Care and Social Services Inspectorate Wales

Transcription

1 Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection report Care homes for older people Parkway 91 Parkway Sketty Park Swansea SA2 8JE Date of publication 23 February 2012 You may reproduce this Report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers

2 Care and Social Services Inspectorate Wales South West Wales Region Government Building Picton Terrace Carmarthen SA31 3BT Home: Parkway Contact telephone number: Registered provider: Registered manager: City and County of Swansea Lynne Pritchard Number of places: 36 Category: Care Home - Older Adults Dates of this inspection: 13 October 2011 and 22 November 2011 Dates of other relevant contact since None last report: Date of previous report publication: 15 August 2010 Inspected by: Sandra Sullivan Page 1

3 Introduction Parkway is registered to care for up to 35 people over the age of 65 years and one named person under the age of 65 years. Parkway is a local authority care home, owned and run by the City and County of Swansea. It is situated in the Sketty area of Swansea. There are local shops and access to local buses within walking distance of the home. The manager, Lynne Pritchard became the registered manager in Prior to becoming the manager, Lynne worked in the home for a number of years and acted up in the manager position from She holds an NVQ level 4 and is appropriately qualified to manage the home. She is registered with the Care Council for Wales (CCfW) as a manager in addition to her registration with the Care and Social Services Inspectorate Wales (CSSIW). The home was purpose-built in the early 1970 s to accommodate up to 36 service users in single rooms. Accommodation is arranged over two floors with stairs and a shaft lift connecting the floors. There are bedrooms, dining and lounge areas on both the ground and first floors. One lounge was used as the designated smoking area. There is a very attractive rear garden, easily accessible from the ground floor lounge and dining room, which overlooks school playing fields. Summary of inspection findings What does the service do well There was a warm, relaxed atmosphere in the home. Service users spoken with were very complimentary about the care they received. On the days of the inspection visits staff were observed to be treating service users in a kind, caring and respectful manner. The home has retained the national Excellence in Customer Service award The home is well integrated into the local community The home has a low turnover of staff, giving a high degree of consistency of care Virtually all of the care workers eligible for registration with the Care Council Wales had completed their registrations. What has improved since the last inspection? Person centred support plans have been introduced into the home. The local authority principal office holds open surgeries in the home to hear directly from service users, staff, relatives and families views on the service provided. What needs to be done to improve the service? a.) priorities No regulatory requirements were made as a result of this inspection. Page 2

4 b.) other areas for improvement It is recommended that staffing arrangements at weekends be reviewed to ensure that there is a satisfactory level of management support to staff at these times. Inspection methods Prior to the inspection the registered provider and the registered manager were required to complete a self assessment of service form and an annual data collection document. Both forms were completed and submitted within the agreed timescale. The inspection was unannounced and was carried out by one inspector over two short visits. During the visits the inspector chatted with a number of service users and relatives to gain their views of life at Parkway. She also talked with the registered manager and with staff on duty, observed care practices, toured the home and looked at a small number of records. Page 3

5 Choice of home Inspector`s findings: Parkway had a clear and comprehensive statement of purpose and service user s guide and there was also a prospectus, in Welsh or English that contained a brief summary of this information. The documents were clear and easy to understand and contained a full description of the home and the services and facilities that it offered, including the admission process. A copy of the most recent inspection report was included in the service user guide. Self assessment documents confirmed that both the statement of purpose and the service user guide were reviewed annually or sooner if changes occurred. The charter at Parkway stated that the aim was to provide a safe and secure environment in which individual needs and rights were recognised around choice, privacy, dignity and independence. There had been no changes to the admission policy or the arrangements for preadmission assessments since the last inspection episode. It was evident from an examination of records that new service users had been admitted in accordance with this policy. Prospective service users were usually referred to the home by social services care managers, and at the time of this inspection all service users had been referred through the City and County of Swansea. Most service users spoken with on this inspection had also had the opportunity to visit and assess the quality, facilities and suitability of the home before deciding on admission. In addition to the comprehensive unified assessment completed by the care manager, which detailed personal information and care needs, senior staff at the home also undertook an assessment prior to admission to ensure that each prospective service user s needs could be met at Parkway. This is a vital aspect of the assessment process to ensure that the home can meet all the service users assessed needs alongside those of the existing service user group. It was recommended following the last inspection that the pre-admission form be revised to ensure that all relevant information is gathered and recorded to enable an informed decision on placement to be made. There had been considerable progress on this since that time. Arrangements were in place for staff at Parkway to receive appropriate training and to have access to the local authority PARIS computer system to ensure that they were able to access full information regarding a prospective service user. In addition new person centred care and support planning documentation had been introduced to underpin the basic admission form completed prior to admission. The admission process in respect of two recently admitted service users was looked at in detail during this inspection as a concern regarding a previous admission had been raised with CSSIW. Both admissions had been planned and both service users had been admitted to the home from hospital. Pre-admission assessments had been completed in respect of both service users and letters were available on file to confirm that Parkway could meet their needs. Page 4

6 Both service users were spoken to during the course of the inspection and the views of their relatives also sought. Both felt that they had been made welcome on their admission. One service user had an opportunity to visit the home for a day before moving in which she had enjoyed, and arrangements had been made for the room to be painted and for the service user s own bed to be installed in the home in readiness for her admission. There was evidence from records and from discussion that there was good communication with the relevant social worker and effective liaison with the service users families prior to admission. Both families commented on the smoothness of the admission procedure and the welcome they received. Requirements made since the last inspection report which have been met: Action required When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: Page 5

7 Planning for individual needs and preferences Inspector`s findings: Records relating to the home and to individual service users were kept in locked filing cabinets within a lockable office. Records examined were generally in good order and up to date. A sample of three residents care plans were examined and found to be comprehensive, providing an account of the individual needs and preferences of each resident at different periods throughout the day and night. It was evident that initial care plans and risk assessments were drawn up on admission and those seen were all appropriately signed. New, person-centred support plans had been introduced to the home since the last inspection and it was evident that these were drawn up with the service user and/or their relatives shortly after admission. Information from these support plans then informed the care planning and risk assessment processes. Although this was a relatively new way of working, staff spoken with were enthusiastic about the benefits and service users and relatives also appreciated the emphasis on the person and not just on their needs. There was evidence that care plans were reviewed on a monthly basis as a minimum, with more frequent reviews if necessary. Daily records of care were well recorded, factual and detailed the actual care given. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: Page 6

8 Quality of life Inspector`s findings: It was evident from discussion with the service users, manager and staff that the home was committed to allowing the service users as much choice as possible. The home aimed to maximise the residents independence as much as they wished and were able. From discussion with several service users during the inspection, it was clear that there was a high level of satisfaction with the care and services provided at the home. Examination of a sample of records indicated that each service user was encouraged to maintain control over her/his life and to make choices. Historically each service user was allocated a keyworker who had particular responsibility for ensuring service needs were met. However, there were some potential difficulties identified with these arrangements, particularly if a key worker was off for some time. There had therefore been a move to four teams of staff who were team key workers as opposed to individual key workers. The registered manager noted that this was felt to embrace a more person centred approach which provided service users with support which was both flexible and which provided choice. Early indications were that this revised arrangement was working well. Routines at Parkway were flexible and varied. An activities programme was available and reminders of forthcoming events were posted on notice boards in the home. Activities included bingo, quizzes, card games, basket ball etc. and a regular programme of visiting entertainers. Open visiting was available at the home and service users were able to receive visitors in a lounge or their bedroom. Again visitors commented favourably. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: Page 7

9 Quality of care and treatment Inspector`s findings: The issue of the privacy and dignity of the residents was seen as central to the care at the home. Service user s private mail was given out unopened or opened with them if they required assistance. There was evidence that medical examinations and treatments always took place in the privacy of service user s own rooms. On the days of the inspection visits, staff were observed to be treating service users in a kind, caring and respectful manner. Service users spoken with were all very appreciative of the care they received, and spoke highly of the staff. They felt well cared for, respected and valued. Service users were able to choose their own GP within the limits of the location of the home. The district nurses visited the home when there were identified nursing needs. The community psychiatric nurses maintained contact to give support to specific service users as appropriate. Mealtimes were flexible and based around individual requirements. Service users were able to have their meals in the main dining room or in one of the two smaller dining areas on the first floor. Service users were very complimentary about the quality of the food. Tables were attractively laid for meals. Service users had also been involved in the development of menus, and all service users spoken with spoke highly of the quality of the food and the kindness and flexibility of the kitchen staff. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations:

10 Staffing Inspector`s findings: Staffing levels on the days of both inspection visits appeared satisfactory to meet the needs of the current service users, and were in accordance with the rota. Rotas indicated that there were usually three members of care staff on duty during the daylight hours and two wakeful members of staff on duty overnight. In addition management, kitchen and domestic staff were on duty daily during the week. During the inspection the inspector was able to observe a care staff meeting and then meet with a group of staff afterwards. Staff generally felt well supported but noted that the absence of any management staff in the home at the weekends sometimes made these times very pressured. Although management staff were on call, they were not present in the home meaning that care staff needed to respond to phone calls, callers etc in addition to attending to the needs of service users. It is recommended that the current arrangements be reviewed to consider how best staff can receive management support at weekends. A sample of recruitment records was examined as part of this inspection. Although recruitment checks were processed by the local authorities human resources department mini-files containing evidence that all processes had been satisfactorily completed were held in the home. Files scrutinised were in good order. The registered manager confirmed that she saw and approved all the recruitment documentation prior to the offer of a job being made. All staff had taken part in training over the last year and all staff received a minimum of five paid days training each year. More than 50% of the care staff were trained to NVQ level 2 or 3 and plans were in place to enrol new members of staff on NVQ training at the conclusion of their six-month probation period. The two members of the management team were qualified to NVQ level 4. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Page 9

11 Good practice recommendations: It is recommended that the current arrangements be reviewed to consider how best staff can receive management support at weekends. Page 10

12 Conduct and management of the home Inspector`s findings: The manager has worked in the home for many years. She has worked in the field of elderly care for over thirty years and was formally appointed as the Officer in Charge in 1999, having acted up in the position for the previous two years. She clearly knows the home and the service users very well. She has an NVQ level 4 in care and is an NVQ qualified assessor. There was evidence that she had continued her professional development by attending training updates and short courses throughout the year. She had also taken part in a management development programme alongside other registered managers of the local authorities care homes. She is registered with the Care Council for Wales in addition to her registration with CSSIW. Supervisions and annual appraisals were divided between the manager and assistant manager. It was evident on the last inspection that there had been significant slippage in both supervisions and appraisals. However it was evident on this inspection that remedial action had been taken. Records examined confirmed that these processes were up to date and discussion with the manager confirmed that all had worked hard to achieve this. Parkway, together with seven other city and county residential care homes for adults had achieved accreditation under the Chartermark, or Customer Service Excellence Scheme. This required them to provide evidence of their quality assurance processes and of the ways they involved all stakeholders in reviewing the quality of the provision. The Principal Officer of the local authority responsible for the home had begun to hold surgeries in the home, during which time any service user, staff member or relative could meet with him and raise any issues of concern, or highlight particularly good practice. Dates for surgeries were publicised on notice boards and alongside activities. Service users said it was nice to see senior managers in the home and appreciated being able to meet with them if they wished to. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Page 11

13 Good practice recommendations: Page 12

14 Concerns, complaints and protection Inspector`s findings: As a Local Authority home, Parkway followed the Local Authority complaint policy and procedure. It was widely distributed in Welsh and English to service users, relatives and others. The service user guide contained information about how to make a complaint, the investigative process and timescales. The guide also contained contact details of the Care and Social Services Inspectorate Wales (CSSIW). In addition a copy of the complaints procedure was provided for each service user in their room. A record was kept of all concerns or complaints received, together with any action taken in response to them. Action had been taken promptly in respect of each of the concerns/complaints recorded. Service users and relatives spoken with during the inspection confirmed that they felt able to voice any concerns and had confidence that the manager would take action in response to any concerns raised. One complaint regarding the home had been received by CSSIW since the last inspection. This was referred for consideration by the safeguarding team, and the general issues raised formed part of the plan for this inspection. Parkway, as a local authority establishment adhered to the South Wales Adult Protection (POVA) policies and procedures. The policy was available in the office of the home and staff spoken with knew where it was. The manager demonstrated a good working knowledge of the POVA procedure and of her reporting responsibilities. The staff induction programme included a session about the protection of service users from abuse and the procedure for reporting abuse or neglect in the home. There was also ongoing training for current staff. Almost all staff had received some training in POVA since the last inspection, either as an update or initial basic awareness training. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: Page 13

15 The physical environment Inspector`s findings: Parkway is owned by the City and County of Swansea and run by its Social Services Department. It is located in the Sketty Park district of Swansea, close to a variety of shops and a regular bus service into the city centre, from outside the home. The grounds provided several sitting areas, an attractive canopied patio and pond with cobbled area. It was accessible to service users with restricted mobility and wheelchair users. The rear garden overlooks the local school playing fields. Development of the garden has been a focus over the last few years resulting in a very attractive, accessible outdoor space for service users. The home is a two-storey building and was purpose built in It provides care and accommodation for up to 36 older adults all in individual bedrooms. There are bedrooms on both the ground and first floors of the home. The home had three dining rooms a large one on the ground floor and two smaller ones on the first floor. There were also three lounges on the ground and first floors. One lounge continued to be the designated smoking room. However there is now only one service user who smokes and he chooses to smoke outside most of the time. The long term plan is for the home to become non-smoking in time. If this change does take place this will need to be clearly stated in the statement of purpose and the service user guide. The bedrooms were situated on the ground and first floor, with a lift that provided access to both floors. Bedrooms had no en-suite facilities, but all toilets were clearly marked and within reach of the bedrooms and lounges. At least one assisted bath and shower was provided on each floor. Hoists were available to assist any service users who had problems with mobility. One corridor, on the first floor is narrow and care needs to be taken to ensure these bedrooms are only allocated to service users who do not have significant mobility difficulties. The maximum 5 stars had been awarded for food safety arrangements in the home. Overall the premises were somewhat tired and would benefit from a significant refurbishment. However the home was generally in good order, with evidence of some updating and replacement. The home was clean and free from odours on both visits, and was a credit to the domestic staff team. Requirements made since the last inspection report which have been met: When completed

16 Requirements which remain outstanding: (previous outstanding requirements) Original timescale for Regulation number New requirements from this inspection: Timescale for Good practice recommendations: Page 15

17 A note on CSSIW s inspection and report process This report has been compiled following an inspection of the service undertaken by Care and Social Services Inspectorate for Wales (CSSIW) under the provisions of the Care Standards Act 2000 and associated Regulations. The primary focus of the report is to comment on the quality of life and quality of care experienced by service users. The report contains information on how we inspect and what we find. It is divided into distinct parts mirroring the broad areas of the National Minimum Standards. CSSIW`s inspectors are authorised to enter and inspect regulated services at any time. Inspection enables CSSIW to satisfy itself that continued registration is justified. It also ensures compliance with: Care Standards Act 2000 and associated Regulations whilst taking into account the National Minimum Standards. The service`s own statement of purpose. At each inspection episode or period there are visit/s to the service during which CSSIW may adopt a range of different methods in its attempt to capture service users` and their relatives`/representatives` experiences. Such methods may for example include selfassessment, discussion groups, and the use of questionnaires. At any other time throughout the year visits may also be made to the service to investigate complaints and to respond to any changes in the service. Readers must be aware that a CSSIW report is intended to reflect the findings of the inspector at a specific period in time. Readers should not conclude that the circumstances of the service will be the same at all times. The registered person(s) is responsible for ensuring that the service operates in a way which complies with the regulations. CSSIW will comment in the general text of the inspection report on their compliance. Those Regulations which CSSIW believes to be key in bringing about change in the particular service will be separately and clearly identified in the requirement section. As well as listing these key requirements from the current inspection, requirements made by CSSIW during the year, since the last inspection, which have been met and those which remain outstanding are included in this report. The reader should note that requirements made in last year`s report which are not listed as outstanding have been appropriately complied with. Where key requirements have been identified, the provider is required under Regulation 25B (Compliance Notification) to advise CSSIW of the of any action that they have been required to take in order to remedy a breach of the regulations. The regulated service is also responsible for having in place a clear, effective and fair complaints procedure which promotes local resolution between the parties in a swift and satisfactory manner, wherever possible. The annual inspection report will include a summary of the numbers of complaints dealt with locally and their outcome. Page 16

18 CSSIW may also be involved in the investigation of a complaint. Where this is the case CSSIW makes publicly available a summary of that complaint. CSSIW will also include within the annual inspection report a summary of any matters it has been involved in together with any action taken by CSSIW. Should you have concerns about anything arising from the inspector`s findings, you may discuss these with CSSIW or with the registered person. Care and Social Services Inspectorate Wales is required to make reports on regulated services available to the public. The reports are public documents and will be available on the CSSIW web site: Page 17

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