CARE HOMES FOR OLDER PEOPLE
Priory (The) 112 Priory Road Noak Hill Romford Essex RM3 9AL Lead Inspector
Ms Helen Fontaine Unannounced Inspection 07 November 2005 10:00 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 Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 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. Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Priory (The) Address 112 Priory Road Noak Hill Romford Essex RM3 9AL 01708 376535 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) Aermid Health Care Limited Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th August 2005 Brief Description of the Service: The Priory is a care home for 30 Older People, situated in a residential part of Hornchurch. It is on a bus route to Romford, where there is a railway station. A private company, Aermid Health Care Ltd, who run other similar homes, owns the home. The house was originally a purpose built children’s home, to which an extension and loft conversion have been added. There are 20 single and five double rooms, with the majority having either en-suite toilets, or one toilet shared by two rooms. The rooms are of varying sizes and shapes, but all are big enough for Service Users to have small personal possessions in place. The bedrooms are on all three floors, which are accessed by a lift and stairs. The dining room, lounge and conservatory are on the ground floor and the latter leads onto a patio and well-tended garden. Personal care is provided on a twenty-four-hour basis and health needs are met by visiting professionals. Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Unannounced Inspection took place over two and half hours and was carried out as part of the yearly inspection programme for the home. This was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. Five Requirements was set at the previous inspection and the registered person has complied with all of the required action. The Inspector looked around all parts of the building and a number of records were inspected. A number of Service Users and a member of staff was spoken to. The assistance of the Manager during the inspection was very much appreciated. What the service does well: What has improved since the last inspection?
The home has now undertaken Adult Protection training with staff and Certificates were seen. The home has another course next week, which should have taken place last month and will cover the remaining staff. During the tour of the home, it was seen that the Conservatory now has a new floor. Service Users were observed to be enjoying this space and this is also used for Service Users who wished to smoke. The previous Registered Manager has now returned to the home full time and will remain as the Manager of the home until a new Manager has been recruited. The Manager present during the inspection said that they had undertaken interviews and were awaiting references.
Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 6 The home is making efforts to make sure that all staff receive supervision and notes of meetings are being kept, awaiting transfer to a permanent file. All equipment that was stored in the loft space has been moved and the loft area was seen as clear. What they could do better: 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. Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 7 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 Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Service Users are assessed before they move into the home and are assured that the home can meet their needs. EVIDENCE: The Pre-admission assessment for the newest Service User in the home was seen. The assessment form is in-depth covering the areas of; personal details, physical well being, personal care, weight, diet and communication. This particular Service User had documented that their communication was excellent. Other areas covered were; sight, hearing, oral, foot care and mobility. Under mobility it is documented that the Service User walked with a stick. The Manager said that from this assessment, verbal contact is made with Service Users and family/representatives on the outcome and whether the home could meet the their needs. The Manager said they home do like the Service User to visit the home, but in the case of this particular Service User this was not possible as they were in hospital. The home currently has two vacancies; the home had not up to the time of the inspection, identified any potential Service Users.
Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 11 Service User’s health, personal and social care needs are clearly set out in Care Plans. The home has a separate document for the issues over death and dying. The homes policies, procedures and practices, around the area of medication protect the Service Users. Residents are enabled to retain responsibility for their own medication where appropriate. EVIDENCE: The Care Plan documents were inspected for the same Service User whose Preadmission assessments were looked at. The document evidenced that the Care Plan was written seven days after the initial assessment and covered in more depth the areas that the Pre-admission assessment covered. Each of the areas had a full page and as an example for personal care it documents that assistance is required. It also covers under the heading personal care, how many carers are needed, whether a hoist is needed and if any special soap is needed. It also documents areas around oral hygiene, hearing aids, glasses and which bathroom the Service User uses. The care plan also covers all the areas in the pre-admission assessment in the same in-depth format and is signed by the Manager, the Service User and family/representative. The care
Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 10 plan is a working document and is used by the staff to meet the needs and aspirations of the Service User. The Medication Administration Records (MAR sheets) were looked at during the inspection and found to be documented appropriately, with a picture of the Service User on the front. The home currently has two Service Users who self medicate and the homes policy covers the area of risk assessment reviewed each month and appropriate storage in their rooms. The home has developed a separate form for the documenting of the wishes of the Service User over death and dying. This form covers the areas of funeral arrangements, burial/cremation, cultural needs, specific requests and funeral arrangements. The home complete this form once the Service User has been in the home for a short period of time, rather than do this at the time of the assessment or care plan. Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15 Service Users have their lifestyle matched in the home, that also meets their expectations and preferences. Service Users maintain contact with family/friends/representatives and the local community. The Service Users receive an appealing balanced diet, in appropriate and pleasing surroundings. EVIDENCE: The homes activities plan was seen in the dining room and there were a number of entertainments. The home had a clothes show last week and during the inspection a trolley was being taken around the home with sweets and toiletries. On two notice boards in the home, there were photos of outings, a fete and birthday parties. One Service Users spoken to said that they have a number of activities during the week, they went out in their wheelchair with family or friends, helping a visiting health professional and taking part in the activities organised by the home. The Service User, whose documentation was looked at, is now being visited by their relative more often than before they moved into the home. The Manager said that this is often happens, as the relatives and friends/representatives have more quality time with the Residents. During the inspection a tour of the building was undertaken and during this tour the kitchen was visited. The main meal of the day was being cooked and it was observed that this was wholesome and appealing. The Service User spoken to wanted the very exceptional meals mentioned and said “where else
Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 12 do you get three roast dinners a week?” All the other Residents spoken to all commented on the good food they received and they were able to have a choice as long as they informed the cook. Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Service Users are confident that their complaints will be listened to and taken seriously. Service Users are protected from abuse by the homes, practices, policies and procedures. EVIDENCE: During a tour of the home, one of the notice boards had information on complaints. The board also had on it, a number of thank you and complimentary cards. The complaints policy book was looked at and had the policy review date and had sample letters and information of the procedure for dealing with complaints. There was one complaint for 2005; the previous complaints had been in 2004. This complaint for 2005 was made by a visitor and was investigated with a discussion on the outcome at the team meeting three days later. The visitor making the complaint was contacted in writing detailing how the complaint was dealt with and with the outcome, well within the time scale set. A member of staff seen and spoken to was very clear that anything even the slightest concern would be dealt with very quickly. The Service Users spoken to were also clear that any concern that they had would be listened to and taken seriously. The clear documentation, policies, procedures and practices makes this one of the areas where the home exceeds the Minimum Standards. The home has in place training for all its staff over Adult Abuse and the last few remaining staff are having training next week. A member of staff spoken to said that they are encouraged and do feel able to inform the Manager or the Commission of Social Care Inspection, if they had any concerns at all about anything to do with Adult Abuse.
Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24 and 26 Service Users live in a safe, well-maintained environment that is clean, pleasant and hygienic. Service Users have their own or a shared room which are comfortable, with their own possessions around them. EVIDENCE: Service Users rooms seen during a tour of the home were personalized with items of the Residents choice. A Service Users spoken to said that they normally share a room, but as the other Service User is in hospital they are in a single room. The Conservatory now has a new floor, which is easy to keep clean. The home during the tour was seen as being homely, warm and welcoming. The home was very well maintained and was safe, clean, pleasant and hygienic. The outside of the house is well maintained, as are the grounds, which were well stocked with plants and containers.
Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 15 Most of the Service Users prefer to use a particular bathroom, where there is a choice of walk in shower or bath. This preference is included in their care plans. Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 The homes recruitment policy and practices support and protect the Service Users. The staff are trained and competent to do their jobs. EVIDENCE: During the inspection the newest member of staff’s file was looked at, along with a member of staff that had worked in the home for sometime. The newest member of staff had two references and a current CRB on the file, as did the member of staff who had worked at the home for sometime. The file had identification, completed application form and the newest member of staff already had certificates for, Adult abuse, NVQ 2, food hygiene, first aid. The other member of staff’s file had, completed application form, signed terms and conditions, NVQ 3 and 2, dementia awareness, adult abuse, risk assessment training, the homes own in house arthritis awareness. In addition to these certificates there were more for, diabetes course in 2003, infection control and administration of medication. During the inspection, there was training taking place. Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 and 38 The home is run and managed by a person who is fit to be in charge and the Service Users’ financial interests are safeguarded. Staff are appropriately supervised and the health safety and welfare of Service Users and staff are promoted and protected. EVIDENCE: The previous Registered Manager of the home is now back in post full time, until a new Manager is recruited. The home has interviewed and the references have been requested. The Service Users finances were looked at and the Manager said that most of the Residents money is dealt with by their relatives or friends. Each of the Service Users have a plastic wallet, containing their spending money and there is a sheet documenting money going in and out. The Manager signs the entries and said that they always give the Residents a receipt. Staff supervision was looked at and the Manager said that they are a bit behind with the documentation of supervision, but it is receiving a high
Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 18 priority. Previous supervision notes were seen and the Manager has a folder with notes of meetings with staff that was also looked at. The home does make the very best of efforts to ensure that their staff and Residents are protected. During the tour of the home, it was noted that two fire doors were wedged open. The Manager was very clear that the fire officer had seen these the last time they inspected the home and said that this did not breach any fire regulations. The Manager thought that this was in writing, but was unable to find the letter. The Manager said that the fire officer was happy about the wedges, as long as they were removed at night, which the home make sure they are. The Manager said that they would enquire about the wedges with the fire officer and this would be looked at, at the next inspection. Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 19 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X X 3 3 X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 3 X 3 Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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. 1 Standard OP38 Regulation 13 (4) Requirement The Manager establishes with the Fire Officer and gets the evidence in writing that it does not breach fire regulations to have the two fire doors wedged open. This is also confirmed to the Commission Timescale for action 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Priory (The) DS0000027872.V264504.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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