Care Home: Parkview

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What the care home does well As at previous inspections we found that relations and interaction between residents and staff are excellent. Care workers are able to represent and support the views of residents, some of whom have limited means of communication. The staff and visitor all praised the management and said that any views or concerns they might have are always listened to and acted on where appropriate. We were told that the registered manager is supportive but runs the home for the benefit of the residents at all times. The home and gardens provide a pleasant and attractive home for the residents and the people who live there benefit from being able to use a wide variety of local facilities. Most of the care staff are trained to NVQ standards and when the remaining support staff finish their current training, all staff will have achieved NVQ at level 2 or 3. All staff also receive the specialist training which enables them to meet the current residents` variety of needs. People who use the service have their health needs met in an individual way and the staff take great care to ensure that residents are supported through any treatment they might need both inside of the home and in the community. What has improved since the last inspection? The manager has introduced advocates to some of the residents so that people can be sure all their views are understood and promoted at all times. The lighting in the home has been upgraded for the benefit of the residents. What the care home could do better: No requirements have been made as a result of this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Parkview 113 Sussex Road Watford Hertfordshire WD24 5HR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia House     Date: 1 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Parkview 113 Sussex Road Watford Hertfordshire WD24 5HR 01923230586 01923230586 viv.fenmore@turning-point.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) : Turning Point Southern Area Office care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 6 6 Parkview is a single storey, purpose built home, providing care for six service users who may have a learning disability or mental disorder. The home is also registered to provide services to individuals in these categories who are over sixty-five years of age. The home is situated in a residential area of Watford, at the end of a cul-de-sac and directly opposite a large park. The home has its own vehicle to transport service users. The main town of Watford is a short drive away, and provides extensive shopping and transport facilities, as well as a wide range of social opportunities. Parkview is one of the Turning Point group of homes. Copies of the homes Statement of Purpose and Service Users Guide are kept in the office, and together with the last CSCI inspection report, are available on request. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home The fees are funded by a Hertfordshire County Council block contract of £6485.31 per month for each person. Care Homes for Adults (18-65 years) Page 5 of 27 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: three star excellent 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 peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was completed on 26th June 2007. The information in this report is based on an unannounced inspection of the home, which took place over one day with one regulation inspector carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The registered manager was on duty throughout the day and we spoke with staff, residents a visitor and a student nurse. We visited all parts of the home and checked a variety of records. Care Homes for Adults (18-65 years) Page 6 of 27 Before the inspection the manager had completed and returned to the Commission an annual self-assessment quality review, the Annual Quality Assurance Assessment, (the AQAA).This document included statistical information about the home and confirmation of policy reviews and equipment checks. We have also reviewed any other information we have received about this service What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 27 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 9 of 27 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. Standards 1, 2, 3 and 4. People who use the service are given appropriate information and have their specialist needs fully assessed so that all parties can be sure the home is the right place for them to live. Evidence: The home has a written Statement of Purpose/Service Users Guide which is in an easy read format and displayed in the home. We spoke with a visitor who confirmed that the document has been provided for all relatives and is shared with the residents. We checked a selection of residents records and all contained written summaries of care needs, sent by referring agencies and detailed needs assessments completed by staff in the home. From this information care staff had completed initial care plans so that everyone could be clear about individual needs and how best to meet them. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: At previous inspections we found evidence that prospective residents are given ample opportunities to visit the home before deciding to move in. There is currently one vacant room in the home but staff confirmed that there would be no rush to fill the room and that they would take time to ensure that the room is offered to someone who would benefit from living at Parkview and who would fit in with the current residents. We observed really good interaction taking place between staff and residents and the relative we spoke with confirmed that the care workers had the skills to understand individual specialist needs and to meet them. Care Homes for Adults (18-65 years) Page 11 of 27 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. Standards 6, 7, and 9. Procedures followed by staff in the home ensure that the individual needs and choices of the people using the service are documented and that staff support all residents to pursue their wishes and take risks wherever possible. Evidence: We spoke with some residents although people living in the home have a variety of communication abilities. We then tracked some corresponding care records. Care planning is person centred and we saw evidence of residents involvement, to varying degrees. The planning is in pictorial format to enable the people who use the service to take part in the recording. The care plans gave detailed information about care needs and means of communication and had reviews recorded which were up to date. We saw details recorded of the advocates used by some of the residents to ensure their particular choices and aspirations can be independently understood. We also saw Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: records of the end of life choices some residents had made. The care staff we spoke with confirmed that wherever possible residents were supported to take risks if this was their wish. Written risk assessments are included in the care plans we saw together with details of the control measures taken to minimise the risks. Care Homes for Adults (18-65 years) Page 13 of 27 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. Standards 12, 13, 15, 16 and 17. People who use the service remain part of the community and enjoy a range of leisure activities. Residents enjoy a healthy diet which adds to their overall well being. Evidence: We saw written details of the daily activities which people living in the home take part in. Residents attend a variety of day centres and colleges where differing courses are offered according to need and ability. One member of staff said that a large part of their role was now arranging activities for the residents. We were told about trips out which had been enjoyed including a trip to Clacton which took place the previous week. Care staff said that residents enjoyed going to the local shops and to cafes and restaurants in the town. The home has its own vehicle so that residents can be taken Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: out with ease. Staff also said that they provide activities in the home which include massage and manicures and that the residents all like to listen to music. The day of the inspection was warm and sunny and the doors to the garden were open so that people could go outside when they wanted. Residents confirmed they enjoyed the garden and there is a vegetable patch which is tended by one resident who has an interest in gardening. The manager confirmed that all residents are registered to vote in elections so that they can be part of the democratic process if they wish. The relative of one resident told us they were welcomed in the home at all times and that visitors were encouraged to take part in events and in decisions about the home. The mid-day meal was prepared and eaten during the visit and residents indicated they enjoyed the food provided. Care staff said that all residents were involved in meal planning. The home uses a four week rolling menu plan which was displayed and appeared well balanced. A recent visit from an Environmental Health Officer has resulted in the home being awarded a commendable four stars for their kitchen standards. Care Homes for Adults (18-65 years) Page 15 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 18, 19 and 20. People who use the service can be sure their health needs will be met in a manner they prefer and confident that the system in the home for administering medication is thorough and helps to protect them from harm. Evidence: During the inspection we saw details of peoples preferences about personal care recorded on care plans and saw the records of how these choices were implemented. Care staff described how routines for personal hygiene and dental care were actioned and records showed the appropriate support provided by health professionals. Care staff of both genders work at the home and residents can make their own choice about which staff support them. We saw specialist equipment provided in bedrooms and bathrooms around the home and care plans described their use linked to each individual. We saw evidence recorded of residents frequent health checks and of appropriate Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: referrals to other professionals when required. We spoke with a student nurse who was working at the home on a training placement. The nurse said that, prior to coming to Parkview they had worked on a ward at the local general hospital and had been very impressed with the procedures followed by staff from the home when a resident was admitted to hospital. The nurse said that a member of staff who knew the person concerned well was always with them on the hospital ward and was able to reassure the resident and able to communicate any specific needs to the hospital staff. The nurse said this liaison was not something that staff from other homes had managed to provide and it had made a big difference to the individuals experience of their hospital stay. A relative we spoke with during the inspection also praised the care the staff took to ensure all the residents health needs were met and their good health promoted. We checked the system for the administration of medication in the home. The system is basically sound and staff have all received accredited training in administering medication. The manager has ordered a fridge which will only be used for medication. The homes medication policy was updated on 30th March this year. We just suggested that a written protocol for any verbal changes is added together with time scales for staff refresher training. Since the inspection the manager has confirmed that all staff have attended a two day refresher training course on all aspects of medication in care homes and confirmed that staff competencies will be checked and signed off annually. Care Homes for Adults (18-65 years) Page 17 of 27 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. Standards 22 and 23. People who use the service can be confident that any concerns they might have will be listened to and acted on and that procedures followed by staff in the home help to protect them from the risk of abuse. Evidence: The home has written policies on complaints, whistle blowing and adult protection. The staff we spoke with said they were aware of these and their implications. The visitor we spoke with said they were fully aware of the homes complaints procedures and the policy is provided in pictorial format for the benefit of the residents. The manager demonstrated a full awareness of the procedures for safeguarding issues used by the joint agencies in Hertfordshire and records showed that staff had all received this training in the past. Such training is provided corporately by the owning company and appears to be provided every three years. The manager said she will ensure that all staff at Parkview receive updates of safeguarding training annually to be sure that procedures followed are current and that residents are protected from abuse at all times. Care Homes for Adults (18-65 years) Page 18 of 27 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. Standards 24 and 30. People who use the service benefit from living in a well maintained home where the procedures followed help to protect residents from any unnecessary risk of infection. Evidence: We visited all areas of the home briefly and all areas were well decorated, very clean and looked well maintained. The manager had provided details of the servicing and equipment checks which have taken place at the home in the returned AQAA document. The home provides spacious accommodation, necessary for the needs of the residents, but is welcoming and homely at the same time. Bedrooms reflect the individual interests of the residents concerned and we saw that appropriate specialist equipment had been provided where this was indicated as a need in the persons care plan. The gardens at the front and back of the home looked lovely and these are planted and tended by the staff, (one staff member in particular) who encourage residents to help so that all the people living in the home can enjoy a colourful and pleasant outside area. All bathrooms and toilets contained liquid soap and paper towels, as recommended for Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: good infection control. Care Homes for Adults (18-65 years) Page 20 of 27 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. Standards 32, 33, 34 and 35. People who use the service are appropriately supported by sufficient numbers of staff who are well trained and professional in their approach. A thorough recruitment system is in operation which protects residents from the risk of harm. Evidence: We checked a selection of staff recruitment records and in all cases saw evidence that all necessary checks had been confirmed before candidates started work at the home. Written references were appropriate and had also been verified by the manager. Application forms had been completed in detail and provided full work histories. Every member of staff also completes a probationary period which is documented and has records detailing assessments and performance and development planning. Every member of staff working at the home has their photograph and work title on display for the benefit of residents and visitors. The manager confirmed that there are usually two or three care workers on duty at the home as well as the manager, but on the day of the inspection we found four care staff on duty plus the manager and the student nurse. The extra staff were on duty as Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: service user reviews were taking place in the office and different staff members would be involved in these meetings. The extra staff ensured that the residents in the home on that day still had all their needs met. We spoke with some staff members and they confirmed they had completed a range of training courses including adult safeguarding and had achieved the NVQ training award. The manager confirmed that two of the care staff have completed NVQ level 2 training and four have completed level 3. One staff member is also a registered nurse. Specialist training relating to the needs of the residents in the home is also provided for all staff and courses completed include the Administration of Rectal Diazepan, Challenging behaviour, Working with People with Complex Needs, Communication Skills and Loss and Bereavement. The more basic, but essential training courses are provided by the owning company on a timed rolling programme. We saw the details of these courses and found that the frequency of some of these courses was not adequate to ensure that all staff have their skills kept up to date. The manager will discuss this with her line managers and said she will complete a new training overview and will ensure that the staff in Parkview all receive regular refresher training. Care Homes for Adults (18-65 years) Page 22 of 27 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. Standards 37, 39 and 42. People who use the service can be confident the home is well run, that their views will be listened to and acted on and that procedures followed by staff will help to ensure that both residents and staff have their welfare promoted at all times. Evidence: The staff and visitor we spoke with praised the management of the home and confirmed that the registered manager was supportive and always listened to their views and included them in the running of the home. We were told that every area of the home is run for the benefit of the residents. We found all the records we examined properly documented and up to date and saw evidence of the regular monitoring completed by the manager to ensure significant trends are monitored and changes are made if any risks are identified. We saw records of the staff and residents meetings which staff confirmed are held Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: regularly. We saw the records detailing the Quality Assurance system which is in operation in the home and which is used to ensure that both residents and stakeholders have their views considered in the homes daily running. We checked the homes fire safety records and accident and incident recording and all records were being well kept. We tracked the system for handling residents personal allowances and checked one residents cash and records. All areas were being thoroughly recorded and audited and amounts of money were accurate. We also saw a relative sign the Visitors Book when they arrived and they told us that all visitors are aware this record is completed when they enter the home. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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