Care Home: Parkview

What the care home does well The home is being well managed. This can be summarised by one commentator who said, I feel the support of residents is excellent. Park View provides a well planned physical environment for residents with plenty of space to wander in safety, both within the building and into the enclosed central courtyard. Although storage space is at a premium other facilities are good, including bedrooms, lounges, bathrooms and the numerous offices for the staff team. Care planning is good and the support of the University of Canterbury in advising on best practice in dementia care is commendable. The staff team seem very loyal and very professional in their approach and the manager acknowledges that the staff team works well together. What has improved since the last inspection? The manager has addressed the few requirements issued when we last visited in 2007. Care Plans, for example have been updated very recently and we checked a number to see that they reflect the current and diverse needs of residents. Accident and complaint records are now satisfactory, we commend the manager for undertaking regular analysis of these two important areas so that lessons can be learned from any untoward incidents. On this occasion no serious problems were identified in our assessment of the procedures for dealing with medicines. The home made changes to the seating arrangements in the lounges so that when the home is full all residents will be able to sit in the main lounges if they choose to do so. Other seating is available in quiet areas to give choice. What the care home could do better: One of the bedroom doors, which are fire doors, was wedged open so we recommend that magnetic door holders are used in any situation where residents prefer a fire door to be held open. We also noted that the window restrictors need to be reviewed to ensure they provide adequate security and safety for the home and residents. We also noted that there were not over ride buttons on final exit fire exits that are controlled by digital locks, although there were key operated devices for doing so. It is recommended that this is also reviewed. We noted that the front door had bolts that would require a key to release them and so these must be replaced by a simple single action bolt mechanism that would not restrict egress in an emergency. We also noted that stairwells are being used as storage space, indicating the need for more storage space for items such as wheelchairs and hoists. Stairwells must be kept free of such items. Amongst the various feedback comments we received one asked that the home provide a few more local outings and local trips and so this suggestion is passed on to the manager. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Parkview 105 Woolwich Road Bexleyheath Kent DA7 4LP     The quality rating for this care home is:   two star good 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: Michael Williams     Date: 2 1 1 0 2 0 0 8 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 Older People 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 Older People Page 2 of 25 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Parkview 105 Woolwich Road Bexleyheath Kent DA7 4LP 02083037889 02083048017 jane.kingsmill@kcht.org.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) : Kent Community Housing Trust care home 69 Number of places (if applicable): Under 65 Over 65 69 dementia Additional conditions: 0 The maximum number of service users who can be accommodated is: 69 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Date of last inspection Brief description of the care home Park View is a purpose built care home providing accommodation to 69 older people who have dementia care needs. The home has 69 en-suite bedrooms, arranged in four units over two floors, 30 rooms on the ground floor and 38 on the first floor. The home has two passenger lifts. Each of the four units has their own combined lounge dining areas.The home is located in a residential area in Bexleyheath in the London Borough of Bexley, and has good road, rail and bus links with reasonable access to local shopping and leisure facilities. The home is part of the Kent Community Housing Trust. The home has a day centre on site, which offers care to elderly people with specialist dementia care needs. The home has car parking to the front of the building and two attractive, well equipped integral garden areas accessible to the residents and their visitors. fees are from 595GBP as at Octber 2008. We are advised that there have Care Homes for Older People Page 4 of 25 Brief description of the care home been no changes to the details of the registered providers since we last inspected it in 2007 but the new manager, in 2008, is Claire Evans. Care Homes for Older People Page 5 of 25 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We made a site visit to this care home in October 2008 when we spoke to many of the residents. We also met with visitors including families and visiting professional staff. We also interviewed some of the staff and the manager. We toured the building to check for safety and comfort. We also checked a wide range of records and documentation. In addition to the site visit we also took account of information provided to us since the previous inspection and we noted the content of the homes AQAA, this is their Annual Quality Assurance Assessment. Care Homes for Older People Page 6 of 25 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Information provided and assessments at the time of admission are well organised. So residents will be well informed about the service and its capacity to meet their needs. Evidence: We met with many of the residents living in Park View and we also had the opportunity to meet several relatives. Whilst the residents were in most cases unable to give a clear explanation of their admission and what information was provided the relatives we met confirmed that the process of admission went very smoothly. They met with care managers, had an opportunity to visit the home and the prospective residents needs were fully assessed. We confirmed by checking a number of case files and bedrooms that a resident guide is provided in each bedroom and the case files contain evidence of thorough assessment prior to admission. this section about choice at time of admission was assessed as good in 2007. We have found no evidence to suggest admission procedures have changed so this section remains good. Care Homes for Older People Page 10 of 25 Care Homes for Older People Page 11 of 25 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Care Plans and the other documents supporting care are well designed and are kept up to date so that the residents, or their representatives, can be assured that their needs are known to staff and that those needs are being met. Evidence: We checked previous inspection reports, we spoke to residents and visitors including professional visitors such as local authority Reviewing Officers and we took into account the 10 feedback forms we had received at the time of our visit. We received no adverse or critical comments from any source. On the contrary, people said of the home, the appropriate support is given and said for example I feel the support is excellent, my husband is well and fine, the home is always clean the food smells lovely. It was no surprise therefore for us to be told by several visitors that they would be happy to live in this care home, a very strong endorsement of the running of this home. The Reviewing Officers comments were most helpful since they visit quite frequently to monitor the care provided and they check in some detail that the care that is required is being delivered. Staff have been given advice and suggestions about Care Homes for Older People Page 12 of 25 Evidence: how care might be improved or modified and we are told that staff respond very positively to improve the quality of lives for residents. In addition to these observations we also checked care plans and records associated with medication. We also checked a number of bedrooms, to assess how well the environment can met needs. We toured the building several times to observe day to day practice, for example how the midday meal is served. Our observations support the feedback we received. Staff were seen and heard to be very gentle and caring and not without some humour. When we checked the medication records we found a small number of gaps in the charts, due it seems to staff making up prescribed fortifying dietary drinks but not returning to sign the chart. The manager was aware of these errors and it was suggested that whoever audits the medication records makes a note on the back of the charts any such omissions or errors so that it is clear to inspectors and others that the errors has been noted by managers audting the charts and they have addressed the issues. Adequate provision is made for the privacy and dignity of residents. In respect of terminally ill residents we note that this is not a nursing home but the home will seek to care for, with the support of visiting nurses, any residents whose needs they can meet up to the point of death so as to avoid unnecessary moves towards the end of life. Care plans are in place and provide details of any special needs, requests or plans for this stage in the residents life. Care Homes for Older People Page 13 of 25 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Residents indicated that they were content with services provided and relatives confirmed this service is meeting the expectations of residents. Evidence: This standard was assessed as fully met when we visited in 2007 and as we have received no information to suggest services in respect of daily life have deteriorated this section remains rated as good. We confirmed this by speaking to residents, by hearing from visitors and checking the written feedback forms. We toured the premises noting the displays of various activities and celebrations throughout the year. We observed practice. We found no evidence to suggest that daily life for residents is anything other than as comfortable and the same good quality it was before. The meal times were by and large happy moments even though some residents are very restless and choose to wander a great deal even at meal times. The staff coped well with this. We pass on one suggestion in the form of a recommendation that the home review the possibility of increasing the number of local outings and trips offered to residents. Care Homes for Older People Page 14 of 25 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 complaints procedures and the procedures for safeguarding residents are fully met and so residents can be assured that any concerns they may have will be listened to and addressed in a professional and timely manner. Evidence: This section was assessed as not fully met in 2007 and so it was then rated as adequate. This was because details of complaints were not being fully recorded and because not all staff we spoke to at that time understood the meaning and purpose of whistle blowing, reporting untoward incidents. These shortcomings have been addressed by the managers and so this section can now be regarded as fully met and thus rated as meeting a good standard. Residents and others are well informed about the complaints procedures and have information about how and to whom to complain. staff are trained in respect of complaints procedures and practice and in respect of protecting vulnerable adults from abuse, now referred to as safeguarding. We checked that best practice had been followed in dealing with complaints and with referrals to the care management team of any safeguarding issues. We also checked that suitable records are now in place to record such matters and we spoke to staff, and to visitors, to confirm that the home now justifies being rated as good in this area of their service. Care Homes for Older People Page 15 of 25 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a well planned, modern building, so it is mostly clean, safe and comfortable for residents but some safety issues must be addressed. Evidence: This section was assessed as partly met in 2007, but most areas were found to have been fully met and remain so. We found this time most standards were fully met but new matters arose on this visit. Seating which was one of the shortcomings is now better organised and sluice rooms less cluttered. We found some fire safety issues such as the need for magnetic door holders if residents want to keep their door open. Final exits must be available without the use of a key in an emergency by having a local override button that also also be operated without the use of a key and stairwells must not be used as storage spaces. We also recommend reviewing window restrictors since they are currently only domestic in style and in some locations they may not be secure enough. Other aspects of this home are very good, such as the layout and general atmosphere of the home. The safe, enclosed courtyard is an asset and so too are the various communal spaces. The residents clearly enjoy walking around the home in this safe and comfortable environment. The figure of eight layout of the floors gives ample walking space in wide and tastefully decorated corridors with seating along the way. The home was clean and tidy when we visited and visitors tell us that this is always Care Homes for Older People Page 16 of 25 Evidence: the case. Care Homes for Older People Page 17 of 25 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. All of the relatives who completed surveys, and those we spoke to in the home, felt care staff have the right skills and experience to look after people properly and so this section about staffing is re-assessed as good on this occasion. Evidence: In the previous two inspections we identified a number of shortcomings including the number of bank and agency staff used in the home and there were some gaps in the documents that must be kept in the staff recruitment file. These matters have now been addressed including less reliance upon temporary staff and those staff that are bank or agency are regular staff who have got to know the residents very well. This was born out by the visitors who thought staff in this home very caring and helpful. Some visitors thought the service excellent and this indicates that the staff team are working well with residents to meet their needs. As on other occasions we checked a sample of the staff files to confirm that recruitment is safe and this now appears to be the case. Staff had completed application forms and provided the names of referees, and there was evidence that the provider had checked peoples identity and had undertaken health checks and CRB/POVA police checks. Photographs of staff that were absent are now on file as required. The manager stated that the organisation would be routinely updating Care Homes for Older People Page 18 of 25 Evidence: employees CRB checks three yearly. A designated member of staff has responsibility for monitoring staff training and a matrix is kept in relation to this. By speaking to the manager, the staff and by checking training records we can see that the home, and its parent company, Kent Community Housing Trust, are providing comprehensive training programmes for all staff and this includes a very detailed induction programme with a check list of areas for staff to learn about. The manager stated that all of the care staff working in the home now hold an NVQ 2 or above qualification in care. Records seen indicated that staff have regular supervision and staff responsible for undertaking this stated they had received appropriate training. Care Homes for Older People Page 19 of 25 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Overall we can judge from the evidence we have seen that this is well run home that is safe for its residents. Evidence: Although the incumbent manager is new to Park View she has many years experience as a manager in similar units. From the comments of staff, families and professional visitors it is evident that they have confidence in her ability to manage the day to day running of this service and that she is regarded as having good leadership skills. The many positive findings in this inspection visit tend to support this. As part of the homes quality assurance the provider Kent Community Housing Trust arranges for an independent body to undertake a comprehensive assessment in relation to the quality of care and service they provide every three years. This independent evaluation is in addition to quality checks within the home and in addition to the Commissions AQAA form the Annual Quality Assurance Assessment. As the manager has described this is Care Homes for Older People Page 20 of 25 Evidence: an organisation with a quality circle focusing on specific areas such as food and activities. Records seen indicate that the manager meets regularly with residents and their relatives, and all staff working in the home. Relatives who competed the Commissions comment cards stated they were very satisfied with the overall care provided and visiting reviewing officer confirm that the home can provide for the needs of the client group. A policy and procedure was provided in relation to management of resident finances. The administrator keeps individual records for residents on the computer and makes these available to residents and relatives. Support is given to residents to manage personal allowances. Records for three residents were viewed and found to be accurate and up to date. Residents pay privately for personal items such as toiletries and clothing and for newspapers, chiropody care and hairdressing. There is a safe to store residents money and a second safe for storage of residents valuables. A list of items stored i is kept in this second safe. Systems were in place to ensure a safe environment is provided although some safety issues arose as we identified in the section on environment but we are confident the management team will address these points promptly and effectively. Safety records viewed included servicing of assisted baths and hoists, lift, gas, and fire safety. All records seen were up to date when we last checked them. We have on previous occasions confirmed that a fire risk assessment was completed on the premises and weekly fire alarm tests are undertaken and fire drills monthly. Fire drill records included the drill times and staff response. The accident record is now simplified and the manager can be commended for devising an internal audit chart that will highlight any patterns emerging as to time, place or persons involved in accident or incidents. Records seen indicate staff have received Moving and Handling training and food hygiene training as well as training in aspects of dementia in respect of which the Canterbury University is working with the home. All team leaders hold first aid certificates. Care Homes for Older People Page 21 of 25 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 Older People Page 22 of 25 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 1 19 23 Final exits must be available without the use of key so key operated bolts must be replaced with simple single action mechanism. This is so as not to impede egress. 30/11/2008 2 19 23 The home must ensure all stairwell are kept clear. This is so that residents can freely evacuate building in an emergency. 30/11/2008 3 19 23 The home must use magnetic door holder if residents wish to hold door open. This is so that residents are protection from the risk of the spread of fire and smoke. 30/11/2008 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 Care Homes for Older People Page 23 of 25 improving their service. No. Refer to Standard Good Practice Recommendations 1 12 It is recommended that the home review the opportunities for residents to have local excursions and trips to local places of interest. It is recommended that the locking mechanisms of windows is reviewed to ensure they offer adequate security from trespass and so as to provide safety for residents. 2 19 Care Homes for Older People Page 24 of 25 Helpline: 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 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. 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