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Inspection on 09/04/08 for Prestwood (Main House) Nursing Home

Also see our care home review for Prestwood (Main House) Nursing Home for more information

This is the latest available inspection report for this service, carried out on 9th April 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Prestwood offers a genuine commitment to care with a highly professional, yet an open and personable approach, which reflects the homeliness of a confident relationship between carer and service user: "All the care services are very kind and caring, doesn`t matter what time we visit. He seems to be happy with the way they all care for him". The establishment of a professionally accountability towards effective assessment, detailed care planning and review of individual needs are meaningful and robust, in formulating an excellent standard of care. This highly personable attitude and approach to care is appreciated, and welcomed by service users and visitors alike. There is a well-structured management system covering all areas of quality assurance. Maintenance of good staffing levels, staff training and development, are well established in safeguarding the interests of people. The overall management style demonstrated a professional approach in maintaining an environment conducive to the care of the elderly. There is a constant appraisal and review process of facilities and services, to maintain that environment by the senior care management and on-site Providers.

What has improved since the last inspection?

The home has demonstrated a commitment to caring for elderly people, with very high standards, which need to be maintained. In addressing care standards` recommendations, the home has demonstrated a robust and meaningful commitment to the ethos of continuing improvement of standards.

What the care home could do better:

The achievements have been recognised, areas of detail will continue to play a part in the ongoing development and maintenance of an honest, solid and homely service.

CARE HOMES FOR OLDER PEOPLE Prestwood (Main House) Nursing Home Main House Prestwood Stourbridge West Midlands DY7 5AL Lead Inspector Keith Jones Key Unannounced Inspection 9th April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prestwood (Main House) Nursing Home Address Main House Prestwood Stourbridge West Midlands DY7 5AL 01384 877440 01384 877900 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Completelink Limited Mrs Jayne Elizabeth Tatler Care Home with Nursing 59 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (59) of places Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2007 Brief Description of the Service: Prestwood House is a registered care home of which provides residential and nursing care for older people, the home is also registered to provide a service for 2 people who suffer with dementia. The home is located in Stourbridge, Staffordshire, off the main A449 near to the village of Kinver. The three storey detached property is set within its own grounds, having idyllic views of the well-maintained gardens and the surrounding countryside. The Home offers accommodation for 59 service users providing a combination of single and shared occupancy bedrooms, located on all three floors in the home. En suite facilities are provided within a number of bedrooms. Bathrooms and toilet areas are situated throughout the home and are in close proximity to bedrooms and communal areas. Service users have access to relevant healthcare services if and when required. The layout and design of the home facilitates people who have a physical disability, having wide corridors and doorframes to accommodate wheelchair users, a passenger lift was also in place. Lounge and dinning areas were pleasantly decorated and equipped with essential furnishings and items to provide a comfortable area for relaxation or to socialise with fellow service users. Staffing is provided on a 24-hour basis to ensure the total support and supervision of service users. The fee chargeable for the service at Prestwood House is from £385.00p £590.00p per week. The fee information included in this report applied at the time of inspection and the reader may wish to obtain more up to date information from the care service Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 5 Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. We considered that the information given to us confirmed that people were presented with the service they needed, and that the service was of a satisfactory standard to ensure peoples’ safety. This unannounced inspection was conducted over one day by one inspector, with the Care Manager and senior staff, in a professional and cordial atmosphere. In readiness for the inspection the manager completed a wellprepared Annual Quality Assurance Assessment (AQAA), and we had received 5 completed surveys from people who use the service and families. Comments of “can always talk to the Nurses and the Managers”; “I have every faith that my Dad is getting the care he needs” were a fair reflection of general response. There were 42 people in the home at the time of inspection, with 30 requiring General Nursing care. The last inspection report was discussed, and it was noted that there were no outstanding requirements, and most of the recommendations have been addressed. Four people were case tracked, which confirmed the establishment of a comfortable and effective care home. A tour of the home allowed free and open access to all areas for inspection. We took the opportunity to speak with a number of service users, relatives and members of staff. Service users and staff took an interested and active role in the inspection process, and contributed to the subsequent report. Throughout the entire inspection a sense of homeliness and familiar confidence pervaded into all aspects of daily activity expressed by those people met. A review of the administrative arrangements confirmed solid practice and effective management. A full verbal report was offered at the end of the inspection to the Care Manager. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. Potential service users and their representatives are able to gain information about the service from the Statement of Purpose and Service User Guide. Our inspection reports can be obtained directly from the Provider, or are available on our website at www.csci.org.uk Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: The achievements have been recognised, areas of detail will continue to play a part in the ongoing development and maintenance of an honest, solid and homely service. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 and 6 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, and on the examination of the homes policies, procedures, practices and discussions with management. The home ensures that prospective service users have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. The home has demonstrated their commitment to promote a partnership of care, to meet the objectives of providing a home to meet individual needs. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Statement of Purpose continues to represent an excellent description of the Home’s aims and objectives, philosophy of care and terms and conditions. All the requirements prescribed in Schedule 1 are addressed. It is recognised that the Statement of Purpose represents the foundation on which the Home operates upon, offering service users and their relatives the opportunity to make an informed choice about where to live. A separate and well-produced Service User’s Guide serves as an easily readable summary of the Statement of Purpose and supporting information, widely used to inform all interested parties. It is expected that an audio presentation will be available within 6 months, and Braille transcription service has been identified for use where necessary. The home continues to deploy a clear statement of contractual agreement. The Statement of Purpose clearly indicates the terms and conditions, which are discussed with service users and relatives prior to admission. Case tracking of four people who use the service clearly identified that the Care Manager or Home Manager, at the point of reference, conducts the preadmission assessment. The documentation was examined and found to be comprehensive, providing a solid foundation for progressive care planning. This assessment is produced with the full involvement of service users and family, allowing them to influence the direction of care. The assessment initiates the process of care, each individual having a plan of care, which includes a daily living plan and longer-term goals and outcomes. Following an assessment the senior nurse assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual and any special needs. Likewise the applicants are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. Any special needs of the individual were discussed fully and documented, ensuring their individual needs would be met. Case tracking confirmed that a valuable exchange between service users and assessor took place and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. From discussions it was evident that prospective service users and their relatives are able to visit and assess the quality, facilities and suitability of Prestwood Main at any reasonable time, to meet with staff and management. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 12 People are admitted for a trial period initially to enable all parties to evaluate whether the home is an appropriate placement and mutual adjustment before any contractual agreement is signed; this is usually a period of 4 weeks. At all times relatives are involved in the process. A suggestion that an ‘Induction visit’ would be helpful “when new residents are accepted, specially for the relatives who may have no idea how such an establishment works, with some introduction to staff”. Staff are aware of the special period of personal anxiety that people have under those conditions, a point well illustrated when talking to service users, and examining records on case tracking. There were no people assessed and referred solely for intermediary care at the time of inspection. Discussions are in progress with Codsall PCT for proposed contract for intermediate care beds. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 The quality in this outcome area is excellent. This judgement is based on the examination of five care plans, discussions with people who use the service, staff, managers, general observations and examination of the home’s medication system. The care assessment, planning and review system is a highly organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with family. The provision of a secure and safe medicines administration is managed efficiently. EVIDENCE: Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 14 Care records and case tracking clearly showed that this standard is well met, maintaining a high quality process of assessment. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process. A comment from a relative: “ Overall I am very pleased with the care my aunt has received in the home, we are fully aware of its standards” reinforced this standard. A profile of the individual’s social, physical and psychological status offered an individual plan of care, based upon activities of daily living, to be implemented and frequently reviewed. Each person’s health, personal and social care needs are carefully assessed in an individual plan of care that is reviewed monthly, including service users and relatives views, to reflect their changing needs. That review was seen to be more frequent, dependant upon the individual’s needs and clinical condition. We observed that the strength of purposeful planned care lies within the frequency of the review process, in monitoring and adapting care profiles. As is appropriate and observed, a checking chart ensures that constant monitoring of high dependency residents is carried out. A daily report is maintained to control monitoring, and offer a very comprehensive account of care and service given. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of goals, care and evaluation models of monthly assessment. Case tracking four people confirmed the extent that the carefully prepared, and well-recorded care plans were appreciated by service users and relatives alike. “Nursing staff are available to discuss any medicine or other matters which might influence on the resident’s health”, “Activities/stimulation, variety of food/choice, named nurse care. Regular meetings for carers/residents, excellent communications, good management, good staff”. Tissue viability, continence, psychological and special needs are assessed and documented, along with nutritional screening, hearing and sight tests as appropriate. The GP service is thorough and supportive; through this service, arrangements are made to provide professional support. Continence is assessed on admission and promoted within the plan of care, and there was evidence that people’s nutritional and hydration needs, and weights were frequently reviewed. On discussion with staff we acknowledged that care staff maintain all aspects of a person’s personal care, overseen by the trained Nurses on a daily basis. This was a direct outcome of an improved keyworker system. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 15 The administration of medicines adhered to procedures to maximise protection to service users. We saw that storage was secure, with satisfactory added security for controlled drugs. We looked at the controlled drug register, and found it to be in order. Random checks of medicine stocks against Medicines Administration Record (MAR) sheets confirmed a consistent and accurate administration. We noted that there are a large number of people on a liquid aperient, which is to be reviewed. Each service user has the opportunity of their own lockable facility in their bedrooms on request. Oxygen cylinders are to be stored in a secure storage space and chained when not in use. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. These policies are reinforced with a staff induction programme and supervised practice. Case tracking confirmed that the policies were implemented, with all people spoken with being complimentary of the degree of respect given, by each and every member of staff. We observed the free, courteous interaction between service users and staff based on a level of confidence of mutual trust and respect, and an observed knowledgeable, and positive attitude towards those service users. “She is encouraged in all aspects of her welfare, and we are well looked after, and “ I know all the staff who are extremely kind, I am very pleased with my situation”. Visitors revealed: “They do look after people, they have all kinds of activities”, “We come and go as we please, there are no visiting restrictions.” Relatives have freedom of visiting, emphasising the importance of maintaining social contact. Satisfactory privacy policies exist for all toilet/bathroom areas and bedrooms. We acknowledged that there exist extremely good working relationships with regular professional contacts, and General Practitioners for the home. The Statement of Purpose clearly and openly states that the wishes concerning arrangements after death would be discussed and respectfully carried out, ascertained as soon as possible, either at pre-admission or shortly after admission. Individual spiritual persuasions were documented and individual diversity respected at all times. People are able to attend the local church services on a weekly basis. Communion and Church of England services, and Roman Catholic services are given as requested. Relatives are welcome to stay as long as they liked in times of stress, including overnight stay. We were impressed with the confidence and closeness within the home of staff, residents and visitors, and the mutual respect that prevailed. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is excellent. This judgement is based on discussions with service users and staff, with examination of records in relation to social activities undertaken, and general observations during to course of the inspection. The home had a relaxed and welcoming atmosphere where people were encouraged to continue with their individualised lifestyle. The quality of activity and socialisation monitoring and management was acknowledged, with evidence in each resident’s file of meaningful profiling by the coordinator and senior care staff. The home offers a good catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied choice. EVIDENCE: We observed the daily routine to be flexible and non-institutionalised, offering choice for meal times, personal and social activities. Discussions with service users and staff clearly identified a relaxed and informal atmosphere in which the resident’s needs were paramount, with the security that there are familiar Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 17 events to the day they could relate to. At pre-admission the person’s personal interests and customs are determined, and where possible accommodated within the routine of the Home. That routine is seen as to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Discussions we had with service users and staff clearly identified a relaxed and informal atmosphere in which the peoples’ needs were paramount An activity co-ordinator has a high profile in contributing to the care planning process, and is clearly well accepted by service users and staff alike. The recording of social activities was seen to be an integral part of care reporting and planning. Evidence was clear in identifying events and results of efforts made. On the day of the inspection, we saw a number of people were engaged in painting, and general chatting. Individual life histories are discussed and used as a basis for personalised social care offering choice and support. The home operates an established open visiting policy, which was seen during the inspection. Relatives and friends are encouraged to maintain social links as part of the planning of care. Comments received from relatives confirm their appreciation and involvement with the progress of their loved one’s health and social status; relatives commented: “Care of my mother is good, washing, dressing and her general appearance, and to mix with other residents in social activities”, and “They do look after people, they have all kinds of activities”. Another relative was appreciative and complimentary of the relaxed procedure, especially at the early days following admission. Personal choice and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. Those peoples’ rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general décor. The tour of the Home demonstrated a degree of expressed individuality in each of the bedrooms inspected. The Care Manager emphasised that the strength of protecting personal rights was secured through the robustness of the procedures in place. This was confirmed on examination of records. Advocacy procedures and services are available to those who require them. Quarterly relatives/carers meetings with service users are valuable forums for open communications, and are recorded. The home offers a good catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied choice. Lunch was served during the inspection and we saw it to be an attractive and well-presented meal. Special diets were accommodated with the cook making effort to engage with people who use the service to discuss personal preferences. A discussion we had with the cook clearly indicated his awareness of the wide range of diverse needs his Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 18 service were expected to respond to. Staff were seen to offer discreet assistance to those who required it. We looked at the kitchen and found it to present a well equipped and organised area. We looked at all fridges and freezers and saw that they were well maintained and checked daily by the kitchen staff, and a cleaning schedule was in place although the records for both need to be kept up to date to reflect the observed standards. Safe handling of chemicals signs (COSHH) and notices were in evidence, with cleaning chemicals secure, appropriate and under control. Laminate action posters would be beneficial for easier access information to coping with an emergency. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Individuals’ legal rights are protected by the systems in place in the home to safeguard them. The home has systems and procedures and to protect residents from abuse. EVIDENCE: The complaints policy was seen and records examined. There were few complaints, none recent, to assess. We had received one complaint since the last inspection regarding clinical procedures, which was dealt with by the Provider appropriately. We saw through case tracking that people who use the service had received information on the procedure to complain, including reference to the Commission for Social Care Inspection (CSCI). On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. A ‘complaints’ book would enhance quality Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 20 control on this issue, with clear recognition of concerns, complaints and allegations. Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to people’s needs, and a readiness to test the robustness of their information and report structures. Individuals’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning, and policies in place i.e. the complaints procedure. This process was evidenced on examination, and case tracking as previously reported upon. People spoken with on this subject felt that they openly spoke with staff as problems arose, knowing their thoughts would be heard: “I’m sure we could speak to someone in authority if necessary”. The care management showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. Staff induction and in-house training programmes led by the training and development manager, clarified the responsibilities of all staff in their daily contact with people who use the service, especially their privileged position in protecting those people from abuse, of all natures. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of décor and furnishings makes the Home a pleasant and comfortable place to live. The home is well appointed to meet the needs of elderly people using the service, in providing a safe and comfortable environment. All communal areas are of a good standard, offering social as well as private reflection, as the mood takes. The overall environment was found to be safe for people’s comfort, within risk-assessed limits. The home was safe and well maintained and very clean and hygienic. EVIDENCE: A tour of the home verified that the premises were fit for purpose, clean warm and tidy, and being satisfactorily maintained. External car parking and Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 22 grounds are spacious and well maintained. The enclosed rear garden offers a very pleasant area for fresh air and reflection. The state of repair and maintenance is generally very good, offering a comfortable, homely yet secure environment. External access is via a long and well-maintained driveway, set in beautiful pastoral countryside. Visitors and service users take advantage of very attractive gardens and grounds; pathways were safe and recently attended to, after a mild winter. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the Home. On admission the Care Manager assesses each individual person’s needs for equipment and necessary adaptations. Communal space, including the welcoming entrance hall, is furnished in a traditional style, yet presented a homely atmosphere. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. The lounge spaces allow activities to be presented in very pleasant areas of the home, with furniture and fittings of good quality. The dining areas are well furnished, and presented to provide a conducive environment to enjoy a good meal. Staff supervision is available throughout the day. Bedrooms were well maintained to meet service user’s personal preferences. On inspection most bedrooms were highly personalised, with most displaying the person’s own furniture, and personal belongings. Efforts had been made to provide a homely atmosphere, and the décor in most areas was found to be of a good standard, with a development programme for continuing upgrading of decor. Each bedroom has adequate space to assist with personal care and dressing assistance. There are an appropriate number of variable height beds (20 Profile beds shared with Prestwood Coach House) with integral protection rails. The nurse-call alarm system was satisfactorily tested, and service record checked. All personal electrical equipment where seen to be PAT tested. There is an adequate lighting, and bedside lamps are available where risk assessed. Radiators are protected; smoke detectors fitted and adequate electrical sockets available. TV and telephone points were available in each bedroom, equipped with large keypad telephones for service users personal use. A locked facility and lockable bedroom doors was available on request, following suitable risk assessment. Several people spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. The heating arrangements throughout the home are by central heating with guarded radiator convection, providing an ambient temperature. Lighting facilities, including individual bed lights, and overall emergency lighting were installed and regularly maintained by the handyman. Water temperature were Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 23 randomly tested and found to be within normal limits. Each room was fitted with a tested fire/smoke alarm. Ventilation is by direct door and window airing. Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the home. The home presented a clean and pleasant, odour-free atmosphere, much to the credit of staff. To complement the presentation there were numerous floral and decorative displays. People have the provision of sufficient and suitable lavatories and washing facilities within the home. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and odour-free. Adequate attention has been given to ensure maximum privacy within risk-assessed boundaries. Infection control figures highly within the staff induction and supervisory training programmes. Care and domestic staff were approached, and were fully aware of the importance of infection control. Sluice facilities are suitable to assist in control of infection. Notices regarding chemical handling the areas that store chemicals displayed appropriate COSHH posters and information charts. Kitchen presentation showed satisfactory standards of cleanliness, and evidence of sound food hygiene practices. The laundry was well organised and equipped to a good standard, meeting demands from the Main House and the Coach House annex. COSHH regulations were available and would be enhanced with posters clearly displaying, and relevant to, solutions in use. It was agreed with the Providers that a development plan for 2008/09 be drawn up and presented to CSCI. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, and on the examination of staff files, working rotas and discussions with staff. The staffing levels in relation to the number of people in residence, and their dependency level was suitable to meeting assessed needs. The procedures for recruiting and appointing staff were seen to be consistent. Staff training records complement the effort placed into staff training. EVIDENCE: There were 30 people receiving nursing care from a total of 42, at the time of the inspection. Two weeks of off-duty were examined, in which the daily care staffing rota showed adequate balance between skills, qualifications and numbers to provide a foundation for a high standard of care. The Care Manager worked supernumerary, but is supported by a Home Manager who contributes fully to the staffing rota. Agency coverage has been Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 25 used to support shortages of care staff, in tandem with overtime and flexible rostering to meet shortfalls. At the time of inspection the duty rotas confirmed a staff coverage as thus: a.m - 2 trained 9 carers p.m - 1 trained 8 carers N.D - 1 trained 3 carers The maintenance, catering, domestic and laundry hours were determined and found to be appropriate for the size of the Home, and the needs of the residents. The home has a full time activity coordinator, receptionist, training and development manager, housekeeping manager and a care link manager. Four staff files were sampled and found to be a well-organised and up to date, procedure. Ongoing personal and training records were kept secure in accordance of the Data Protection Act 1998. The Providers and Care Management have established a comprehensive procedure for interview, selection and appointment of staff. This involves a standard application form to assess and profile, two references taken and CRB (enhanced) checks gathered before a contract is offered to successful candidates. The thoroughness of staff selection has a significant effect upon the provision of cares to ensure protection of people. Service users are supported and protected by these practises, and all new staff goes through an induction process that will ensure that they are going to be the right person for the home. Four staff on duty were interviewed, each having had a statement of terms and conditions. It is a declared policy that recruitment is based on equal opportunity. Each member of staff spoke well of the training and supervision offered to them, and of the good working conditions that prevail. Each were very settled and enjoyed their positions, and were proud of the high standards of care given. There were no problematic issues raised by the staff. Completelink (Prestwood) were seen to have an in-house training facility, governed by a Personal Development Manager. The Care Manager indicated the Home’s commitment to training and to achieving targets for NVQ level 2. There are 33 staff with NVQ level II and level III (73 ), and a further 4 are currently being trained. Fire training, manual handling, safe working practice, COSHH, Food Hygiene, POVA and infection control were seen to be well organised and all-inclusive. The management were aware of their expected roles within the Mental Capacity Act 2007, with the need to ensure awareness at all levels. A training development plan for 2008/09 had been prepared by the Personal Development Manager. The Providers are committed to a learning environment. Staff induction programmes are well established; very well designed, forming the base upon which in-service supervision and training are planned and Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 26 achieved. Staff records displayed an account of training that includes the General Social Care Council’s code of conduct, obtained to complement existing guides. Records were available to demonstrate an on-going process of supervised practice, showing training sessions and appraisals to be a routine feature of staff development. Prestwood Main has held the Investor in People Standard for the past 8 years, which is reviewed every three years, to ensure appropriate protocols are in place to promote equality and diversity throughout the Home. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is excellent. This judgement was based on discussions with the Registered Providers, the Home Manger and Registered Care Manager, the examination of the Home’s policies and procedures with regards to effective management, general observations during the process of the inspection, and discussions with service users and staff. The Care Manager has consistently demonstrated the appropriate skills and experience to effectively manage the Home. There is a confidence apparent in the interaction of residents, staff and management; that demonstrated a highly positive relationship that pervades throughout the Home. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 28 EVIDENCE: The Registered Care Manager Jayne Tatler, has demonstrated a long-term commitment and competence in running the Prestwoods, in establishing a solid professional policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. A qualified general Nurse with an extensive professional portfolio of practical and managerial experience. She is ably supported with a Home Manager, a Registered Nurse who has worked at Prestwood Main for 18 months. She has the Registered Managers Award, and has actively promoted, and enhanced the Keyworker and Named Nurse team concept. The inspector was impressed by the openness and confidence in the observed interactions of staff, relatives and service users. The relationships were seen to be of mutual trust and respect. Appropriate risk assessments are in place for service users, through care planning and recording, staff selection and the general environment, these are up to date and accurate. Health and safety notices can be seen throughout the home. The Registered Providers have a high profile and involvement in the smooth running of the Home, and are prepared to delegate a wide range of management responsibility to good effect. The Provider with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. This includes a care plan review process that is recorded at least once a month, a staff training programme, and a quality development programme, including the setting of objectives, and target dates to aim for. Social Workers’ review meetings are often a vehicle for assessing quality. The Home has an open door policy and a commitment to equal opportunities. As previously mentioned there is a willingness to create a training environment, and a staff supervision policy and procedure is in place in the home. Cascading training programmes are established as part of the normal management/training process. All care staff receive six sessions of individual formal supervision annually. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. Random samples of records they were found to be well maintained, accurate and up to date, ensuring that the people’s’ rights and best interests are safeguarded. Records inspected included, fire prevention tests on equipment, six monthly fire training and procedures, Health and Safety checks on equipment servicing and planned preventative maintenance and risk assessments. A Fire protection Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 29 report 3/12/07 was received and seen to have been addressed satisfactorily. Water temperature logbook, the record of testing and servicing of hoists, and gas servicing. The procedures manual was randomly examined, and found to offer a very comprehensive reference. The Manager offered evidence of safe working practices including: - Movement and handling training, fire safety training, disposal of waste and handling abuse. Training on infection control is also undertaken, and the policies and procedures for this subject are working documents in the home. Relevant legislation was discussed and is fully understood by the management, i.e. changes from CSCI, updates on Health and Safety issues, etc. The health and safety of service users and staff are promoted with safe storage of hazardous substances, regular electrical PAT and servicing of electrical and gas appliances and regulation of the water system. The accident book was seen and found to be in order for staff, service users and reporting arrangements to Riddor. A 3-monthly analysis is recorded on trends and frequency. Health and safety notices can be seen throughout the home. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of people. Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 13 14 15 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 4 30 4 4 4 3 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 4 3 3 3 3 4 4 Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? None STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP16 OP24 OP26 Good Practice Recommendations A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. A development plan be drawn up for 2008/09 That COSHHE laminates be displayed in all areas involving the use of hazardous chemicals, to complement existing procedure sheets. Ensure cleaning record in the kitchen is kept up to date. That Oxygen cylinders be kept secure and stored safely when not in use. 4. 5. OP38 OP38 Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Prestwood (Main House) Nursing Home DS0000022361.V362734.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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