touch, feel and look at. This was discussed with the clinical development nurse during the inspection visit. For some residents who would be unable to use the emergency call system, the use of assistive technology may be beneficial when they are in their bedrooms or even sitting in lounge chairs where they may have a tendency to fall forward. The use of assistive technology will often obviate the need to use a lap or other form of restraint. Again this was discussed with the clinical development nurse during the inspection. We did observe that some bedroom doors had been wedged open contrary to the home’s fire policy and this was addressed during the inspection and the appropriate action taken by the staff. From information contained in the annual quality assurance assessment (AQAA), and from comments received there does appear to be a high turnover of staff at the home. The AQAA does not give any explanation for this and perhaps this is an area which can be addressed by the service for the future benefit of residents. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 (standard 6 does not apply to this service) People using this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. Prospective residents, and their relatives, are given sufficient information to enable them to make an informed decision on the suitability of the service. People are encouraged to visit the home before making a decision, and a comprehensive pre-admission assessment is undertaken to make sure that the home can meet the assessed needs of the prospective resident. EVIDENCE: We looked at 20 files during this inspection and all of them contained a comprehensive pre-admission assessment, which had been used to compile the care plans. Pre-admission assessments are undertaken by the senior sister from the unit that the prospective resident may be joining and for very complex cases the registered manager may undertake a second assessment. In discussions with residents, 2 of them told us that they had not been able to visit the home but their families had visited on their behalf. One resident Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 12 stated “I am very happy with his choice, I have no complaints what so ever”. We also spoke to several relatives, some of whom had visited the home prior to the resident’s admission and we were told “We looked at four other homes but we were impressed with the staff’s interaction with the residents and the atmosphere. We have not been disappointed with our choice and he has settled well”; “I looked at other homes but felt this was the best and she is happy here which is the main thing”; “We looked at so many homes we originally wanted Brentwood but decided on Park View, the care is very good” and finally “he had been coming here for respite and I was so pleased that they had a permanent bed when he needed it”. No appointments are required to view the home and prospective residents and relatives are welcome any day, any time. Residents now have either a contract, if privately funded, or a statement of terms and conditions if support is being given by a local authority or a primary care trust. The statement of purpose and service user guide is available in the home, and copies are made available to prospective residents and their families. The statement of purpose has been reviewed and is now much clearer as to the needs of prospective residents which can or cannot be met. The service also offers free access to a financial advocacy service as stated in the annual quality assurance assessment (AQAA). Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 13 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 and 11 People who use this service experience excellent outcomes. We have made this judgement using available evidence including a visit to the service. People using this service can be sure that their health, personal and social care needs are set out in a care plan, and that the identified health care needs will be fully met. They will be protected by staff who have been trained in the administration of medication, and who follow the home’s policies and procedures. People using the service can be sure that they will be treated with respect and their right to privacy upheld, and also that at the time of their death they will be treated with care, sensitivity and respect, as will their families. EVIDENCE: We looked at the files of 20 residents during this inspection, 5 on each of the 4 units. All of the files had a pre-admission assessment from which comprehensive and person centred care plans had been produced and included ‘A likes to have a bath every morning’. When we spoke to A we were told that this was the case. The care plans cover areas such as personal, social, health, communication, mobility, religion, gender, sexuality, behaviours which Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 14 challenge and relationships, as well as hopes and concerns for the future. These care plans have been developed and are working documents that are easily read and understood by the nursing and care staff, and from reading them a clear sense of the person is gained. Care plans are being evaluated on a monthly basis and regular reviews are also taking place. Many of the care plans include a life history of the individual and again, staff were able to demonstrate a knowledge of the individual. They told us that the life history really helps them to get to know the resident, who themselves may not be able to remember significant events in their lives because of dementia or other cognitive impairment. We were very satisfied that residents on all of the units receive effective personal and healthcare support using a person centred approach, based on the rights of the individual. Staff ensure that care is person led and that personal support is flexible and able to meet the changing needs of the residents. When we spoke to staff they demonstrated a good knowledge of the individual’s needs and preferences. We observed staff responding appropriately and sensitively to residents, even when it was apparent that a member of staff was busy doing something else. A comment received from a relative was “they are the most caring people you could wish to have to look after your wife.” A resident told us “I am very happy with the care I am getting, the staff are very kind and caring.” Other residents told us “they look after me really well, the girls knock on my door before they come in, I like that it’s respectful”; “They know I’m slow and they don’t try and rush me”. On all units we noted that the daily records are being written in a way that is a reflection of the care the resident has received and they relate to residents’ care plans. Referrals to specialist health care professionals, such as tissue viability nurse, palliative care team and diabetic nurse specialist are being made as necessary, and this was evidenced in the care plans and other documentation. There were care plans relating to specific health needs such as pain management, catheter care, and skin pressure care, continence and weight management. Records were being maintained of weights and where necessary referrals were being made to the dietetic/nutritionist service. However, currently because of staff shortages within the primary care trust, there is a waiting list with the Speech and Language Therapy services (SALT). Records indicated that residents have access to a GP, dentist, optician, chiropodist and physiotherapist. We were told by residents and relatives that appropriate action is taken when health care professionals are required. We spoke to one relative who was visiting her mother who has dementia, and who is bed-bound, and she told us that “mum always is kept clean and well cared for. Where she was before I would often find bruises on her arms, and I know she bruises easily but I never find bruises on her Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 15 now. The only problem is sometimes the room smells because of the dirty pads being kept in the yellow bag in the en suite.” We did speak to the clinical development nurse about this and she has undertaken to immediately address this matter. Infection control policies may indicate the situation of yellow bags, but staff need to ensure that they are emptied on a very regular basis. We looked at monitoring charts with regard to repositioning and food/fluid intake, and although generally these were being maintained and recordings being made at the time of the action, this is not always being done. This was discussed with the clinical development nurse and the newly appointed deputy manager who have undertaken to ensure that in future all charts are completed appropriately, and used where necessary. Risk assessments were looked at as part of the case tracking process, and those seen were detailed and covered areas such as personal safety/protection, skin pressure care, use of oxygen, moving & handling, use of bedrails and hoists, leaving the building and behaviours that challenged. There was evidence that risk assessments are being regularly reviewed. We saw that all of the care plans had night care and many had end of life/preferred place of care plans. The wishes of some of the residents regarding their preferred place of care during their final days, and subsequent death and funeral arrangements, had been sensitively discussed with the residents (where appropriate) and relatives. This is an ongoing piece of work because of the possible distress that this can cause to residents and relatives, and staff demonstrated a very deep understanding around this very sensitive area of care and planning. The home does provide palliative care and works to the Gold Standard Framework. The two units providing care for younger adults with dementia and cognitive impairment are operating to a high standard. We spoke to nurses and care workers who told us “we really enjoy being on these units, the residents are great and it is wonderful to see them making improvements.” Generally these younger residents have very complex care needs which may have been caused through such things as alcohol/drug abuse, other illnesses such as Huntington’s or early onset dementia. One resident has been able to be discharged back into the community, and another resident who was immobile on admission to the home is now mobile and has an improved quality of life. The staff on these units have undertaken specialist training to meet the needs of the individuals and from records and talking to several relatives and staff it is apparent that many of the residents have improved since moving to Park View. One relative told us “he has really improved since being here, he is so much calmer.” Another relative told us “I live abroad and come to visit about every six weeks, but she always seems happy and the staff Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 16 are excellent.” Staff on these units in particular were able to demonstrate an understanding and awareness of changes in mood, behaviour and general wellbeing and fully understood how they should respond and take action. Family relationships for these residents can also be very complex and traumatic, and again staff showed a good understanding of the needs of both residents and families. We looked at the medication administration records (MAR) on all units, including the controlled drugs and records, and found them all to be in good order. Regular temperature recordings were being made with both the fridges and the rooms, and regular audits are being undertaken by the nurses and also the registered manager. We discussed the use of assistive technology for some residents who would be unable to use the emergency call system. Such equipment can be beneficial when residents are in their bedrooms or even sitting in the lounge areas when staff may not always be close to hand, as this equipment can alert staff more quickly to a possible problem. We were told that the organisation does use assistive technology within a risk assessment framework, and we would recommend that consideration be given to the use of such equipment for some residents. There are currently issues with regard to the prescribing of medication through the local health centre, and this has been referred to the local authority as a safeguarding issue and is still being investigated under the Protection of Vulnerable Adults procedures. This in no way is a reflection of the service being provided by Park View to its residents. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 17 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 and 15 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. People using this service can participate in a programme of activities for either groups or individuals according to their preference. People can be sure that they will be served nutritious meals in pleasant surroundings and that any specialist dietary need will be catered for. People will be assisted to exercise choice and control over their lives which will enable them to retain as much independence as is possible. EVIDENCE: We visited all of the units at different times throughout the day and generally saw staff interacting very well with many of the residents. During the morning some residents, which included some from the upstairs unit, were having a social gathering in the garden. They seemed to be having a good time enjoying the sunshine and having drinks (which included beer, wine and soft drinks) and nibbles. Some people were singing along to tapes and some were helping in potting up some plants. Later in the morning, other residents were sitting inside and trying to think of a name for the new bird which had been purchased for the home. One resident was sitting doing a jigsaw puzzle and Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 18 told us “I have been here for several years and am very happy, the staff are excellent.” During the afternoon nail painting was available for those residents who had chosen this activity. Other activities that take place on a weekly basis are karaoke, a film afternoon, going to the park and to a pub for lunch. Staff (including the housekeeping staff, maintenance person, chef and kitchen staff and the administrative staff) were also seen spending time talking to the residents, and there was a really good rapport between residents and staff. Whilst staff on all of the units were observed to be interacting with many of the residents, we did feel that there should be more stimulation for residents on the Memory Lane unit. The organisation has invested in equipment and resources but we did not see staff using these with the residents. Many of the residents were sat in chairs, and appeared to be sleeping most of the time. It is important for residents living with dementia to be encouraged to participate in the world around them, and this can be done through the use of the Memory Lane equipment and through the provision of such things as magazines, newspapers and ornaments which they can touch, feel and pick up. One relative stated “There appears to be times when there is not enough staff in the lounges and when they are there they don’t sit and talk to the residents or look at a magazine or a newspaper with them.” We were sitting in one of the lounges and observed care staff sitting and completing paperwork but not engaging with the residents. However in the other lounge a care worker was sitting completing her paperwork but was also chatting with the residents. The London City Mission visits once a month and takes a service and members of the mission sit and chat with the residents. A visit was taking place during our inspection visit. Residents on the two Oak units are younger and more mobile, and therefore, more activities include going out of the home for walks, shopping, pub lunches and other forms of entertainment. The home does have its own minibus which seems to be in constant use. Family and friends told us that they can visit at any time and are always made to feel welcome. Residents are also taken out by their families and friends, and one relative told us “he likes me to take him to the bank, and also to do some other shopping.” Residents are encouraged to personalise their own bedrooms, and we saw evidence of this when walking around the home and visiting residents in their bedrooms. Meals are mostly served in the dining rooms, although some residents take their meals in their bedrooms if they wish. Meals are served at small tables for four residents and were nicely laid with table clothes, cutlery, napkins and a small vase of flowers. Menus were also evident on tables and also in lounges Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 19 for those residents who choose not to go to the dining rooms. The atmosphere in the dining rooms at meal times was very relaxed and calm. Breakfast and lunch were observed and where some residents required assistance with eating their meal this was carried out by staff in a sensitive and caring manner, allowing the resident time to eat. At all meals there are choices, and other meals can be provided if the resident does not want either of the choices on offer. One resident stated, “If I don’t like something, K does a lovely egg & chips or a salad”. Relatives were equally complimentary; one relative told us “The food is wonderful, he has put on weight and I have had to buy him new trousers.” We visited the kitchen and spoke to the chef and other kitchen staff, and were told that there is always a good supply of fresh fruit and vegetables and of other provisions, and this was confirmed through observation. We were told by two of the residents that they had been involved in the selection of the new chef. They told us that they had had to sample meals that had been cooked by the candidates and they had chosen K who is the current chef. They also told us that he was an excellent cook, and recently there had been problems with some of the kitchen equipment but K had continued to do a marvellous job. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 20 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 and 18 People who use this service experience excellent outcomes. We have made this judgement using available evidence including a visit to the service. People who use this service, and their friends and relatives, can be confident that their complaints will be listened to and taken seriously with the necessary action being taken by the management. People can also be sure that they will be protected from all forms abuse, so that they can feel safe and secure at the home. EVIDENCE: We observed that the complaints procedure is clearly displayed in the home, and residents told us that they knew who to complain to if they needed to. A comment made by a relative on a returned questionnaire was “any complaints that I have are very quickly and efficiently responded to. All of the staff are always calm and polite when dealing with queries and do their very best to sort things out. For us satisfactory conclusions have always been arrived at.” Another comment was “the home manager is very good at dealing with any queries and does so very quickly and efficiently. She is always able to find the relevant information and clearly knows what is going on in the home and how she wants staff to operate.” A record of all complaints is held by the service and we looked at these during the inspection and found that all complaints had been responded to in line with the organisation’s complaints policy and procedure. The manager ensures that Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 21 lessons learned from complaints are used to improve the service to residents, and this is part of the quality assurance procedures in use at the service. There is an open culture within the home where residents and relatives feel able to express concerns in relation to safety and protection. We spoke to various members of staff who all confirmed that they had attended ‘Safeguarding Adults’ training (which was supported through training records), and demonstrated an awareness of the actions to be taken if they had any concerns regarding the welfare or safety of the residents. One member of staff stated “I wouldn’t think twice of shopping someone who I thought was abusing a resident.” We were told by nurses that safeguarding is always on the agenda at supervision sessions, and again this was confirmed in discussions with staff. The registered manager is absolutely clear when an incident needs to be referred to the local authority as part of the safeguarding procedures and is always very open and transparent when discussing incidents with external bodies. Any incident of a possible safeguarding nature is always notified to the Commission. At the time of this inspection the Commission has not received any complaints about this service. Staff at the home are encouraged to whistleblow and this is enforced during training and in the staff handbook. We spoke to the local safeguarding team and they told us that the manager is very proactive around safeguarding issues, and always works very co-operatively with them in the best interests of the residents. Some of the staff, especially those working on the 2 Oak units with younger adults who have dementia, had had training in what restraint is, and that alternatives to its use in any form are always looked for. Wherever possible residents are involved in the decision making process about any limitations to their choice in this area. Individual risk assessments are completed which involve the resident, where possible, their representatives and any other health/social care professionals as necessary. There have been several safeguarding referrals since the last inspection and annual service review, and all were dealt with appropriately by the registered manager, who works in close co-operation with the local authority and the Commission. Where necessary staff were suspended pending the outcome of the investigation and in some instances staff were dismissed or retrained. There is a current safeguarding referral being investigated by the local authority around the prescribing of medication to the home by the local health centre. This in no way is a reflection of the service being provided by Park View to its residents. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 22 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, 23 and 26 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. People using this service can be sure that they will live in a safe, wellmaintained environment that is clean, pleasant and hygienic. They will also be able to personalise their bedrooms to suit their individual needs, and make living at Park View more homely. EVIDENCE: We did a tour of the home and found that the home was clean, hygienic with no offensive odours. However, a comment made on a returned questionnaire was “mum’s room is not always as clean as it could be, i.e. debris on floor and a pile of dirty linen left on floor in the en suite area.” A relative told us that sometimes her mother’s room smells because of the dirty incontinence pads which are left in a yellow bag in the en suite area. This was discussed with the clinical development nurse during the inspection, and she told us that she would take steps to resolve this problem. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 23 Residents told us that they can have a bath when they want to and that there is always plenty of hot water, and also that the temperature in the home is always right for them. The home has recently undergone a major refurbishment programme on all units. All of the communal areas have been redecorated, with new carpet and soft furnishings. There is a current programme of replacing carpets and furnishings to most of the bedrooms on the nursing and Memory Lane units. Many of the bedroom doors have been fitted with door closures which are activated by the fire alarm, and this mean that these doors can be left open. However, we did see some bedroom doors that had not been fitted with these closures being wedged open, which is contrary to the home’s fire policy. This was addressed at the time of the inspection. There are several communal areas which provide a choice of space for residents to meet with relatives and friends in private. Bathrooms and toilets are fitted with appropriate aids and adaptations, and are in sufficient numbers and locations to meet the needs of the residents. The home does have a good infection control policy and staff were seen implementing this by washing hands and disposing of used incontinence pads appropriately. We visited the kitchen and laundry areas and found these to be clean, tidy and well maintained. Generally the garden areas were tidy, but some areas required weeding. We did speak to the maintenance man who told us that he had been on his own recently, but that a new gardener was due to start soon. Park View DS0000069386.V366194.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 and 30 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. People using this service can be sure that they are in safe hands and that the numbers and skill mix of staff will meet their needs. The service has a robust recruitment procedure and provides staff with training so that they are competent to do their jobs for the benefit of the residents. EVIDENCE: The service has a highly developed recruitment process that ensures that staff are appropriately recruited and that the necessary checks, references and criminal records bureau disclosures are obtained prior to commencing work at the home. We were satisfied that on the day of the unannounced inspection there were sufficient numbers of staff on duty on all of the units, and this was normal as substantiated by looking at the staff rotas. A comment made by a relative on a returned questionnaire was “the staff seem to be well trained in their work. Unfortunately there does seem a constant turnover of staff which made it hard to maintain relationships. However, those that have been there a while are extremely good in the care they provide.” The high turnover of staff is confirmed in the annual quality assurance assessment which has been Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 25 completed and returned to the Commission by the service. There is no explanation for the high staff turnover, and this may be an area that the service will need to look at and address for the future. Training at the home is of a good standard and staff can undertake many courses, and the service has recently appointed a Home Trainer who is working with new staff to ensure they are taught correct policies and procedures. Recent training has included, care planning, clinical supervision, dementia awareness, customer care, diabetes, fire training, first aid, food hygiene, health and safety, funeral awareness, HIV, Huntington’s disease, moving and handling, Mental Capacity Act, oral hygiene, safeguarding and POVA. All new staff undertake induction training, but the service is planning to work towards a more comprehensive induction programme which will ensure that a mentor for new staff is identified for the first 6 weeks. A relative told us “I have been very pleased with the care and attention that mum receives. I have not had any problems with mum. Before she moved in here she had several falls and T.I.A.’s (transient ischemic attacks) but they use a hoist to move her and they are always very gentle with her. They have her on the right medication and mum likes the carers and seems content.” Another comment made by a relative on a returned questionnaire was “the staff have a genuine interest in the residents as individuals and they are able to make very strong and caring relationships with them. They give the residents lots of emotional support and treat them with a great deal of kindness and respect.” Staff working on the 2 Oaks units with younger adults living with dementia have been specially recruited and have undertaken specific training to ensure that the complex and varied needs of these residents can be met. We spoke to many staff including nurses, care staff, domestics, chef, activity co-ordinators and the maintenance person and all were enthusiastic and positive about wanting to provide a good quality service. All said that they enjoyed working at Park View and comments included “I love working here, I get real job satisfaction and I think we do a really good job”; “I have only been working here a short time but it feels I have been here a long time, I am really enjoying it” and “We work as a team and we want the best for them”. Staff told us that they receive regular supervision and attended staff meetings, and this was supported in looking at files and in the annual quality assurance assessment. Some staff members are currently undertaking their NVQ 2 and one care worker told us “I have received a lot of support and I feel that the course is a good experience, I have learnt a lot”. Park View DS0000069386.V366194.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, 36 and 38 People who use this service experience excellent quality outcomes. We have made this judgement using available evidence including a visit to the service. People who use this service benefit from there being a manager in charge who demonstrates leadership and ensures that the ethos and management approach is always in the best interests of the residents. Staff receive appropriate supervision so that they are always working to a high standard so that residents are respected and their rights safeguarded. Both staff and residents can be sure that their health, safety and welfare will be promoted and protected. EVIDENCE: The registered manager at Park View has many years of nursing and management experience, and manages the home in a highly visible, proactive and transparent manner. A comment made by a relative was “the manager Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 27 is highly efficient and shows strong leadership skills.” This was also substantiated when talking to staff and some of the residents. The manager has a sound knowledge of both strategic and financial planning, and has a sound knowledge of the organisation’s strategic and financial planning systems and how the business plan for the home fits with the organisation’s business plan. The development of the 2 units for the care of younger adults living with dementia had been a vision of the manager and she has worked extremely hard to ensure that this service is of a high standard. It is a much needed service in the area and has greatly benefited the current service users. The manager communicates a clear sense of direction, and is able to evidence a sound understanding and application of best practice operational systems, particularly in relation to continuous improvement, customer satisfaction and quality assurance. From feedback and observations during the inspection, we were pleased to see that the home is run with equality and diversity, human rights and person centred thinking at the heart of the service. There is an effective senior management team, and this has recently been enhanced by the recruitment of a deputy manager. The service recognises the importance of ensuring that the annual quality assurance assessment is fully completed and the importance of this in informing the home’s quality assurance systems. Record keeping is of a high standard and records are kept securely in accordance with the Data Protection Act. Residents can contribute to their care plans and reviews and can gain access to their records when they wish. The organisation employs an external auditor to ensure health and safety compliance, and the regional health and safety co-ordinator is based in the home. Maintenance records viewed were in good order and up to date, and this included lift, gas, electrics, water, fire, wheelchairs, hoists and other equipment. The administrative staff at the home work to a high standard and there are efficient systems to ensure effective safeguarding and management of residents’ money and valuables. The manager maintains a record of all accidents and safety checks and notifications under Regulation 37 of the Care Homes Regulations 2001 are always sent to the Commission. Visits under Regulation 26 of the Care Homes Regulations 2001 are also undertaken by the organisation with reports of these visits being kept at the home, and copies sent to the Commission. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 28 Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 3 X X X 3 X 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 4 X 3 X 3 3 X 3 Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 Requirement The registered persons must ensure that all fire doors which have not been fitted with a door closure which can be operated by the fire alarm, are not wedged open in compliance with the home’s fire policy. This is in the interests of the safety of all of the residents. Timescale for action 30/06/08 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 OP8 Good Practice Recommendations It is recommended that the registered persons give consideration to the use of assistive technology within the home, within a risk assessment framework, for the benefit of those residents who are unable to use the emergency call system. It is recommended that the registered persons give consideration to the greater use of the memory lane resources within the lounge areas. This should enable staff to better stimulate residents living with dementia to DS0000069386.V366194.R01.S.doc Version 5.2 Page 31 2 OP12 Park View 3 OP27 enable them to more fully participate in the world around them. It is recommended that the registered persons consider the reasons for a high staff turnover, and endeavour to address these wherever possible. This is in the interests of care to residents and team building. Park View DS0000069386.V366194.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 DS0000069386.V366194.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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