Care Home: Park View (Streatham)

What the care home does well Prospective residents are able to visit the service before making a decision to move in for a trial period and their needs are assessed before a placement is offered. Residents have adequate information about the services provided in the home and their individual needs and aspirations are assessed and recorded in a written plan. People have an opportunity to visit the home for a trial period before making a decision to move in. Residents live in a clean, comfortable and safe environment. There is a range of communal areas and the gardens have been improved and provide residents with a pleasant outdoor space. Assessed and changing needs and goals are reflected in written plans for how care is to be provided to each resident. Residents are consulted about their personal plans and about wider house issues. Personal information is stored securely and staff understand the need for confidentiality. There is regular consultation with residents and their views and suggestions are acted upon. Residents are able to enjoy the lifestyle of their choosing within the confines of shared living and house rules. Residents receive personal care in the way they need and in the way that they prefer. Physical and emotional health is well monitored and staff assist residents to make and attend appointments if necessary. Medication is handled well by staff and residents are encouraged to take responsibility for their own medication where possible. People can work and attend college whilst living in the home and they can also maintain their friendships and relationships. The home manager responds to complaints well and encourages residents to use the complaints procedure. Staff are trained to recognise abuse and they know what to do if they suspect someone is unsafe or being abused. The manager is registered and experienced and the staff and residents know him well. Residents said they would go to him if they wanted to complain or raise a concern. What has improved since the last inspection? A written guide to the services provided is currently under review and has been improved with the addition of colour photographs and symbols to make it more accessible and interesting. There is evidence that residents are more involved in preparing the written plans detailing how they need/want to be cared for and supported. There are more opportunities for residents to develop their independent living skills within a risk management framework that ensures that residents are given the right amount of support as their skills increase.Residents have more control of the temperatures in their own bedroom. Central heating radiators have been fitted with new thermostatic controls and residents can turn the heating up or down as they wish. There is now an attractive area outside the main kitchen. A barbeque and cooking area with a sink has been fitted and the garden courtyard has a fountain and pleasant seating areas. There is progress in developing a qualified staff team and staff recruitment procedures are more robust. This ensures that residents are protected. The home is well run and the manager is updating his qualifications. More is being done to get feedback from all stakeholders about how the service is run and the registered provider is monitoring the home properly. CARE HOME ADULTS 18-65 Park View (Streatham) 17 Streatham Common South Streatham London SW16 3BU Lead Inspector Sonia McKay Unannounced Inspection 25 September 2008 08.25a th Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 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 (Streatham) DS0000022747.V366101.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 Adults 18-65. 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 (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park View (Streatham) Address 17 Streatham Common South Streatham London SW16 3BU 0208-679-2364 0208 679 2364 crownwise@yahoo.com 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) Crown Wise Limited Mr Allen Amuaku Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 17 21st August 2007 Date of last inspection Brief Description of the Service: Parkview is a private residential home for seventeen adults with mental health needs. It is one of three homes in the locality owned by the same proprietor. The large detached home is in a residential street overlooking Streatham Common, within walking distance of transport links, shops and leisure facilities. The majority of service users have been at the home for many years and the home aims to provide them with the various degrees of support. Where appropriate, the home also helps to prepare service users for independent living. A written guide to the home is available on request at the home. A copy of the most recent Commission inspection report is also available in the home. Fees range between £273.00 per week and £978.36 per week and vary in accordance with the level of support required for an individual. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience Good quality outcomes. This inspection was carried out in 7.5 hours. The methods used to assess the quality of service being provided were: • • • Talking with the registered home manager Talking with both deputy home managers and other staff on duty Looking at the ‘Annual Quality Assurance Audit’ which was completed by the registered home manager before the inspection (this document is sometimes called an ‘AQAA’ and it provides the Commission with information about the service) Talking with residents individually and in a small group over lunch Talking with a visiting Community Psychiatric Nurse (CPN) A tour of the communal areas of the premises Looking at records about the care provided to three of the residents Looking at records relating to recent staff recruitment and training Looking at the way medicines are handled by staff in the home Looking at issues that the Commission has been notified about since the last inspection and how they were handled Sending surveys to residents, relatives, staff and visiting professionals Completed surveys were received from five residents and two members of staff • • • • • • • • • The Commission would like to thank all who kindly contributed their time, views and experiences to the inspection process. What the service does well: Prospective residents are able to visit the service before making a decision to move in for a trial period and their needs are assessed before a placement is offered. Residents have adequate information about the services provided in the home and their individual needs and aspirations are assessed and recorded in a written plan. People have an opportunity to visit the home for a trial period before making a decision to move in. Residents live in a clean, comfortable and safe environment. There is a range of communal areas and the gardens have been improved and provide residents with a pleasant outdoor space. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 6 Assessed and changing needs and goals are reflected in written plans for how care is to be provided to each resident. Residents are consulted about their personal plans and about wider house issues. Personal information is stored securely and staff understand the need for confidentiality. There is regular consultation with residents and their views and suggestions are acted upon. Residents are able to enjoy the lifestyle of their choosing within the confines of shared living and house rules. Residents receive personal care in the way they need and in the way that they prefer. Physical and emotional health is well monitored and staff assist residents to make and attend appointments if necessary. Medication is handled well by staff and residents are encouraged to take responsibility for their own medication where possible. People can work and attend college whilst living in the home and they can also maintain their friendships and relationships. The home manager responds to complaints well and encourages residents to use the complaints procedure. Staff are trained to recognise abuse and they know what to do if they suspect someone is unsafe or being abused. The manager is registered and experienced and the staff and residents know him well. Residents said they would go to him if they wanted to complain or raise a concern. What has improved since the last inspection? A written guide to the services provided is currently under review and has been improved with the addition of colour photographs and symbols to make it more accessible and interesting. There is evidence that residents are more involved in preparing the written plans detailing how they need/want to be cared for and supported. There are more opportunities for residents to develop their independent living skills within a risk management framework that ensures that residents are given the right amount of support as their skills increase. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 7 Residents have more control of the temperatures in their own bedroom. Central heating radiators have been fitted with new thermostatic controls and residents can turn the heating up or down as they wish. There is now an attractive area outside the main kitchen. A barbeque and cooking area with a sink has been fitted and the garden courtyard has a fountain and pleasant seating areas. There is progress in developing a qualified staff team and staff recruitment procedures are more robust. This ensures that residents are protected. The home is well run and the manager is updating his qualifications. More is being done to get feedback from all stakeholders about how the service is run and the registered provider is monitoring the home properly. What they could do better: 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 (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents are able to visit the service before making a decision to move in for a trial period and their needs are assessed before a placement is offered. This means that the home manager is able to assess whether the service can meet the person’s needs and make initial plans for how this will be done. Some long standing residents thought that they were not given enough information about the service before moving in. A written guide to the services provided is currently under review and has been improved with the addition of colour photographs and symbols to make it more accessible and interesting. The guide does not contain adequate information about how the fees are spent and this must be added. EVIDENCE: There are two documents that provide information about the services provided, a statement of purpose and a service users guide. The service users guide contains a summary of the information provided in the statement of purpose and additional information about the services provided, the home environment and the outcomes of resident satisfaction surveys. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 10 During the previous inspection a requirement was made as the ‘resident’s guide and associated individual contracts did not provide sufficient detail about costs of a standard package of service. The terms and conditions (including fee levels) that apply to key services (both personal care and food) and the payment arrangements (resident contribution/local authority contribution) are not stipulated. The guide must also state whether the terms and conditions (including fees) would be different in circumstances where a person’s care is funded, in whole or in part, by someone other than the resident. A requirement was made about this in the last inspection report. There is some progress in updating the service users guide and colour photographs and symbols have been added to the document to make it more accessible, although there is still insufficient information about fees and what they are used for. (See requirement 1) There have been no admissions to the home since the last inspection visit. During the previous inspection it was assessed that adequate pre-admission information is obtained and care needs are assessed and developed into an initial care plan before placement is offered. Prospective residents are offered an opportunity to visit the service before moving in for a trial period. Feedback from four of the current residents indicates that they did not receive enough information about the home before moving in. Care must be taken to ensure that the written guides are distributed to prospective residents and that there is ample time for them to learn more about the home during resettlement. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Assessed and changing needs and goals are reflected in written plans for how care is to be provided to each resident. Residents are consulted about their personal plans and about wider house issues. There are more opportunities for residents to develop their independent living skills within a risk management framework that ensures that residents are given the right amount of support as their skills increase. Personal information is stored securely and staff understand the need for confidentiality. EVIDENCE: Each resident has an allocated key worker; responsible for meeting with the resident on a regular basis and updating the care plans. Care plans are reviewed regularly and are in accordance with decisions made in the care programme approach (CPA) meetings also held with the majority of residents. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 12 The three care plans examined during this inspection were comprehensive and up to date. Goals are set and there is evidence of evaluation of whether and how plans and goals have been achieved. During the last inspection it was noted that some plans had not been agreed with the resident themselves (there was no evidence that the resident had read and signed their agreement to the planned care arrangements). The three sets of care plans examined during this inspection had been signed by the respective residents. A requirement made in this regard is therefore met. Staff respect peoples rights to make decisions, and that right is limited only through the assessment process, involving the resident and as recorded in the persons care plans. Residents choose when to get up, when to go to bed and how to spend their time. They are consulted on and involved in making decisions about daily menus, activities and house issues. The registered provider sends each resident a questionnaire every month. This consultation relates to a wide range of user satisfaction topics and provides people with an opportunity to inform decisions about the range of activities provided by staff and other house issues. The outcomes of these consultations are also discussed in regular and recorded house meetings, when residents, who wish to, can meet as a group with members of staff. Each resident has detailed risk assessment around any known risk areas and this reflects the risks identified in care needs assessments and CPA review notes. Risk assessments are reviewed along with care plans or when new risks are identified. As recommended in the previous inspection report, there is now an increasing focus on supporting residents to develop their independent living skills. Staff have a risk assessment audit tool in place to enable them to do this safely. This tool enables staff to assess the risks associated with activities of daily living, such as cooking, and to develop appropriate support plans. This is a way of ensuring that residents do not receive too much or too little support. Missing persons procedures are in place and the staff respond promptly to any unexplained absences by notifying the appropriate authorities. Written information is stored securely and staff understand the need for confidentiality. There is a policy about maintaining confidentiality and staff were observed to ensure that individual care issues are not discussed in areas of the home where confidentiality is not ensured (for example, in communal areas). Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are able to enjoy the lifestyle of their choosing within the confines of shared living. There is a range of activities available in the home but there is some indication that they are in need of review. People can work and attend college whilst living in the home and they can also maintain their friendships and relationships. Meals are enjoyed and menus consider cultural needs, health needs and preferences in most cases. EVIDENCE: Resident’s comments about life in the home include: “ I am allowed to be on my home in my assigned room with visitors if I wish or when I wished to maintain my solitude ”. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 14 “ I only have one suggestion about how the service could be improved. Maybe we could get a communal Internet connection”. “ The meals have become repetitive of late, there should be more variety, but on the whole the food is always well presented and served fresh and hot ”. “ I am allowed to develop my skills and earn a small additional supplementary allowance by volunteering my abilities doing ancillary works such as restocking supply cupboards in the home and shopping. I am empowered by this work and I have my dignity respected and rewarded ”. “ As an added extra treat we have an outing to the seaside and also a catered summer barbecue with no expense spared which is well attended ”. Residents are able to maintain their friendships and relationships. Family and friends are welcomed, and with the resident’s agreement are involved in meetings and activities. However, house rules do not allow for overnight visitors, although people can have guests in their private bedrooms. Many residents have lived in the homes for a long time and a social network has developed with residents in two other care homes in the area (also owned by the registered provider). Residents were observed to be going out shopping, to visit a café and other local facilities. Some regularly attend daycentres. A range of the recreational activities is available including art classes, social evenings and occasional day trips to the seaside. There is an ‘in-house’ social gathering each Saturday evening and there is also a movie projector and screen for regular movie nights. There are manicure days. There are quiet areas for people to relax in and many enjoy the garden and courtyard. There is a lounge with a games machine and television. Annual holidays are not part of the package of care provided by the home. (See recommendation 1) The opportunities for social activities are generally limited to group activities. Whilst there is value in such activity, and some residents said they enjoyed having people over, feedback from others indicates that not all are so happy for their home to be used in this way. There should be an option for residents who may not want to have their evening meal during a social gathering scheduled for each Saturday. (See recommendation 2) Some residents are involved in employment and college courses. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 15 Times for getting up and going to bed are not fixed. Residents are offered a key to the front door and to their own bedroom and all bedrooms and bathrooms can be locked from the inside. Records are kept of all main meals served in the home. Meals are prepared by a cook and served in the communal dining room at reasonably set times, although residents wishing to have a meal later can do so. I had lunch with a group of residents in the pleasant communal dining room. There were several meal options and the food tasted good and was served hot. There are small dining tables and residents sit in small groups, staff eat the same meals but in their break-times. A reasonably varied range of meals is provided, including some culturally appropriate meal options and themed menus for social evenings, such as Indian, Irish, African and Caribbean. Health needs, such as diabetes, are catered for and all meat served is Halal, as some residents are Muslim. The bulk of the food provisions are stored in a locked pantry in the basement. Provisions available include fresh fruit and vegetables and food is stored hygienically. There are more opportunities for residents to plan, shop and prepare their own meals. This is of great benefit for residents who wish to move to their own homes in the future. The home manager plans to provide better nutritional support in the coming year, with advice from peoples GPs as necessary. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff support residents to maintain their physical and mental health and can provide support with personal care if necessary. Medication is handled well by trained staff and residents are encouraged to take responsibility for looking after and taking their own medication where possible. EVIDENCE: A resident commented about staff support with issues of health and personal care: “ I am allowed to maintain my personal dignity when attending my personal hygiene bathing daily regimen. There are locks on all toilet doors. The care home staff are very understanding in that they do not harass or cajole me in this respect”. “ Assistance is always proffered if liaising between the NHS surgery or hospital becomes necessary, for example phone calls and appointments. There is also adequate logging of health records, medication records and any visits to the Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 17 doctors or outpatients clinics. Privacy and necessary sensitivity are also maintained when dealing with correspondence”. One resident explained that staff sometimes try and help by trying to check his wardrobes and advise him of what might need to be thrown away. He finds this to be an invasion of his privacy. Care should be taken to negotiate the type of support that is needed for people to maintain their personal space as staff routinely check bedrooms to try and maintain environmental health and safety. (See recommendation 3) People are generally able to manage their own personal care with little more than occasional reminders or advice. When a resident needs assistance with things like washing and bathing, the nature of the support required by staff is carefully detailed in a written care plan. Assistance with personal care is given in the privacy of bedrooms or bathrooms. There are both male and female staff and staff from a diverse range of cultures. This is reflective of the resident group and local population. There is a written record of the physical and psychiatric healthcare attended by each resident. The cases tracked during this inspection show that an appropriate range of healthcare professionals are involved and residents also receive support to make and attend appointments if necessary. All residents are registered with a local GP practice and most have input from community based psychiatric nurses. A CPN (Community Psychiatric Nurse) visited a resident in the home during the inspection. He spoke positively about staff support and communication with his health team and said, “ The service is improving. There is more rehabilitation work going on and staff always call me if they notice a change in someone or their mental health deteriorates “. A District Nurse also visited to do blood tests for a resident with diabetes. She said, “ Staff ask questions and take our advice on board. They work well. We have no concerns”. Accidents are recorded in an accident book that is in accordance with Data Protection legislation. Staff seek emergency medical advise as necessary. Medication is stored in a secure medicine cabinet in the office and is administered by staff. There is also special storage for controlled drugs if any are prescribed and a refrigerated medication cabinet for medications that must be kept chilled. Temperatures are monitored and recorded to ensure safe storage. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 18 Medicines are supplied by a local pharmacy, mostly in blister packs. The supplying pharmacist regularly inspects the handling of medication in the home and the most recent report of February 2008 indicates that the pharmacist is satisfied with the arrangements in place. Only staff who have been trained in safe administration can administer medication. A sample signature list of trained staff is available. There is a clear audit trail of medication entering and leaving the home and procedures around the administration of controlled drugs are robust. Justified stock checks take place regularly and the outcomes recorded. This is a check on whether medication is being administered properly. There are no gaps in recordings on the MAR charts examined during this inspection (Medication Administration Records). Staff also retain a record of medications such as depot injections and insulin administered by others (CPN and District Nurses). This ensures that staff have an accurate record of what medication people have had and when. This information is critical in a medical emergency. Residents are supported to be responsible for taking their own medication where possible. A resident commented,” I have been self-medicating since 2005 and staff assist me in maintaining my medication administration record sheets and by collating at the end of each month”. Appropriate lockable storage is available in bedrooms. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home manager addresses any complaints and gives the person making the complaint feedback about what has been done. Residents are encouraged to use the complaints procedure and to raise any concerns that they might have. Staff are trained to recognise abuse and what to do if they suspect someone is unsafe or being abused. Record keeping must be improved to ensure that valuable items are properly accounted for. This will better protect residents from possible financial abuse and exploitation. EVIDENCE: A resident commented, “I have never been at a loss to be able to adequately communicate my needs and concerns to staff”. All residents who completed surveys or spoke to me said that they knew how to make a complaint and felt able to do so. There is a complaints procedure, which includes timescales for investigation and feedback. The complaints procedure is given to each resident in the written guide to the home. A copy of which is available in each bedroom. The record of complaints shows that have been two complaints made since the last inspection visit. Both complaints were allegations about staff conduct. Both were investigated and unsubstantiated. In one case the investigation was carried out with the input of a local authority social worker. These allegations were not reported to the Commission. (See requirement 2). Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 20 There is evidence of the feedback each complainant is given, as required in the previous report. This is important so that people are reassured that their complaints have been listened to and if necessary, acted upon. Procedures are in place for responding to suspicion or evidence of abuse or neglect (including whistle-blowing) and for referring staff that may be unsuitable to work with vulnerable adults for inclusion on the protection of vulnerable adults register. There have been no adult protection issues referred to the local authority safeguarding adults team since the last inspection visit. Staff demonstrate an understanding of the occasional verbal aggression by residents and deal with it appropriately. Physical intervention is not used. The homes policies and practices regarding looking after people’s money and financial affairs ensure their protection from financial abuse. Staff have received training in the protection of vulnerable adults. Most residents are able to manage their own finances. The registered provider acts as the state benefit appointee for some residents and residents can also ask staff to keep their money in safe-keeping to help them with budgeting. Good records are kept of these accounts and receipts are obtained for expenditures. A spot check of money held in safekeeping showed that detailed and accurate records are maintained. There is no record of each resident’s valuable personal possessions. This record should be kept to ensure ownership of items is clear. (See requirement 3) Whilst cash belonging to residents held in safekeeping is well accounted for and recorded there is no record of valuable documents also sometimes held in safekeeping. For example, bank books and passports. (See requirement 4) Records are kept of any accidents and incidents. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a clean, comfortable and safe environment. There is a range of communal areas and the gardens have improved and provide residents with a pleasant outdoor space. EVIDENCE: Comments from a resident include: “We always have new furnishings to use and rooms are always central heated with no rationing of essential utilities. Its a pleasant place to live. In the past two years there have been positive improvements in and around the home. The handyman is forever kept busy cleaning, renovating, painting, grooming the courtyard and quadrangle”. The home is clean, well furnished and attractively decorated. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 22 There is a ground floor communal dining room that is also used for social activities. There are two more communal lounges on the second floor, both with roof terraces. There are front and back garden paved areas with shrub planting, hanging baskets and seating. A large barbeque and seating area has been built in the back garden since the last inspection. This means that residents can make more use of out door space and enjoy some meals outside in good weather. A programme of cyclical redecoration is ongoing and recent improvements include the addition of a barbeque and cooking area outside the main kitchen. There is good access to local amenities, services and transport links. The home overlooks Streatham common, an open green space. There are 14 single bedrooms and one double bedroom. The use of shared bedrooms is being phased out, and there are now only two people sharing a bedroom. This is positive, as rooms should only be shared if people request this. Eight bedrooms have en-suite facilities. There are twelve shower facilities, two bathrooms, and fifteen toilets. There is a communal laundry in the basement. Although there are four bedrooms situated on the ground floor, the home is not suitable for people with a physical disability as the only accessible communal area is the ground floor dining room. As required in the previous inspection report, residents can now adjust the central heating radiators in their own bedrooms. New thermostats have been fitted. As there is new legislation about smoking in public. This affects the communal areas of the home. Residents can now only smoke cigarettes in the garden or in some instances their own bedroom. Some residents are still concerned about passive smoking risks and the unpleasant smell. The staff must continue to try to ensure that residents abide by house rules and wider legislation in this regard. (See recommendation 4) There is a payphone in a ground floor communal hallway. It is currently not easily used by residents as one resident uses it frequently. The payphone is often damaged and cannot be used. The home manager is trying to address this challenging situation, but a suitable solution has yet to be identified. The manager said that if the payphone is not available or working residents can ask staff to use the office telephone. This is not ideal. (See recommendation 5) Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is progress in developing a qualified staff team and staff recruitment procedures are more robust. This ensures that residents are protected. There are plans to further develop and train the staff team. EVIDENCE: A resident commented, “I have always found them (the staff) all to be equally committed and selfless in giving time to attend to my views/care. Another resident said, “The staff are getting better”. Observations of interactions between staff and residents during lunch indicates that there are good relationships and staff show understanding, tact and a thoughtful response to situations as they arise. Feedback about staff from visiting health professionals is positive. The home manager states in the AQAA. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 24 ‘Of the current 15 care staff, 5 have obtained an NVQ (National Vocational Qualification in Care) at level 3 and 8 have the NVQ at level 2, 3 are currently taking the Level 3.’ This shows good progress in developing a qualified workforce. There is a staff training and development plan in place. This ensures that staff receive mandatory training and appropriate refresher course updates for things like first aid and fire safety and areas of training specific to the needs of the resident group. There are also plans to provide update training in infection control. There are male and female staff on the team and staff reflect the cultural diversity of the resident group and local population. Recruitment records for one new member of staff were examined and all documents and checks have been completed as required. However, reexamination of a staff file that resulted in a requirement in the previous inspection indicates that an additional criminal records check had not been taken up. The member of staff has a recent CRB check but it was taken up by another care provider and CRB checks are not transferable. The home manager said this was an oversight, as new staff have been recruited in accordance with legislation. An immediate requirement was issued. The immediate requirement states: ‘Staff cannot work in the home without a POVA First check and/or a satisfactory criminal records check’. Care Homes Regulation 19. The registered home manager took immediate action to safeguard residents by suspending the member of staff from active duty in the home and organising the updated criminal records and POVA check. The member of staff will not be re-instated until satisfactory checks have been taken up. An induction record examined indicates that new staff are supported and trained when they start work in the home. Staff also receive support through regular team meetings, supervision and appraisal. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well run and the manager is updating his qualifications. More is being done to get feedback from all stakeholders about how the service is run and the registered provider is monitoring the home properly. Record keeping must be improved to ensure residents are safeguarded. EVIDENCE: The registered manager has been in post for many years and has a medical qualification. He is competent and experienced and, as required in the previous inspection report, he is currently undertaking an NVQ at level 4 and the RMA (Registered Managers Award). There are now two deputy home managers. Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 26 There are quality-monitoring systems in place that are based on seeking the views of the residents. The results of these topical surveys are published and made available to residents, along with the action that is being taken to address any specific issues identified in the consultation. The views of other stakeholders (for example health professionals, families and advocates) in regard to how the home is achieving goals for service users are also sought. As required in the previous inspection report, the registered provider completes monthly home monitoring visits and provides the manager with written feedback about the outcomes of these inspections. There is generally good compliance with requirements made by the Commission. A record is kept of any accident, and action taken as a result. This includes use of emergency services as required (for example, calling an ambulance). Steps are taken to ensure environmental safety; such as risk assessment and having gas and electrical equipment professionally safety tested each year. There are regular fire evacuation drills and tests to make sure that the fire detection equipment is working properly. A fire safety office conducted a home inspection during this inspection and he spoke positively about the fire safety arrangements in place. Employers Liability Insurance is in place and the certificate is displayed in the staff office. The registration certificate is up to date and is also displayed. As mentioned earlier in this report, there are some areas of record keeping that need improvement. There is no record of each resident’s valuable personal possessions. This record should be kept to ensure ownership of items is clear. (See requirement 3) Whilst cash belonging to residents held in safekeeping is well accounted for and recorded there is no record of valuable documents also sometimes held in safekeeping. For example, bank books and passports. (See requirement 4) Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement The registered person must revise the service users guide in accordance with recent changes in legislation. Although there is progress, the timescale (30/11/07) given for action to be taken to meet this previous requirement has passed and the requirement is not met. A new timescale is given for completion. The registered person must notify the Commission if any allegation is made about the misconduct of any registered person or member of staff. There must be records of valuable items (for example, passports and bank books) belonging to residents that are held in safekeeping. Each resident must have an inventory of possessions (including aids, furniture and valuables) so that ownership is clear. Timescale for action 31/12/08 2. YA23 37 31/10/08 3. YA23 17 31/10/08 4. YA23 17 30/11/08 Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 29 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. 2. 3. Refer to Standard YA14 YA17 YA18 Good Practice Recommendations The registered person should try and arrange annual holidays for each resident. The needs of residents who may not want to join in activity evenings and communal meals with residents from other homes should be better considered and catered for. The nature of support needed by residents to maintain the safety of their personal space should be considered and agreed with each resident. Staff should be sensitive and mindful not to invade anyone’s privacy when doing any necessary environmental safety checks. The registered persons should take steps to ensure compliance with recent changes in legislation about smoking in communal areas and protect residents from passive smoking. Residents must have access to a telephone at all times. Residents should be able to make calls in private. 4. YA28 5. YA26 Park View (Streatham) DS0000022747.V366101.R01.S.doc Version 5.2 Page 30 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. 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