Care Home: Park View Nursing Home

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What the care home does well The care plans are clear about each individual who lives there.People receive personal and health care in the way they want and need.People told us they go to theatres, the park and rides in the minibus. They enjoyed their holidays too. People told us they liked all their meals at the home. They choose what they want.The rooms are clean and well furnished.The staff in the home are friendly and meet each person`s needs well.The home is good at making sure staff are trained to support people in the right way. What has improved since the last inspection? The complaints procedure on the wall in the entrance hall has Widgit symbols to help people to understand.There were photographs of the staff so that they knew who was on duty.Staff now have regular supervision meetings with a nurse or the manager.Automatic mechanisms on doors have been replaced so that doors will close if there is a fire.All windows had been assessed for security risks and restrictors were fitted to keep people safe. What the care home could do better: A second person must check and sign when a nurse adds something to medicine records so that people always receive their medicines as a doctor has prescribed. The manager must make sure there is not too much medicine kept on the premises.When people`s money is taken out a second person must be a witness and sign the record sheet. Key inspection report Care homes for adults (18-65 years) Name: Address: Park View Nursing Home 13 Gedling Grove Nottingham NG7 4DU The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Meryl Bailey Date: 1 1 0 9 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 30 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Park View Nursing Home 13 Gedling Grove Nottingham NG7 4DU 01159790776 01159790779 parkview@crystal-ns.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Crystal Nursing Services Ltd care home 18 Number of places (if applicable): Under 65 Over 65 18 7 0 0 learning disability physical disability Additional conditions: 1 x LD(E) for a named service user - as identified in the registration report. Within the total number of beds, a maximum of 18 may be used for the category LD Within the total number of beds, a maximum of 7 may be used for the combined category of LD/PD Date of last inspection 1 5 0 9 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home The home is close to a park. There is a tram to Nottingham city centre shops and theatre. There are nurses and care support staff. Everyone has their own bedroom. Care Homes for Adults (18-65 years) Page 5 of 30 There are sitting rooms and a dining room on both floors. There is a garden and car park. It costs at least £706 each week to live there. Care Homes for Adults (18-65 years) Page 6 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 30 How we did our inspection: This is what the inspector did when they were at the care home The inspector talked to the people who live at the home. Everyone seemed happy there and said, I like staff and I like living at Park View. Some staff completed survey forms for the inspector during the visit and these helped us to understand what it is like at Park View Care Homes for Adults (18-65 years) Page 8 of 30 The inspector looked at documents that have to be kept. She looked at: Care plans. Staff files. Medicine records. The inspector looked around the home. This was to make sure it was safe and comfortable. What the care home does well The care plans are clear about each individual who lives there. Care Homes for Adults (18-65 years) Page 9 of 30 People receive personal and health care in the way they want and need. People told us they go to theatres, the park and rides in the minibus. They enjoyed their holidays too. People told us they liked all their meals at the home. They choose what they want. The rooms are clean and well furnished. The staff in the home are friendly and meet each persons needs well. Care Homes for Adults (18-65 years) Page 10 of 30 The home is good at making sure staff are trained to support people in the right way. What has got better from the last inspection The complaints procedure on the wall in the entrance hall has Widgit symbols to help people to understand. Care Homes for Adults (18-65 years) Page 11 of 30 There were photographs of the staff so that they knew who was on duty. Staff now have regular supervision meetings with a nurse or the manager. Automatic mechanisms on doors have been replaced so that doors will close if there is a fire. All windows had been assessed for security risks and restrictors were fitted to keep people safe. Care Homes for Adults (18-65 years) Page 12 of 30 What the care home could do better A second person must check and sign when a nurse adds something to medicine records so that people always receive their medicines as a doctor has prescribed. The manager must make sure there is not too much medicine kept on the premises. When peoples money is taken out a second person must be a witness and sign the record sheet. Care Homes for Adults (18-65 years) Page 13 of 30 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Meryl Bailey Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 14 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into the home to ensure the home can meet their needs appropriately. Evidence: There were no new people living at the home. The three files we examined each contained a detailed preadmission assessment. There were also specialist assessments from social work staff and health professionals. Care Homes for Adults (18-65 years) Page 16 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care and support is planned and people who live at the home make choices with support. Risks are well managed. Evidence: We looked the support plans for three people in detail and found that these included action plans for each area of need with clear risk assessments linked to them. Each action plan had been reviewed within the last three months. At the end of each review a timescale was given for the next review. Changes to the support plan were made when needs had changed. In addition to the full support plan there was a daily plan for each person and personal choices and preferences were noted. People told us they could choose what they wished to do each day and they could get up and go to bed when they wanted. Care Homes for Adults (18-65 years) Page 17 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to enjoy positive lifestyles and healthy meals. Evidence: Some people were at Day centres or college on the day of this inspection. There were weekly activities timetables or suggestions for activities on individual peoples files, so that staff knew what people would be interested in. Planned daily activities included jigsaw puzzles, going for a walk, contacting friends by phone. On Sundays people regularly went for a scenic ride in the minibus. For one person who had bed rest each afternoon there was a note When I am back in bed I will listen to music or have a nap. Two people told us that they like to walk around the local park. During the morning we saw one person having individual support to do some art work and in the afternoon two others were making cards with a member of staff. One person told us about a recent holiday to the Greek island of Zante. Three people went with three staff and another person told us of a different holiday planned for the following week. A group had also been to a hotel in Blackpool. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Some people told us they enjoyed going to see Mamma Mia at a theatre in London in October 2008 and they were planning to go to see the lights in Oxford Street in London later this year. There were no visits from family members during this inspection visit, but there were records of visitors and some people told us of contact with their families. There were individual plans about how contact is maintained. There was a dining room on each floor and all meals were prepared in the ground floor kitchen, which was well organised. The cook showed us some menus and told us that she prepares alternatives on request. People had Macaroni cheese or Egg salad at lunch time on the day of this visit. The menus showed a variety of meals and there was information about special diets and food preferences. The manager told us that since the last inspection they had started to collect photographs of meals to prepare a picture menu for people to choose from, but this had been mislaid and they planned to start the process again. People told us they liked their meals and ate what they wanted. Care Homes for Adults (18-65 years) Page 19 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Healthcare needs of people living in the home are met and they receive personal support in the way they prefer and require. Medicine administration is improving and action is being taken to ensure nurses attend to detail an avoid risks to people. Evidence: Peoples personal preferences about how there personal care and support was given was set out in the individual plans. These plans were written by key workers involving people who signed their agreement. There were instructions about how many care staff were needed and the gender of care workers, for example on one file we read that where two staff were needed for hoisting one carer must be female and this was respected. Daily notes completed and we saw that, for one person looked after in bed, there were charts completed to ensure regular care and attention was given. All people living at the home were registered with a local General Practitioner (doctor) and there was always at least one nurse on duty within the home. There were records of incidents when people have needed emergency treatment and these show that staff made arrangements appropriately as needed. In the Annual Quality Assurance Assessment (AQAA) form the manager stated there were four such incidents in the last 12 months. There were also records of regular health contacts and appointments for each person in separate nursing records. These provided information about all clinical issues Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: and specific illnesses as well as doctors and hospital appointments, visits to the home from the consultant psychiatrist, dentists appointments and involvement of psychologists and speech and language therapists. We found that all medication was kept in a locked cabinet and was administered by registered nurses. No one looked after their own medicines, but the manager told us that should anyone request to do so they would be supported by staff following a risk assessment. Medication records were mostly completed appropriately, but some prescribed tablets that were handwritten on the sheets were not all signed by two staff. For one person there was one gap on the record, so that we could not be sure if the tablet had been taken. The manager checked the stock and found that the tablet was not there. She assumed the nurse had given it, but forgotten to initial the sheet. Some tablets had been counted and the number remaining was recorded on the sheet, but this had not been done every day and some confusion was due to medicines being taken out of the home when people were visiting family members. We found the number taken out was recorded, but there was no record or explanation about medicines returned. We saw that there was additional stocks of one controlled drug that was not needed and the manager agreed to arrange appropriate disposal. The manager showed us some new procedures about medication, but these had not yet been adopted at the home. There was some training booked for two half days on 22 and 25 September 2009 about completion of Medicine Administration Records and Controlled Drugs. All nurses and seniors were to attend this training and disciplinary action was being taken where omissions occurred. The responsible person for the company that owns the home has written to us since the inspection to confirm this and he told us that he will continue to monitor medication practices very closely. Care Homes for Adults (18-65 years) Page 21 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and Safeguarding procedures offer protection to people at the home. Evidence: There was a complaints procedure on the wall in the entrance hall and this contained Widgit symbols to help people to understand. The registered manager told us that in the last twelve months no complaints had been received. We looked at a file containing Compliments and Complaints, where details of older complaints were written in full and there were several compliments. We saw evidence that checks were made through the Criminal Records Bureau and two satisfactory references were received on new staff in order to protect people. Staff told us they had received training in Safeguarding Adults and the local policy and procedures for Nottinghamshire were available. People we spoke with that live at the home told us they would tell staff or Mary, the manager if they had any concerns about anything. We looked at arrangements for looking after peoples money and counted some peoples cach. We found the records were accurate for these and receipts were kept in envelopes, but not all transactions were witnessed. Care Homes for Adults (18-65 years) Page 22 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are well maintained and appropriate for meeting the needs of people living there. Evidence: We found that all areas of the home were well maintained and provided a comfortable environment. Adaptations had been made to keep people safe and meet changing needs. For example, pictures were secured to the walls, hoisting equipment was available and assisted bathing equipment was provided. last inspection all windows had been checked regularly and restrictors were in place for safety and security. The manager told us of further plans for more new flooring in some rooms. Bedrooms were well decorated and personalised with individual items and photographs. People told us they had chosen the colours they wanted. Most people had lights and reflective images in their rooms, selected to meet their individual preferences. Staff told us that this equipment helped people to relax in the evenings. All areas were found clean and we saw that spillages were dealt with immediately. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient trained and supervised staff are provided to meet the needs of people at the home. Evidence: The manager was the nurse on duty and was responsible for the ground floor. A senior support worker was in charge on the upper floor. The rota showed that there were either two nurses or one nurse and one senior on duty at all times. In addition to this there were two other carers on each floor. They told us they move around if the need arises for more assistance on one of the floors. There were always male and female staff on duty. At night there was one nurse and one carer. Domestic staff were employed in addition, but there was currently no dedicated laundry worker, which meant care staff were involved with this role. The manager told us that a new laundry worker was being recruited. People living in the home said the liked the help they had from staff and there were photographs of the staff so that they knew who was on duty. Staff themselves felt there was a sufficient number of staff to meet care needs. Data information about staff showed us that the staffing team was made up from varying cultures, age and sexual orientation. This meant that people were allocated a key worker of the same cultural background. We saw in a sample of the staffing records that checks were made through the Criminal Records Bureau and two satisfactory references were received before new staff start work Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: with people at the home. The induction training included Fire safety, Dealing with Aggression, Safeguarding Adults, Moving and Handling and Infection Control. Staff then worked towards a Learning Disability Qualification. Staff told us on the returned survey forms that they appreciated the continual training available to them. In the Annual Quality Assurance Assessment (AQAA) form the manager told us that they employed six nurses; one senior care support worker who held a National Vocational Qualification (NVQ) level III and fourteen care support workers, nine who held the NVQ level II and two who were working towards their NVQ level III. All staff received mandatory training plus many other relevant training courses including non-violent crisis intervention training accredited by the British Institute of Learning Disabilities (BILD). All staff were employed subject to a three month probationary period and had an interim interview after each month. The manager told us that since the last inspection staff had 1:1 supervision meetings with a nurse or the manager every two months. We looked at a sample of records and found recorded meetings in February, April and June. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of people living there. Evidence: Either the registered manager or the deputy manager was in charge at the home during the day time. Both are registered Learning Disability Nurses. The registered manager was present during this inspection. We received the Annual Quality Assurance Assessment (AQAA) form from the manager after the inspection visit and it was comprehensively completed to give us the information we asked for. In this the manager told us that there were regular meetings held which allowed everyone to put forward their views and make comments on and suggestions for change or improvements to their personal lives, the home, the food and activities. Customer satisfaction questionnaires were sent out annually to all relatives and during the inspection visit, we saw five of these that had been returned. These were mostly very positive and the manager said that a report would be written in response to comments made. We also saw a the file of compliments received. One student nurse had observed, The residents were treated with love, care and respect. All aspects of care were seen met each day. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: Staff training certificates and discussions with staff have informed us that staff have received training in the safe working practices. Since the last inspection automatic release and closure mechanisms on doors have been replaced so that doors were not propped open. We also found that all windows had been assessed for security risks and restrictors fitted to promote safety. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 Ensure all handwritten entries on medicine administration sheets are signed and verified as correct. 30/11/2009 This is so that people always receive their medicines as a doctor has prescribed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 20 23 Monitor stocks of controlled drugs so that only the amounts required are kept on the premises. All transactions involving peoples money should be witnessed by a second person who should sign the record sheet. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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