Care Home: Purley View Nursing Home

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What the care home does well We have judged that this home still continues to provide excellent quality outcomes for the people who live there. It is widely recognised, by the local authority and the PCT, that staff are able to provide a high level of nursing care within the home with the result that many of their residents are funded by the continuing care programme or require palliative care. The home is registered with The Liverpool Care Pathway and is currently undertaking accreditation with The Gold Standards Framework, which are models of care developed to provide expertise in supporting those who are nearing the end of their lives and their families and relatives. All of the trained nurses and many of the care staff have received training to help them with this which is delivered in conjunction with St Christopher`s Hospice. The home tells us that they feel it is very important that they listen to the views of the people that use their service and they are given opportunities to contribute their ideas and influence the way that the service is run. This might include the activities that are arranged and the meals that they are served as well as the way that they are supported in their daily lives. The people that we spoke with were all very keen to tell us how kind and caring the staff were in the home with one resident explaining that no one was ever made fun of, because of their dementia, which was something that she had witnessed before. She also told us that staff always had the time and patience to sit with those who needed help to eat their meals in contrast to previous experiences that she had. Staff turnover in the home is very low which provides continuity and familiarity for the residents. Training for staff in the home is given a high priority with both nurses and carers being encouraged to attend various sessions which help them to understand the problems of those who use the service, and also to acess distance learning courses. The home has recently participated in a medication programme run in conjunction with the community pharmacist and gained full marks in the recent audit. There is a very low incidence of complaints about the home and The Commission has bot received any concerns since we last visited. What has improved since the last inspection? Since the last inspection the programme of redecoration and refurbishment in the home has continued. New flooring has been laid and the lounge area has been decorated and rearranged to provide more room for residents to walk around. Decking has been provided in the garden to give residents somewhere to sit in the warm weather. Extra nursing beds and lounge chairs have been purchased. Three new bedrooms ave been added each with a very nice walk in shower. A new communal shower has also been installed with a special basin for the hairdresser to use. What the care home could do better: We have not issued any requirements or recommendations following this inspection.The home is aware of the need to continue to develop staff to ensure a high level of expertise with regard to caring for people who are nearing the end of their lives. Also to continue to listen to the views of all of those who use the service to ensure that it meets their needs in the way that they prefer. Key inspection report Care homes for older people Name: Address: Purley View Nursing Home 20 Brighton Road Purley Surrey CR8 3AB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Ford     Date: 2 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Purley View Nursing Home 20 Brighton Road Purley Surrey CR8 3AB 02086450174 02087632456 purleyanna@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Glancestyle Care Homes Limited care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: A variation has been granted to allow one specified service user in the Dementia - over 65 (DE(E)) and Terminally Ill - over 65 (TI(E)) categories to be accommodated. Date of last inspection Brief description of the care home Purley View is a care home registered with The Commission for Social Care Inspection to provide nursing care for up to thirty-nine older people. It is situated in Purley with easy access to both road and rail links and close to the centre of town. The rear of the property offers off street parking for up to eight cars and there is metered space around the home. The home offers accommodation over three floors, all of the bedrooms have en-suite facilities. A passenger lift ensures accessibility to all parts of the home. There is a large communal lounge, on the ground floor, which also provides a dining area and a pleasant rear garden where residents can sit in the fine weather. Fees at the time of this inspection ranged from £560.30 - £770 per week and these and any extra charges payable would be discussed prior to admission. Care Homes for Older People Page 4 of 26 Over 65 39 0 Brief description of the care home Copies of The Statement of Purpose for the home and the latest inspection report can be obtained from the home. Inspection reports can also be downloaded from the Care Quality Commission website. Care Homes for Older People Page 5 of 26 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 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: This report follows an unannounced inspection visit to the home. When writing the report we have also taken into consideration other information that we have asked for or been given since our last inspection in March 2007. This has included notifications that the home has sent about anything that has happened there, comments made by people who use or visit the service and information that we have about how they have handled any complaints. In addition the home continues to send us their annual quality assurance assessment (AQAA) which is their self assessment of how well they believe they are meeting the needs of the people who use the service and also about their plans for the future. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: We have not issued any requirements or recommendations following this inspection. Care Homes for Older People Page 7 of 26 The home is aware of the need to continue to develop staff to ensure a high level of expertise with regard to caring for people who are nearing the end of their lives. Also to continue to listen to the views of all of those who use the service to ensure that it meets their needs in the way that they prefer. 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 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 Older People Page 8 of 26 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 26 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. No one is admitted in to the home without having had a full and comprehensive needs assessment undertaken, which ensures that it will be suitable to meet their needs. The home does not offer intermediate care facilities so standard 6 does not apply. Evidence: We looked at the care plans of four residents and were able to see that a comprehensive pre-admission assessment is undertaken, by a senior member of staff, in order to make sure that the home will be suitable and that the persons health care needs can be met. We also spoke with some relatives who were visiting and they were able to confirm that they this process had been undertaken and that they had been able to visit the home and meet with the manager and staff prior to admission. Residents themselves are generally too frail to come and view the home but all placements are subject to review after three months to make sure that everyone is happy. Many of those admitted into the home have a high level of nursing needs and Care Homes for Older People Page 10 of 26 Evidence: are funded through the continuing care pathway. These residents would also have a comprehensive needs assessment which has been undertaken by the local PCT. All of the residents and their families are able to meet with the manager before admission to allow them the time to discuss the placement and any anxieties that they may have. At the time of admission residents and their families are also given written information about the home in the form of a Service User Guide, which tells them about the home, a brochure and a copy of the last inspection report for the home. Care Homes for Older People Page 11 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home continues to provide an excellent standard of care which meets the health care needs of the people who live there. Evidence: The staff in the home work with the residents and their families to help them plan the care and support that they need and make their own decisions wherever possible. This includes in depth discussion regarding peoples wishes at the end of their lives and any special wishes that they would like to fulfil before that time. The care plans that we looked at were well organised, detailed and informative. They ensure that all of the staff are aware of how people prefer to be supported. Risk assessments and nutritional assessments are in place along with strategies for addressing challenging behaviour and and the problems associated with dementia. Factors which may predispose to pressure sores are monitored regularly and appropriate preventive equipment is in place. The doctor has been caring for the people in the home for over twenty years and visits weekly, Other health care professional are also consulted where appropriate such as the palliative care nurse, Care Homes for Older People Page 12 of 26 Evidence: chiropodist and optician. There are regular meetings with the community psychiatric nurse to address any concerns and with the hospice liason nurse regarding The Gold Standards Framework Of particular note is the fact that this home often admits residents with very high levels of nursing needs or for palliative care. Staff are able to carry out procedures that other homes are not, such as the administration of subcutaneous fluids and enteral feeding. The manager is frequently approached by the PCT to admit residents who might otherwise have needed to be cared for in hospital as they are able to provide this level of expertise in a more homely environment. They are committed to participation in the Liverpool Care Pathway for residents who are nearing the end of their lives and are completing their accreditation for the Gold Standards Framework. These initiatives are designed to provide the best possible care for residents who are in the latter stages of their lives, and their families, and all of the staff are participating in the training. We noted that staff are very kind in their approach to the residents treating them with dignity and respect. All of the residents told us how lovely all the staff were, caring and willing to do anything to help you. One resident told us no one ever makes fun of people with dementia, they always have time for them, not like in some other places I have been, and some relatives observed they always explain what they are going to do when they approach people, so that they dont get upset or anxious. The home has recently participated in the community pharmacy inspection programme. Shortly before our visit a full inspection of medication policies procedures, administration and storage had been undertaken and full marks awarded. Care Homes for Older People Page 13 of 26 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. The daily life within the home suits the people who live there. They enjoy the meals that are served and their friends and relatives are always made welcome. Evidence: Regular residents meetings that are held in the home give people an opportunity to make suggestions about activities they would like to participate in and the meals that they would like to see on the menus. Care staff encourage them to choose what they would like to wear that day and every effort is made to make daily routines flexible for individual residents. Although there are some organised activities for those who wish to take part it is recognised that many of the residents in this home are extremely frail or unwell. With this in mind there is more of an emphasis on taking the opportunity to spend time with people individually. Attempts to take people on trips out of the home have not always been successful with residents seeming to prefer the familiarity of the home and the people working there. On the day of the inspection we noticed that staff are able to sit with residents chatting to them and holding their hand and it was evident that there is a general ethos of staff trying to provide good care for the people that live in the home. Relatives that were visiting told us that they are always made Care Homes for Older People Page 14 of 26 Evidence: welcome and that they had seen how attentive staff were toward residents. People all told us that the meals served in the home were very good. Traditional British food is generally served however, other preferences and special diets can easily be catered for. The chef has worked in the home for some time and is familiar with peoples particular likes and dislikes. there is a choice of a hot meal in the evening and extra snacks and drinks can be provided. One lady told us The food is wonderful, I can have as much as I like, and I will look like a coffee pot soon there is so much. I can even have breakfast in bed if I want. Care Homes for Older People Page 15 of 26 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. A clear complaints procedure ensures that any concerns would be dealt with promptly. The home has the appropriate policies and procedures in place to ensure the safety of the people who live there. Evidence: The home has a simple and clear complaints procedure. It is contained within the information that is given to people prior to admission and a copy is available in the entrance hall. Complaints are viewed as a positive process which helps the home to change its practices so that they meet the needs of those people who use the service. People that we spoke with told us that they would feel quite comfortable raising any concerns with the manager or her staff and they were sure that they would be addressed. The Commission has not received any complaints about the service since the last inspection. Policies and procedures are in place to ensure the protection of the people who use the service. Staff have all received training in recognising and reporting suspected abuse and the home supplies them with a handbook at the time of their induction. No new staff are employed until all of the necessary checks have been undertaken in order to ensure that those who have been judged as being unsuitable to be working Care Homes for Older People Page 16 of 26 Evidence: with vulnerable people are prevented from doing so. Care Homes for Older People Page 17 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clean and comfortable accommodation with specialist adaptations to suit the needs of the people who live there. Evidence: This home provides a clean well maintained environment for the people who live there and, since we last visited, there has been a lot of redecoration. New flooring has been laid and the lounge has been rearranged to provide more room for residents to walk around. New beds and furniture have been provided and decking has been laid in the garden to enable more people to enjoy being outside in the warm weather. Three new bedrooms have been added all of which have lovely walk in showers and a new communal shower has also been installed along with a special sink for the hairdresser to use. Residents have been able to bring in items such as pictures, photos and small pieces of furniture to help personalise their rooms and make them feel more comfortable. They have appropriate nursing style beds with pressure releiving equipment where necessary.all of the rooms have en-suite facilities. Adaptations are in place throughout the home to help those with limited mobility including in communal toilets and bathroom facilities. A nurse call system is in place. Care Homes for Older People Page 18 of 26 Evidence: The home is well maintained and as on previous visits was clean ad free from any malodour. Care Homes for Older People Page 19 of 26 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. There are always enough appropriately trained and experienced staff on duty to meet the needs of the residents. Evidence: The home employs a mixture of trained nurses and care staff and the rotas show that there are always enough staff on duty to meet the needs of the residents. Rotas have been organised to ensure that there are more staff around when the home is busy. Staff turnover in the home is low which provides a continuity of care that is important to the people who live in the home. Care staff are always supported by a range of catering and domestic staff and also a maintenance man. There is a robust recruitment procedure in place with no new staff being employed without all of the appropriate checks being done. The registration details of trained staff is checked yearly. Any new staff members receive a comprehensive induction programme to ensure that they are safe and competent. Training is given a high priority in the home with more than 95 of care staff having achieved or working toward gaining an NVQ level 2 qualification. A range of other training is also organised to help staff to understand and meet the needs of the people Care Homes for Older People Page 20 of 26 Evidence: that they are supporting. This has included training about enteral feeding, palliative care and dementia in addition to those subjects thought to be mandatory such as moving and handling and health and safety. On the day we visited, staff were receiving fire safety training and ancillary staff were also able to join in. Part of the session was held in the sitting room with some of the residents also taking an interest in the proceedings. Care Homes for Older People Page 21 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the intersts of the people who live there and their views are actively sought and taken in to consideration. Safe working practices help to ensure their well being. Evidence: Both the Registered Manager and her deputy have been in post for some years and have achieved an NVQ level 4 and The Registered Managers Award. The manager has also gained a diploma in Gerontology and is currently working toward a law degree in mental health. Both of them have always displayed a thorough understanding of the needs of the people in the home and have developed a stable committed workforce with clear lines of accountability. There are regular staff meetings held so that all staff are kept well informed of developments within the home and are encouraged to contribute their ideas. Staff all participate in a supervising and appraisal process and this includes the manager whose supervision is undertaken by the companys operational manager. He Care Homes for Older People Page 22 of 26 Evidence: also conducts monthly visits to the home in line with Regulation 26 which include talking to both residents and staff in order to satisfy the company that the home is meeting its aims and objectives. Regular meetings give residents and their families the opportunity to comment on the services that the home provides and discuss issues such as activities and the menus. They are also sent satisfaction surveys so that the home can monitor how well they are doing. Policies and procedures are all updated regularly and records that the home is required to keep as evidence of its commitment to the health and safety of the people who use the service are audited annually. The information that we have from the home tells us that equipment and services are all appropriately checked and maintained, there are regular fire drills and fire safety inspections. We are always informed of any incidents in the home, in line with the regulations. The home does not currently keep any money on behalf of any of the residents. Care Homes for Older People Page 23 of 26 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 24 of 26 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 Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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