CARE HOMES FOR OLDER PEOPLE
Prestbury Court Residential Home Brimley Lane Bovey Tracey Newton Abbot Devon TQ13 9JS Lead Inspector
Andrea Peryer Unannounced Inspection 7th January 2006 14:00 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.V269964.R01.S.doc Version 5.1 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.V269964.R01.S.doc Version 5.1 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.V269964.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th September 2005 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 exsisting 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 aqnd 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.V269964.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out through a Saturday afternoon, with the homes manager. The inspector spoke to staff, residents and their relatives. A small sample of documentation was examined, this included care plans and assessments and the inspector toured the premises, entering all areas of the home. What the service does well: What has improved since the last inspection?
The manager and proprietor have started to extend some of the documentation in the home such as risk assessments for residents and care plan information. These improvements demonstrate the service commitment to improvement and these documents make clearer the care the residents require and receive from the home. The accommodation has been further improved by attention to health and safety issues such as restricting windows that previously opened wide enough for a resident to fall through. The staff kitchen previously left unlocked, offering the opportunity for residents who may have some memory loss to wander in and hurt themselves on kitchen equipment, was locked. Other improvements have been the guarding of radiators safeguarding residents from harm of burning and the fitting of fire detection devices. Some Risk assessments for the property have also been extended and the manager was continuing to update risk assessments. The service has also started developing audit checklists as part of their quality assurance systems to ensuring high quality services to residents. Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 6 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. Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 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 Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 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): Not inspected on this occasion EVIDENCE: Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 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): 8 Residents’ health and personal care needs are fully met, they are treated with respect and their right to privacy is upheld. EVIDENCE: Although not fully inspected on this occasion please refer to daily life and activities standards 14 and 15 as they make reference to the care in the home and care planning. Please also see the previous inspection report. Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 10 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): 14,15 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. One resident had chosen to sit in the homes large foyer area so that she could greet anyone visiting the home and another chose to sit the homes office to chat to the manager and this was treated by staff and the manager as their right to sit in the home wherever they safely wanted too, without feeling that they were imposing or being intrusive.
Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 11 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. One resident said that they felt the standard of service was “slipping” when asked to expand the resident was unable to do so and discussion took place with the manager on this persons care and how the home ensure that this resident has an opportunity to express themselves and reassured about the services available in the home. One resident’s file was examined as the manager was describing the changes to recording that had taken place since the announced inspection. The file contained care plan and assessment documents that had been adapted from a reputable company’s policy and procedures guidance and were more detailed than had previously been available. The file also included extended details of the mental health needs of the resident and any possible challenging behaviours. This area was covered at the previous announced inspection and explored in more detail at the next inspection of the home. Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 12 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): Not inspected on this occasion EVIDENCE: Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 13 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): 19,21,22,25,26 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: Since the last inspection key areas of health and safety in relation to the premises has improved for example the homes radiators are now guarded, window restrictors are in place, fire/smoke detection is now in all residents rooms and areas such as the staff kitchen was secure. The home is made up of two sections: the older part, which has benefited from communal areas being refurbished and the newer extension, which has added an additional conservatory lounge, dining room and bedrooms. The older part of the home was clean and tidy and had been personalised to reflect residents’ personalities with items of furniture, photographs and flowers. This part of the home has two rooms that are in need of attention to replace carpeting and
Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 14 redecorate and the manager confirmed that there were plans to update these rooms in the near future. The new extension part of the home while also clean and tidy lacks the warmth and personal appeal as walls remain bare and bathrooms clinical and functional but not appealing. The manager confirmed that they had been unable to progress in this area until the new part of the home had really had a chance to be fully completed and they had made some efforts such as clocks and calendars, notices on doors and personalisation of some bedrooms to try to address this. Despite these shortfalls the home continues on the whole to provide a good standard of accommodation. The new corridor in the new part of the home had been fitted with a camera, this was turned off and the manager confirmed that this is no longer used. Areas that make the home not safe are in ensuring that fire exits are not blocked as on the day of inspection two fire exits were blocked with wheelchairs and other equipment, ensuring all fire doors marked “keep locked” or “keep shut” are locked or shut and in fitting hand rails in the corridors of the new wing to assist residents moving around these areas and to prevent injury from falls. In addition food (large bags of vegetables) were being stored in the homes activities/sensory room, which are a trip hazard and is not hygienic. The manager stated that this was an emergency temporary measure as leaking to the outside food storage area meant storing items in the home until the repairs could be made. The kitchen while clean and tidy is in need of upgrading as the kitchen units are of a domestic nature and are old and worn. The manager confirmed that there were plans to upgrade the kitchen, replacing units. The manager confirmed that Risk assessments were being extended they were not examined in detail at this inspection. Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 15 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 Residents’ needs are met by the numbers of staff on duty and the skill mix of the staff. EVIDENCE: The manager confirmed that the home operated with a minimum of four 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 report). 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. Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 16 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): 38 The health, welfare and safety of residents and staff is protected in some areas, while in others there are areas of concern. EVIDENCE: Please refer to the section on environment standards 19 to 26 and the homes previous inspection report. The home has improved in some areas of health and safety while some areas remain to be addressed. Some aspects of quality assurance have been introduced such as audit checklists and the Commission now receives monthly provider/owners reports, however the reports are to be extended as to include details of residents and staff comments and the home are continuing to explore quality assurance tools. Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X 3 3 X X 2 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 18 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 OP7 Regulation 14,15 Requirement All documentation including care plans, monthly and daily assessment must continue to be extended, fully and consistently completed, showing the needs of the resident and how those needs have been met. [Previous timescale (12/12/05)] Risk assessments for the premises must continue to be extended to include, all areas of the home, identifying hazards and showing how the home have addressed these hazards. [Previous timescale (12/12/05)] Ensure corridor areas in the new part of the home have hand rails Two residents rooms must be refurbished Ensure all fire exits are free from anything blocking them and fire doors marked “keep locked” or keep shut” are shut and locked. Continue to extend and develop a quality assurance system with extended provider monthly reports. Timescale for action 01/02/06 2 OP9 12,13,25 01/02/06 3 4 5 OP19 OP24 OP24 12,13,25 12,13,25 12,13,25 01/02/06 01/02/06 01/02/06 6 OP33 24 01/02/06 Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 19 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 OP24 OP24 OP27 Good Practice Recommendations Continue as planned with personalising the new parts of the home Continue as planned with changes to upgrade the kitchen Continue to monitor the number of staff on duty in the home and their skill mix and to increase the number of staff if the changing needs of the residents require additional staffing. Prestbury Court Residential Home DS0000033222.V269964.R01.S.doc Version 5.1 Page 20 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
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