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Inspection on 19/12/05 for Preston Glades Care Home

Also see our care home review for Preston Glades Care Home for more information

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Residents spoken to said, that they are well looked after and all appeared to interact well with staff. One resident told the inspector "the staff are really good and will do anything you ask of them". A visitor spoken to at the time of the inspection told the inspector that she visits regularly to see her mother and always finds the staff helpful and friendly she stated "they are never any different, even when they don`t know you are observing them". Staff were seen responding to the residents needs appropriately and all tasks of a personal nature were carried out in a sensitive and caring way. There is a good senior staff group that supports the registered manager in the day-to-day management of the home. As this home is owned by a large company there is also good external management support.

What has improved since the last inspection?

The care documentation has improved and the structure of the care plans appeared more consistent and fully detailed the care needs of the individual resident. Training is now being implemented in relation to the management of challenging behaviour. A Criminal Record Bureau (CRB) check had been obtained in respect of the activity coordinator who had commenced employment prior to her being appropriately cleared. The recruitment procedures are now good and all prospective staff do not commence employment until all the required checks have been successfully completed.

What the care home could do better:

A number of issues require addressing in relation to the physical standards of the home. In addition there have been concerns raised by the Environmental Health department in relation to the standards of the kitchen and food hygiene procedures. All training must be comprehensively recorded in order that evidence can be obtained as to what training has taken place and what training needs to be planned. All induction training must be fully recorded and signed by the trainer and the trainee. Oversees staff must be cleared through the British Criminal Record Bureau. Risk Assessments must be kept under constant review.

CARE HOMES FOR OLDER PEOPLE Preston Glades Care Home Miller Road Preston Lancashire PR2 6NH Lead Inspector Mrs Lillian McMullen Unannounced Inspection 19th December 2005 10:30 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 Preston Glades Care Home DS0000006072.V260371.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. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Preston Glades Care Home Address Miller Road Preston Lancashire PR2 6NH 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) 01772 651484 01772 651514 None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Valerie Francis Care Home 65 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (34) of places Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Registered Person must employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 65 service users to include: Up to 31 service users in the category of DE (Dementia) Up to 34 service users in the category of OP (Old Age over 65 years) Registered numbers to include one (1) named person under 65 years of age 4th August 2005 Date of last inspection Brief Description of the Service: Preston Glades Nursing Home is owned by, Four Seasons Health Care. The Home is registered with the Commission for Social Care Inspection to provide nursing and personal care to elderly people of both sexes over the age of 65 years. This comprises of 33 service users with dementia and 31 service users with old age in need of nursing and residential care. Preston Glades is a purpose built two-storey building and care is provided in two areas of the home for the two categories of service user. Those needing care regarding dementia are cared for on the first floor of the home, and those needing nursing and personal care on the ground floor of the home. There are 62 single bedrooms of which 16 have en suite facilities and 1 double room. There is a passenger lift to each floor of the home. The home is situated in its own grounds and there is an enclosed garden area at the rear of the home with a pleasant a sitting area. There are parking areas available at the side and front of the home. Preston Glades is located in a residential area of Preston and it is close to local shops and amenities. It is situated on a bus route into Preston town centre. Service users are encouraged to return to their links with the surrounding community and visitors are welcome at anytime. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 10.30am until 5.30pm during a typical working day. At the time of the inspection there were 64 residents living at the home. The inspection was carried out by two inspectors and the Pharmacy Inspector will visit at a later date to carry out a full inspection of the medication procedures. As is normal usual practice, a separate letter will be sent to the homeowner with the outcome of the pharmacist inspection. Prior to this inspection, resident and relative and general practitioners comment cards provided by the Commission For Social Care Inspection were sent to the home for completion. At the time of writing this report four comment cards were returned from General practitioners, one from a resident and one from a relative all of which contained positive comments. The inspector spoke with seven residents, four staff members and the registered manager. Documentation in respect of the homes recruitment procedures, complaints, protection and resident’s finances were viewed. What the service does well: What has improved since the last inspection? The care documentation has improved and the structure of the care plans appeared more consistent and fully detailed the care needs of the individual resident. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 6 Training is now being implemented in relation to the management of challenging behaviour. A Criminal Record Bureau (CRB) check had been obtained in respect of the activity coordinator who had commenced employment prior to her being appropriately cleared. The recruitment procedures are now good and all prospective staff do not commence employment until all the required checks have been successfully completed. 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. Preston Glades Care Home DS0000006072.V260371.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 Preston Glades Care Home DS0000006072.V260371.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): EVIDENCE: The above core standards were assessed at the previous inspection. Intermediate Care is not provided at Preston Glades. Preston Glades Care Home DS0000006072.V260371.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): EVIDENCE: Standards 7, 8 and 10 were assessed at the previous inspection. The Pharmacy Inspector will inspect the standard in relation to the medication procedures within the next few weeks. As is usual practice, a separate letter will be sent to the care provider with his findings. Preston Glades Care Home DS0000006072.V260371.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): EVIDENCE: All the above core standards were assessed at the previous inspection. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 11 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): 18 Residents are protected, good polices and procedures are in place. EVIDENCE: The procedure for the Protection of Vulnerable Adults is robust and implemented should there be an allegation of suspicion or abuse or bad practice. A corporate approach is adopted to the homes procedure which the registered manager demonstrated her knowledge and informs all staff during their induction training of all good practice issues and what they should do if they witness any practice that they consider unacceptable. In addition formal training is provided to all staff as a mandatory subject. All local staff are cleared through the Criminal Record Bureau (CRB), however whilst the inspector acknowledges that oversees staff have been police cleared in there country of origin the inspectors advised that all oversees staff should also be referred to the British CRB for clearance. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 12 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): 19,20,21,22,23,24,25 and 26 Some areas of the home require attention and action needs to be taken to eradicate the unpleasant odour. EVIDENCE: A maintenance man is employed who carries out minor repairs and on going maintenance. However a number of concerns were identified during a tour of the home by the inspectors. • The stair way at the rear of the home was grubby and in need of cleaning. • A number of carpets require cleaning or replacing. • A number of bedrooms require some decoration as paintwork/wallpaper is damaged. • Tiles in bathroom 3 are broken and require replacing. • Bathroom 26 the flooring is damaged and requires replacing. • Toilet 27 the ceramic towel holder is broken and poses a safety risk. • The light switch on the rear stairway requires attention as the plasterwork around it is damaged. • A number of windows require new catches. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 13 • • • • • • • • • • • Toilet room number 32 had no extractor fan, resulting in a hole in the ceiling. A number of radiators are still not covered and at the time of the visit were extremely hot Bedroom number 17 the call bell was hanging off the wall and requires immediate attention. One fire extinguisher required replacing as identified by the service engineer in April 05. A number of call bells were placed out of reach of residents. A number of bedrooms did not have towels or soap. The cupboard in the downstairs sluice room is damaged and poses a risk in relation to infection control. A number of bedrooms contained bubble bath, which could pose a risk if accidentally ingested by residents. Evidence of Pat Testing must be recorded on all portable electrical appliances. A number of floors were dirty and sticky and required cleaning. Action must be taken to eradicate the unpleasant odour. The registered manager was made aware of all the above issues and an immediate requirement notice was imposed in relation to The damaged flooring, the call bell in room 17, the missing window catches, call bells being placed out of reach of residents and radiator covers not being in place. This immediate notice requires the registered manager to take action within a specified time scale. All the above issues will be followed up by, the Commission for Social Care Inspection prior to the next planned inspection. In addition there have been concerns raised by the Environmental Health department in relation to the standards of the kitchen and food hygiene procedures. Whilst action has been taken to comply with the requirements of the Environmental Health Department formal action is being considered. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 14 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 and 30 Staffing levels are satisfactory to meet the needs of the residents. The policies and procedures for the recruitment of staff provide safeguards for the protection of residents. EVIDENCE: At the time of the inspection staffing levels were satisfactory to meet the needs of the residents with adequate staff working on the two floors of the home. Trained nurses are on duty at all times who manager the care staff and ensure good practice. There have been some staff changes in the staff group since the previous inspection and currently the home has two staff vacancies. Additional kitchen support staff have been employed to ensure standards can be consistently maintained. The inspector examined four staff files and found that the recruitment procedure had been consistently followed. All staff are interviewed and two written references are sought together with clearances through the Criminal records Bureau. Whilst the Criminal Records Bureau checks are carried out the inspector provided some advice as noted previously in this report in relation to obtaining Criminal Record Bureau checks for oversees staff. The registered manager is very pro active in obtaining appropriate training for her and the staff group. Discussion with the registered manager revealed that Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 15 the company employ personnel to provide training and focus on developing the staff team in order that they have the skills and knowledge to meet the needs of the residents. NVQ training is encouraged and currently thirteen staff members have attained this qualification with another three staff members near completion. Seven further staff members are enrolled to commence this training and once they have completed their studies this will ensure over 50 of the staff group that are NVQ qualified. Induction training is provided, however this needs to be recorded consistently with signatures being obtained by the trainer and the trainee. Relatives spoken to say that, the staff are friendly and helpful and even though busy did respond to the needs of the residents. The inspector observed staff working with residents and was satisfied that all tasks were carried out in a pleasant and courteous way. Relatives commented that whenever they visit there is always adequate staff in the home. Preston Glades Care Home DS0000006072.V260371.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): 31, 33, 35 and 38 The home is managed in a way that supports staff to ensure residents receive consistent quality care. EVIDENCE: The manager has many years experience in caring for the elderly and has a Diploma in Management. At the time of the inspection she is near to completing the Registered Managers Award. The manager has achieved positive improvements in developing the systems that ensure good care practices. Information provided in the pre-inspection questionnaire completed by the manager stated that all safety equipment is regularly serviced. The quality of the service provided is closely monitored and this was evidenced as the home has recently been informed that following the reassessment by Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 17 The Residential and Domiciliary Benchmarking company Preston Glades has retained it four stars status for two consecutive years. There are good corporate health and safety policies in place and it is company policy to hold monthly health and safety meetings. Procedures are in place and equipment is regularly serviced. However as stated previously in this report a number of environmental standards require improving. The portable electrical appliances (pat testing), needs to be recorded properly as a number of plugs were noted without labels whilst others did not contain the required information. The registered manager stated that staff are offered training in all mandatory subjects, however whilst copies of certificates are retained on staff files these did not correspond with the training matrix. The registered manager was asked to ensure all details are correct in order to make sure that all staff are satisfactorily trained to perform their role and have received training in all mandatory subjects. A fire risk assessment is in place together with other risk assessments in relation to safe working practices. The registered manager was asked to keep risk assessments under constant review. Resident’s finances are protected by robust systems in place. Examination of the records revealed that all expenditure is recorded with receipts attached. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 18 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? 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. 2 3 4 5 6 7 8 9 10 Standard OP19 OP25 OP21 OP26 OP19 OP24 OP23 OP23 OP29 OP38 Regulation 23 23 23 16 23 23 23 23 18 17 Requirement The environmental standards must be improved. All Radiators must be guarded Tiles and extractor fans in bathroom must be in place The cupboard in the sluice room must be replaced. Window catches must be in place Damaged floor covering must be replaced. Call bells must be placed in reach of residents. The call bell in room 17 must be repaired. All training must be consistently recorded Evidence must be available to confirm all staff have received training in all mandatory subjects. Timescale for action 19/12/05 31/01/06 06/01/06 06/01/06 06/01/06 19/12/05 19/12/05 19/12/05 06/01/06 06/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 20 No. 1. 2. 3. Refer to Standard OP38 OP30 OP28 Good Practice Recommendations Risk assessments must be regularly reviewed. All documents should be fully completed and signed 50 of the staff group should be trained to NVQ level 2 Preston Glades Care Home DS0000006072.V260371.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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. 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