Inspection on 09/03/07 for Preston Glades Care Home

This inspection was carried out on 9th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Preston Glades Care Home 01/10/08

Preston Glades Care Home 04/09/07

Preston Glades Care Home 24/04/06

Preston Glades Care Home 19/12/05

Preston Glades Care Home 04/08/05

Preston Glades Care Home 23/02/05

Preston Glades Care Home 24/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Preston Glades Care Home Miller Road Preston Lancashire PR2 6NH Lead Inspector Phil McConnell Unannounced Inspection 09:00 9 March 2007 th 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.V325055.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. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 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.V325055.R01.S.doc Version 5.2 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 24th April 2006 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 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 is close to local shops and amenities. It is situated on a bus route into Preston town centre. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced which meant that the provider was not aware that the inspection was to take place. The inspection was carried out by two inspectors and took place over a period of eight hours. The focus of the inspection was to review any requirements or recommendations from the last inspection and to assess all of the key standards identified in the National Minimum Care Standards for Older People. The Regional Director was present during the inspection and there was the opportunity to speak to some of the service users, staff members, and some visitors to the home. The Regional Director indicated that they were carrying out a review of the management of the home. Six service users’ files and six staff files were examined during the visit. The organisations policies and procedures were also examined and a tour of the home was undertaken. Feedback was given to the Regional Director following the inspection visit of the areas that need addressing. At the time of the inspection visit the home had 42 people living there with 23 vacancies. What the service does well: What has improved since the last inspection? The pre admission assessments and pre admission information for service users has improved since the last inspection. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 6 The medication procedures are now more robust and better organised, helping to ensure that individuals medication needs are accurately provided. 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. The summary of this inspection report can be made available in other formats on request. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 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.V325055.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 n/a) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a thorough pre admission assessment process in place, which helps to ensure that individuals needs will be correctly assessed and met. EVIDENCE: The policy and procedure for a new service user moving to the home was examined and found to be thorough and satisfactory. New service users are admitted into the home only on the basis of a full assessment undertaken by the manager of the home. Six service users’ files were examined, including those for two of the most recent admissions to the home and all of their files contained full and relevant assessment documentation including: admission assessments, care plans, diet and weight, mobility, continence, mental state and social interests. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 9 From the assessment a care plan for each service user had been developed. The ‘Cornell scale’ for depression in dementia and the ‘Dolphin 2 scale’ were amongst two of the assessment frameworks used by the qualified nursing team. One relative said, “My father came from a home that closed down, it was hard work at first, but he made the choice to come here and he has settled in quite well” another person said, “My dad came here two months ago and everything is fine”. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good care plans and risk assessments are in place, helping to ensure that individual’s needs are being appropriately met. EVIDENCE: Six service users’ care plans were examined and they were found to be up to date, containing relevant information with clear guidance on how to provide individuals care needs. It was evident that service users’ care plans were developed from the initial assessment. The care plans set out in detail what action was required to ensure that all aspects of health, personal and social care needs of service users are met. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 11 Individual information was available with regard to service users’ specific health needs and there was evidence that, hospital appointments, GP’s appointments and other treatments and consultations with other health professionals had been carried out. This helps to demonstrate that people’s health needs are monitored and treated correctly when necessary. Each care plan consisted of individual assessments including risk of falls, nutrition, pressure sores, falls and well-being. The care plans and risk assessments are reviewed on a monthly basis. Some of the comments from service users were, “I’ll tell you one thing, you get everything done for you, it’s great” and “It’s all very pleasant, nice bed, food on plate and I have shave and a bath when I want, what more could you want”. Service users were assessed by a qualified nurse to identify if they are at risk of developing pressure sores. It was recorded that one service user had a pressure sore and it was documented in the care plan that appropriate intervention had been undertaken. Nutritional screening is undertaken upon admission and was seen on a periodic basis to record the level of maintained nutrition, including weight gain or loss and the appropriate action taken. There is a policy in place for staff to adhere to regarding the procedures for the receipt, recording, storage, handling, administration and disposal of medicines. Records were examined to ensure that all medicines received and administered were maintained. Medicines were kept in a locked trolley and any controlled drugs were kept in a separate locked secure cabinet. Controlled drugs were administered by qualified members of staff and countersigned by a second carer according to the homes policy. ‘Boots’ supply the medication in the home and the staff were aware that they could consult the pharmacy if they had any questions or queries regarding service users’ medication. The medicine storage room was unclean and it was pointed out to the team leader on each unit that the area needs to be sanitised and kept to a good standard of cleanliness. In observation throughout the visit, service users were treated respectfully and with dignity. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is insufficient evidence to demonstrate that service users are provided with stimulating recreational activities or leisure pursuits. EVIDENCE: The previous inspection highlighted the need for the introduction of a more detailed programme of activities. Following this an activities-organiser was recruited and for a time there was an improvement. Unfortunately this person is now on long-term sick leave and the situation with regards to the lack of appropriate activites is the same as before. There is little evidence of any form of stimulating activity, leisure or recreational interests taking place for service users. Some of the service users and one visitor commented that initially there had been some improvement, but as one person said, “Unfortunately things are the same again, with nothing to do”. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 13 In discussion with some of the staff and the service users, there was little to suggest that individuals have the opportunity to venture outside of the home unless accompanied by a relative or friend. It is important that people are encouraged and motivated to maintain interests and be involved in appropriate and relevant activities, in order to provide stimulation and promote well-being. There is an open house policy at the home and in discussion with some visitors, they were able to confirm that they can visit whenever they wish and they are able to see their relative in the privacy of their own room. Some of the service users said they choose to spend most of their time in their rooms and one person said, “I keep myself to myself, this is my choice and I have all of my meals in my room” The staff were observed taking meals to other service users, who also chose to have their meals in their bedrooms. It was observed during a tour of the premises that people had brought into the home their own personal belongings. This helped to demonstrate people’s own choices and individuality. A new cook had been recruited since the last inspection visit and in discussion with some of the service users; there was a general consensus that the meals were very good, with one person saying, “the food is absolutely good, lunchtime light meal and evening you have a full cooked meal, I like the food”. There was the opportunity to have lunch at the home and it was well presented with an appetizing varied selection. The menus were looked at and they appeared to be well thought out and planned with plenty of variety and choice. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Insufficient and unacceptable practices, with regard to CRB clearances are potentially placing service users at risk of harm or abuse. EVIDENCE: There was a copy of the homes complaints policy and procedures available for inspection. In discussion with some of the service users and their relatives, there was an understanding of who to complain to if there was a need to make a complaint. There had been a couple of complaints made to the home since the last inspection and it was evident that the correct procedures had not been adhered to. The Commission for Social Care Inspection (CSCI) had not been adequately informed of complaints or of their outcome. It is also a requirement of the registered person to provide a monthly visit report. There is no evidence of these reports having been received by CSCI. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The overall standard of the home is inadequate to ensure that people live and work in a safe, clean and comfortable environment EVIDENCE: Areas of the home were not very well maintained and service users individual and collective needs were not being met in a homely and comfortable way. The tour of the building revealed areas that needed some significant improvement. Bedrooms and bathrooms were in particular tired with wallpaper, and plaster exposed in five of the rooms. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 16 Damage was found to some of the radiator covers and some bedrooms had strong unpleasant odours. Grab rails were evident throughout the home, in the communal areas and the bathrooms and toilets. Aids and hoists were also visible in the home. Storage areas were limited and three service users had their wheelchairs stored in their rooms. One bathroom had a mattress being stored and another had equipment stored in it. The home employs two cleaners on each of the two floors seven days a week. As already mentioned some areas of the home were offensive with bad odours and food debris was found on the floor of the upstairs communal lounge. The medication storage area on both floors was in need of sanitising and the laundry storage area was unkempt and in need of a general good tidy. It was reported that “the furniture on the dementia unit was 2nd hand and it is very difficult to be kept clean, it’s not suitable for such a unit with people who have high needs”. Currently the staff members write in the maintenance book areas that they see that are in need of repair, which then should be carried out by the onsite maintenance man and larger jobs are given to outside contractors. The Regional Director was present during the inspection visit and she was informed of the areas that need attention. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes poor recruitment practices and the limited training available are putting the service users at potential risk. EVIDENCE: Six staff files were examined, one of which was the most recent employee to join the staff team at Preston Glades. All of the files were limited in the necessary information that they should contain. Some members of staff had been recruited without the legal requirement of a CRB clearance or POVA list check having been obtained. There was no documented evidence that formal supervisions had taken place and although staff said they had received training, the training matrix/programme was clearly inconsistent. The number of staff who have achieved national vocational qualification (NVQ) training is also inadequate. A revised ‘Induction standards for new care workers’ document was available for inspection and this gave very detailed information to a new employee, including, principles of care, understanding the organisation and the role of the worker, maintaining safety at work, communication, how to respond to abuse and neglect and how to develop as a worker. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 18 The Regional Director was made aware of the concerns regarding the CRB inadequacies, the lack of formal supervisions for care staff and the apparent limited training available. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not appropriately or sufficiently managed, to ensure the best interests of the service users EVIDENCE: Most recently the organisation had identified areas of the home’s management which it was concerned about and was carrying out further investigation. The home has not been particularly well run for some time now and the latest situation has increased some of the concerns that were already evident. The management of staff recruitment and systems of staff support were poor. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 20 Written records were maintained for all service users in the home with regards to their personal money. Where the staff handle the money of individual service users, the manager has ensured that receipts are appropriately kept. At the present time only one account is kept for all of the service users’ personal money. It was recommended to the Regional Director that separate bank accounts should be established for each service user. It was stated that the senior administrator for ‘Four Seasons Care’ is aware of this and changes will be made. The home has secure facilities for the safe keeping of money and valuables, however some minutes from a staff meeting revealed that the office administrator had been storing service users’ money in an unlocked drawer in the office. All inspection certificates were in place and up to date including, gas safety certificate, electric check certificate, fire extinguisher checks, and emergency lighting certificate. Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 2 X X 2 Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 22 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 OP12 Regulation 16 (2) (m) (n) (22) (7) (a) (b) 13 (6) Requirement There must be adequate leisure and recreational activities provided, in consultation with the service users. The commission for social care inspection (CSCI) must be informed of all complaints and kept informed of the outcomes. Criminal record bureau checks (CRB) must be received before the provider can employ a person to work unsupervised. The environmental standards must be improved. (Previous timescales of 19/12/05 & 24/7/06 not met) 5 6 OP19 OP26 23 (2) (d) 12 (1) (a) The home must be kept clean and reasonably decorated. The registered person must ensure that the health and welfare of service users is promoted and adequately provided. The registered person must ensure that there is a robust recruitment process in place. DS0000006072.V325055.R01.S.doc Timescale for action 31/05/07 2 OP16 30/04/07 3 OP18 10/03/07 4 OP19 23 30/06/07 31/05/07 10/03/07 7 OP29 19 (4) (C) 10/03/07 Preston Glades Care Home Version 5.2 Page 23 8 OP30 18 (1) (a) (i) & (2) 9 (1) (a) 9 OP31 The registered person must ensure that staff are suitably trained and are appropriately supervised. The organisation must ensure that the home is effectively managed. 30/04/07 31/05/07 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 OP33 Good Practice Recommendations Regulation 26 monthly-unannounced visits to the home should be carried out by the organisation and forwarded to the commission for social care inspection (CSCI). A training programme/matrix should be implemented to help ensure that staff training is satisfactorily monitored and provided. Efforts should be made for service users to have individual bank accounts. 2 OP30 3 OP35 Preston Glades Care Home DS0000006072.V325055.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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