CARE HOMES FOR OLDER PEOPLE
Prestbury Court Residential Home Brimley Lane Bovey Tracey Newton Abbot Devon TQ13 9JS Lead Inspector
Andrea East Unannounced Inspection 21st June 2006 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 Prestbury Court Residential Home DS0000033222.V293289.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. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Prestbury Court Residential Home Address Brimley Lane Bovey Tracey Newton Abbot Devon TQ13 9JS 01626 833246 01626 833236 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) Avens Care Homes Ltd Mr Andrew James Avens, Mrs Samantha Avens Mrs Rosalyn Nolan Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40), Old age, not falling within any other category (40), Physical disability over 65 years of age (40) Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7/01/06 Brief Description of the Service: Prestbury Court Care Home is registered as a Care Home providing Personal Care for forty elderly frail residents who may have additionally a degree of physical or mental disability. The home has two floors and had recently increased the accommodation of the property to include a large conservatory lounge on the ground floor, an additional dining area and an increase in residents’ private rooms/accommodation. This is additional to the existing lounge and dining areas so that the home has two lounges and two dining areas. The extension to the home has also increased the number of toilet and bathroom facilities and has also increased the number of staff on duty at any one time. The home also has a sensory room. Three staff live on the premises on the top floor of the property opposite residents accommodation. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out over a day, a range of documents including staff and service users files, policies, procedures and the homes service users guide were examined. Service users were spoken to in the homes lounge and in private rooms and members of staff were also spoken with. The homes manager was present throughout the inspection. Feedback about the home was also received by post in quality questionnaires provided by the Commission. What the service does well: What has improved since the last inspection?
Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 6 Since the last inspection the documents stored in the home, despite some gaps in information have been extended and were more consistently completed. The manager has invested in guidance from an outside company (Croner), which supplies up to date policies and guidance on all areas of care and this has enabled the manager to extend some of the homes policies and procedures including initial assessments and admission procedures, this will also help staff understand and meet the resident’s needs. Residents care plans, on the whole, had been improved with more detail included in the assessment and care plan of residents needs. The daily records of assessment or “daily review” of residents care, had significantly improved for some residents records while other’s had improved but still remained uncompleted. Two issues related to the premises were raised at the previous inspection were: fire/smoke detector to be fitted and a resident had bed rails protected by sheets tied around them to try and protect the resident from injury by knocking against the sides. Both these issues have now been resolved. The manager is developing a quality assurance system and as part of this system the proprietor has submitted monthly reports to the Commission out lining the areas the proprietor had considered when visiting the home. This document has been extended to give more information to the Commission. What they could do better:
The home needs to provide evidence that potential residents and their families had received the homes service users guide or the statement of purpose, this is important so that potential residents are fully aware of the facilities and services the home provides. The documents in the home detailing residents care despite some gaps in information have been extended and were more consistently completed than the last inspection and the manager is aware of the need to continue to fully complete all documents and to ensure any new residents in the home have a complete assessment prior to entering the home. This will ensure that members of staff have the information they need to ensure residents needs are fully met. The home administers medications safely, however an area of concern was in the collection and the storage of oxygen cylinders. The homes manager has taken steps to safeguard the area with notices warning staff of potential danger, however to reduce potential risks the cylinders should be returned to the pharmacy as soon as possible. The entertainment provided includes musical exercise, a musical entertainer, crafts, trips out and games, the manager also described one to one discussions
Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 7 with residents and some of these activities are detailed in daily records, however these records are not consistently completed for all residents. This needs to be recorded so that staff can monitor and review activities in the home and match them residents needs and preferences. There is also no record of how residents are benefiting from a specialist activities area that the home has invested in, residents planned or more informal use of this room needs to be recorded so that staff can monitor how best to use this room for the residents benefit. The home needs to provide consistent records clearly showing that all staff have received regular training in a range of areas including adult protection and dealing with abuse. An ongoing record of training would demonstrate an overview, planning and addressing gaps in staff training to ensure staff are fully trained and will reduce the risk to residents. All members of staff must have a completed criminal records checks and work permits in place (if applicable) before working or living in the home. If these checks are not in place this puts residents at risk from abuse from staff who may not be suitable to work with vulnerable adults. The home has a number of areas of concern in relation to health and safety and the premises, this includes ensuring the extension of the home has received a building control certificate, completing the upgrading of residents rooms, ensuring windows are restricted, radiators are guarded and fire doors are not wedged open. In addition the homes manager must ensure risk assessments for the premises, including fire risk assessments are fully completed, reviewed and updated. These issues potentially put residents and staff at risk of harm. 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. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 8 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 Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 9 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): 1,3,6 The quality of the outcomes for service users in this outcome area is adequate. Prospective residents do not have the information they need to make an informed choice about where they live. Residents do not move into the home without having his or her needs assessed. (The home does not provide intermediate care.) EVIDENCE: There was no evidence available that potential residents and there families had received the homes service users guide or the homes statement of purpose, this is important so that potential residents are fully aware of the facilities and services the home provides. A random sample of residents files were examined and they included the homes initial assessment forms for residents needs, which the manager said was completed in discussion with the resident, the residents family and any professionals that had been involved with the resident while living in the community. A range of supporting documents which also provided information on residents needs were also on file, these documents included weight charts and more detailed assessments. The residents who had been in the home for some time had most of the assessment information completed. However, one
Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 10 file which was of a more recent admission of a resident to the home had not been fully completed. Initial assessments from the placing authority and care plans completed by Social Services representatives or hospital staff were also held on individual files. The manager confirmed that the home also completes an admission sheet and issues contracts to residents that gave information on the services and facilities available. The documents examined despite some gaps in information have been extended and were more consistently completed than the last inspection and the manager is aware of the need to continue to fully complete all documents and to ensure any new residents in the home have a complete assessment prior to entering the home. This will ensure that members of staff have the information they need to ensure residents needs are fully met. Since the last inspection the manager has invested in guidance from an outside company (Croners), which supplies up to date policies and guidance on all areas of care. This has enabled the manager to extend some of the homes policies and procedures including initial assessments and admission procedures, this will also help staff understand and meet the resident’s needs. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 The quality of the outcomes for service users in this outcome area is good. The resident’s health, personal care, and social needs are set out in an individual plan of care and residents are treated with respect with their right to privacy upheld. The residents are protected by the homes policies and procedures on dealing with medication. Resident’s health care needs are met EVIDENCE: A sample of residents care plans were examined and on the whole there had been some improvement in the detail of the care plan so that staff providing the care could easily see the care needs of the resident and how to meet those needs. This included for some residents detailed assessments and care planning for risk of falls, how to move a resident safely and residents preferred sleep pattern. However some files had not yet been fully completed so that blank forms were on the file such as uncompleted weight charts and a record of when residents had bathed. The manager is aware of the need to ensure all documents are fully completed for all residents. The daily records of assessment or “daily review” of residents care, had significantly improved for some residents records while other’s had improved
Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 12 but still remained uncompleted so that it was unclear how some residents had had spent their day, what visitors they may have had or activities they may have participated in and how this linked to their care plan. The manager is aware that the staff team need to continue to work on fully completing ongoing records and she confirmed that this has been discussed in staff meetings and individual staff discussions. These inconsistencies could indicate that staff may be unaware of resident’s needs or how to meet them, so they don’t write about them, it could also indicate that staff were unable to write about the care of the resident as no care was given. Consistent recording is important as it shows any changes in care for residents so that carers can respond to those changing needs. This was also highlighted in the review of residents care plans as it was not clear if residents needs and how they were to be met had been reviewed monthly. A new format for recording reviews was available for inspection and the manager said that this was to be implemented immediately. Residents spoken too and who were able to respond said that they were pleased with the care provided and feedback forms returned to the Commission indicated that the staff gave care and support where needed and listen and act on what residents say. The home operates a monitored dosage system of medication administration so that medicines are stored, labelled and administered on an individual basis. Records of medicines given to residents were well maintained and this included a new controlled drugs book and a new returns of medicine book. The home has a medication policy, which includes controlled drugs and cover medication. This indicates that the home administers medications safely. One area of concern was in the collection and the storage of oxygen cylinders. The homes manager has taken steps to safeguard the area with notices warning staff of potential danger, however to reduce potential risks the cylinders should be returned as soon as possible. The inspector observed staff throughout the day interacting with residents and they were observed to treat residents with politeness and dignity, knocking on doors and apologising when interrupting residents to ask them about what they preferred for supper. The residents seemed to enjoy the contact with members of staff and the members of staff were relaxed in the company of the inspector and happy to discuss how the home cared for residents. This indicates good relationships between the staff and the residents based on respect and dignity. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15, The quality of the outcomes for service users in this outcome area is good Residents find the lifestyle in the home matches their preferences and satisfies their social and recreational needs, maintaining contact with family and friends and the local community as they wish. Residents are assisted to exercise choice and control over their lives and they receive a wholesome appealing balanced diet in pleasant surroundings at times convenient to them. EVIDENCE: Most of the residents spoken were unable to answer complex questions and some were not able to express themselves other than in smiles and nods. The residents who were able to express an opinion said that they had a choice of how they spent their time and a choice in menu and where they eat. Staff spoken too also said that as much as possible all residents were offered choices and encouraged to do as much for themselves as they could or wished too. Members of Staff were observed talking to residents about what they would like for tea and if they wished to go to the homes lounge or their private bedrooms. Menu plans showing plans for resident’s lunches and suppers were available for inspection and Staff confirmed that staff asked each resident what they would like for supper, such as sandwiches, soup and light suppers. Staff were also observed with a desserts trolley filled with a range of pastries and puddings and when asked staff and residents confirmed that this was standard practice in the home with this level of choice always available.
Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 14 Overall residents who were able to express themselves said that they felt well cared for and that care staff helped them their personal and health care needs. Residents were observed in the homes lounge areas, moving around the home and in their own rooms and those being cared for in their rooms appeared to be comfortable, relaxed and staff were observed checking if residents wanted or needed anything and offering drinks and cakes. Residents who were able to speak to the inspector were pleased with the way home provided activities but did not force everyone to attend, so that residents had a choice about how they spent their time. Some residents preferred to remain for long periods in their rooms while others chose to sit in either of the homes lounges or in the dining rooms. On the day of the inspection there were several visitors to the home, and the manager supplied the inspector with a list of some of the activities planned for the next few months this list had previously been displayed on a notice board. The “entertainment plan” includes musical exercise, an musical entertainer, crafts, trips out and games, the manager also described one to one discussions with residents and some of these activities are detailed in daily records, however these records are not consistently completed for all residents. The home has a minibus. These things continue to maintain links for residents with the community and outside events. The new extension to the home has meant some changes to the accommodation previously used including one room being turned into a sensory room, with relaxing music, large soft chairs and a lighting system that stimulates and relaxes. The homes manager stated that this room is still being slowly introduced to residents and the home are exploring the best way to use this area. For residents this room could be an important opportunity to have one to one time with staff or have a gentle mental stimulation that they have not previously had. There is no record of how residents are benefiting from this area and residents planned or more informal use of this room needs to be recorded so that staff can monitor how best to use this room for the residents benefit. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 15 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): 16,18 The quality of the outcomes for service users in this outcome area is poor. Residents and their friends and families are confident that their complaints will be listened too and acted upon. Residents are not protected from abuse. EVIDENCE: The home has a complaints procedure, which the manager confirmed continues to be included in the service users guide, in the homes policy and procedure manual and is in the homes contract with residents. The residents spoken too said that they felt able to bring any concerns to the attention of the manager or staff and they would be resolved. Since the last inspection the manager stated that there had been no complaints or concerns raised in the home and consequently there was no record of any concerns raised. Discussion took place on recording of complaints no matter how minor so that the home could clearly demonstrate how concerns or complaints had been addressed. The home also has a policy on dealing with abuse issues and this includes reference to the NHS “No Secrets” guidance. The manager confirmed that all staff received in house training on abuse that includes the homes policies and procedures in this area. However the staff training records examined did not show this. Some staff individual files indicated that training in this area had been given while others did not include this information. An ongoing record of staff training including adult protection was not available for inspection. An ongoing record of training would demonstrate the homes overview, planning and addressing gaps in staff training to ensure staff are fully trained and will reduce the risk to residents. One member of staff did not have a completed criminal records check and is living on the premises this potentially puts
Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 16 residents at risk from abuse from staff who may not be suitable to work with vulnerable adults (also see staff and recruitment standards). By ensuring that members of staff receive training, documents are in place to remind staff and ensuring that residents feel able to express themselves protects residents and staff from harm/abuse. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 17 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): 19.26 The quality of the outcomes for service users in this outcome area is poor. Residents live in a clean, pleasant and hygienic home with comfortable indoor and outdoor communal areas and comfortable bedrooms that residents have furnished with some of their own possessions. Residents do not live in a safe environment. EVIDENCE: The inspector toured the premises entering every resident’s room, communal areas, toilets and bathrooms. The home presented as clean, and odour free, with lots of personal affects making the home comfortable and homely. The new extension adds to the home a large conservatory lounge and the proprietor had purchased new furniture of good quality throughout the home, such as new dining furniture and new lounge chairs. The home has enclosed patio areas that have also been furnished to enable residents to sit outside. Overall the home presents as providing a good standard of accommodation for residents. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 18 Throughout the home redecorating and recovering floor areas has continued to take place, however one resident’s room in particular continues to be in need of redecoration. This was discussed with the homes manager who confirmed that this work was planned for the future, and the delay had been due to the resident’s reluctance to proceed. This work has now been planned for some time with no progress being made. There were several areas of concern that the inspector discussed with the manager at the previous inspection that have now been addressed for example. One resident’s room did not have a fire/smoke detector fitted so that if there had been a fire in this room it would not have alerted the alarm, putting this resident and other residents at risk. One resident had bed rails protected by sheets tied around them to try and protect the resident from injury by knocking against the sides. Both these issues have now been resolved. However areas of concern that remain outstanding are that; One resident’s room on the first floor had a window that opened well over 12 inches and was easily large enough for the resident or any other resident to fall out of. The manager stated that the resident preferred lots of fresh air and discussion took place on achieving this while keeping the window restricted and making sure there is minimal risk to residents. Discussion took place on the progress made in this area and the manager confirmed that they had spoken at length with the resident, this needs to be resolved as a priority. Several radiators (in the new wing) were unguarded and residents are potentially at risk of injury from the radiators, for example if they fell and hit themselves on the radiators sharp edges. This was discussed with the homes manager and it was agreed that risk assessments would be carried out and radiators would be covered/guarded. In addition it was noted that the fire doors in the home were being wedged open with devices not approved by the Fire Authority and that the new extension had not yet received a completion certificate from the Building Control department of the Local Authority, which includes fire prevention measures. The manager gave several reasons for the delay in obtaining an certificate and the use of door wedges and agreed to take action to address this. The homes risk assessments for the premises, including the home fire risk assessment were not available for inspection. The manager stated that these documents had been removed to be updated including making sure they were dated, signed and extended to include each room in the home and covering guarding radiators, window restrictors and fire safety. These documents will highlight potential risks and show how the home have minimised risks keeping Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 19 staff and residents from harm. These records must be maintained on the premises. The homes kitchen cupboards and units are in need of updating and the manager confirmed that the proprietor was taking action to address this. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30, The quality of the outcomes for service users in this outcome area is poor. Resident’s needs are met by the numbers of staff on duty and the skill mix of the staff. Residents are not supported or protected by the homes recruitment and training policies and practices. EVIDENCE: The manager confirmed that the home operated with a minimum of six care staff, plus one person in charge (the manager or senior person), who were supported by cleaners, catering staff and admin support from the homes owners. Staff have a mix of skills, with some staff being employed at the home for years, while others have been newly recruited from abroad (please refer to previous reports). The residents have varying levels of needs with some residents described by the staff as “self caring” while others needing full assistance to eat, drink and attend to personal care. On the day of the inspection the majority of residents indicated that they felt well cared for. However given the frailty of the residents the home must be aware of the need to increase the numbers of staff on duty should residents needs change or how the staff team is made up changes, for example staff leave and all new staff on duty. The manager confirmed that staffing had been increased when it was noted that accidents were occurring at certain times of the day, so additional staff had been recruited at these times.
Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 21 Staff files examined did not clearly and consistently show that the home had operated thorough recruitment and induction procedures for all new staff, in that one staff file did not have a written reference and one member of staff had not had a criminal records check or a work permit before starting work at the home. There was also no application form for one member of staff and no records of interview taking place. Consistent induction records meeting national training organisations standards for staff were not available for inspection and the manager stated that this was due to staff taking them off the premises to complete. Staff records must be maintained in the home. Staff appraisals and supervision records were available for some staff but not for all staff an ongoing record of staff training and any need for training was not available for inspection, although a new book recording some training was in place it did not demonstrate an ongoing monitoring or proactive approach to staff training. Recruitment, selection and training of staff is an area that the manager needs to urgently review and update so that residents receive care from all staff who have been deemed fit to work with vulnerable adults and from a staff group who are trained and competent in meeting residents needs and knowing the home. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 The quality of the outcomes for service users in this outcome area is poor. The health, welfare and safety of residents and staff is protected in some areas, while in others there are areas of concern. Service users financial interests are safeguarded EVIDENCE: The proprietor is a registered nurse who had been previously employed in the health authority and has a past family history in the care industry. The manager of the home has been at the home for some time prior to the current proprietors purchase of the home and she confirmed that she has continued to obtain a range of qualifications within the care field and has now completed her NVQ4 in Care Management. The residents said that the manager and staff tried their best to accommodate each resident’s individual interests and preferences. The managers and staff description of care and the care detailed in some of the care plans indicates
Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 23 that the home is run in the best interests of the residents, for example the opportunity to attend activities and for staff too reassure residents if they are concerned about anything. There were a number of health and safety issues linked to the environment (please see standards 19-26 Environment) and recruitment (please see standards 27-30 staffing) , which the manager confirmed would be addressed. However some of these issues have been outstanding for some time and now should be treated as a priority for example a window that is not restricted in it’s opening, radiator covers/guards and obtaining a certificate of completion from the Local Authority. The home has a system of recording and monitoring Residents finances which is a separate account to the homes business account and the manager confirmed that no one acts as power of attorney for the residents. The financial accounts included receipts for any money spent on behalf of residents and is audited by the proprietor. The manager is developing a quality assurance system and as part of this system the proprietor now to submits a monthly report to the Commission out -lining the areas the proprietor had considered when visiting the home. This document has been extended to give more information to the Commission since the last inspection. The quality assurance system complies mainly of tick box forms, where the manager has looked at some areas of the home and ticked to say everything is in place. Discussion took place on extending this to highlight what was looked at for example who’s staff file or residents files was examined, what shortfalls were identified and how the home addressed them. It is also important how to show the home have consulted with residents and their families on the running of the home and the care received. The proprietors feedback will help to keep the Commission informed of the day to day events in the home and how the home continues to progress. Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 24 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP18 Regulation 13 Requirement Timescale for action 20/09/06 2. OP19 12,13,23 3. 4 OP19 OP19 12,13,23 12,13,23 Ensure that all staff have received training on adult protection and abuse issues and that this is clearly recorded. The registered person must ensure that all staff receive training and regular updates to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 20/09/06 Risk assessments for the premises must be extended to include, all areas of the home, identifying hazards and showing how the home have addressed these hazards. This must include window restrictors, fire safety, radiator guards and hazards for those residents that may be confused or disorientated. These records must be maintained on the premises. Previous timescale 12/11/05 not met Window restrictors must be fitted 20/08/06 to all windows Previous timescale 12/11/05 not met Fire doors in the home must not 20/08/06 be wedged open with devices not approved by the Fire Authority
DS0000033222.V293289.R01.S.doc Version 5.2 Prestbury Court Residential Home Page 26 5 OP19 12,13,23 6 7 8 OP19 OP24 OP29 12,13,23 16 19 9 10 OP30 OP30 18 18 The new extension must receive a completion certificate from the Building Control department of the Local Authority Radiators must be guarded. Previous timescale 12/11/05 not met Resident’s rooms must be refurbished. Previous timescale 01/02/06 not met The registered person must not employ a person to work at the care home unless the person is fit to work at the care home; and he has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of schedule 2 and is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of schedule 2 in respect of that person. This relates to the lack of work permits, completed criminal checks and incomplete documents such as application forms. Staff must receive induction training that meets National Training Organisation standards. The registered person must, having regard for size of the care home, the statement of purpose and the number and needs of service users ensure that persons employed by the registered person to work at the care home receive - training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. This must be recorded 20/08/06 20/08/06 20/09/06 20/08/06 20/09/06 20/09/06 Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 27 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 Refer to Standard OP1 Good Practice Recommendations Provide evidence that potential residents and there families had received the homes service users guide/and or the homes statement of purpose. All documentation including care plans, monthly and daily assessment should continue to be updated and must be fully and consistently completed, showing the needs of the resident and how those needs have been met Continue as planned to return Oxygen Cylinders provided for residents to the hospital or pharmacy. Consistently complete records that will indicate the activities residents have participated in, including their use of the sensory room. Record any complaints or concerns and how these complaints were addressed and resolved. As planned update the homes kitchen cupboards and units. Continue to extend the system for monitoring the quality of the services provided and in ensuring service users are consulted with about the quality of services provided. 2 OP7 3 4 5 6 7 OP9 OP12 OP16 OP24 OP33 Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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 Prestbury Court Residential Home DS0000033222.V293289.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
