Inspection on 09/11/05 for Preston Park Nursing & Residential Home

This inspection was carried out on 9th November 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.

Other inspections for this house

Preston Park Nursing &... 11/11/09

Preston Park Nursing &... 28/09/07

Preston Park Nursing &... 29/06/06

Preston Park Nursing &... 09/06/05

Preston Park Nursing &... 18/01/05

Preston Park Nursing &... 27/07/04

Preston Park Nursing &... 09/03/04

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Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Preston Park Nursing & Residential Home Preston Road Yeovil Somerset BA20 2EF Lead Inspector Barbara Ludlow Announced Inspection 9th November 2005 09:40 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 Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Preston Park Nursing & Residential Home Address Preston Road Yeovil Somerset BA20 2EF 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) 01935 474023 01935 431727 Somerset Care Limited Ms Janice Anne Passmore Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly persons of either sex, not less than 60 years, who require general nursing care. Up to 9 places for personal care. Registered for a maximum of 30 `nursing` clients. Date of last inspection 9th June 2005 Brief Description of the Service: Preston Park House is a ham stone listed building with a two-storey extension and an attached bungalow. Behind the home are attractive private gardens. Preston Park is situated near the centre of Yeovil, with local amenities of a pub, post office and shops within walking distance. The home offers general nursing care for up to 30 people and personal care for up to 33 people in total. The home provides day care for personal care for up to 6 people per day. The Day Care service does not need to be registered. Accommodation is in single rooms with double rooms available should couples move in to the home and wish to share. Somerset Care Limited, operate the home. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken by B Ludlow for CSCI. The homes Manager was available throughout the whole day and the homes Deputy Manager was available throughout her shift; both assisted with the inspection process. Written information pre inspection was submitted to CSCI. Discussion took place on arrival and a tour of the premises was made. There were 28 service users in residence (26 Nursing and 2 residential category service users) and 3 day-care service users. All service users were seen during the day. Seventeen service users and seven staff were spoken with during the inspection both in the communal areas and some were seen in private in their rooms. Fifteen service user feedback cards and two professional feedback forms were returned to CSCI. Records for recruitment, maintenance of equipment, staff training, care planning and contracting were sampled. Medication storage and records were seen and sampled. Meals were observed served in the dining room. Written feedback was received by CSCI from service users, their relatives and visiting professionals, comments received are incorporated into the body of this report. The inspector would like to thank all who contributed to the inspection process for their help and comments. Overall the findings at this inspection reflected positively upon the care and service offered at Preston Park House. What the service does well: The home is welcoming with a warm and comfortable environment, which is well maintained. Although not purpose built the home has been well adapted and equipped to meet the general nursing and personal care category of service users. The home has attractive accessible gardens. The home offers a good range of activities. All 15 service users responding to the CSCI questionnaire said they liked living at the home, liked the food, felt safe, were treated well by staff and had their Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 6 privacy respected. All reported that they felt the activities were suitable and that they would know who to speak to if unhappy with their care. Positive verbal feedback was heard throughout the inspection day from service users and their visiting relatives. Positive feedback was received from visiting professionals (G.P and health and social care worker). Record keeping and management of records, was of a good standard. What has improved since the last inspection? What they could do better: Monthly checks of the emergency lighting system is recommended in line with the guidance Fire Safety ‘An Employers Guide’, which is recommended by Somerset Fire Brigade. Attention to the latest guidance from the health protection Agency for the use of lancet holding devices for taking blood samples for routine blood sugar monitoring. The practice of receiving verbal instructions for changes to a prescribed medication must be improved to ensure safe practice and be in line with the guidance for registered nurses from the Nursing and Midwives Council (NMC). Staff personnel recruitment practice must include the receipt of evidence from two reference sources. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 7 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 Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 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 Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 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): 1,2,3,4,5, NMS 6 does not apply. The home has a statement of purpose and service users guide that provide a good level of information for prospective service users. Visits to the home can be made. Pre-admissions assessment is undertaken to ensure that the prospective service users needs can be met at the home. EVIDENCE: Somerset care provide a Statement of Purpose and a Service User Guide for the home. The home has a brochure. All were sampled at this inspection. Contracts for three service users were examined, funding arrangements were clear; the Registered Nurse Care Contribution (RNCC) was documented. The sample contained evidence of social service spot purchase of a place, selffunding contract and a block-contracted place being taken up. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 10 Pre-admission information was seen in the care plans; the community single assessment process (SAP) document and community specialist nurse information were seen held on file. Care needs had been assessed prior to admission. The home offers day care services; this enables service users to have experience of the home. Three day-care service users attended during the day. Charges are made for extras such as hairdressing, toiletries, newspapers/ magazines and some activities. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 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 Care plans were sampled, these demonstrated attention to holistic health and social care assessment. The homes medication management was much improved. Service users confirmed that they are treated well. EVIDENCE: Four care plans were sampled. These included service users recently admitted to the home and where there was ongoing wound care and chronic disease management. The care records demonstrated input by the GP and community health care professionals such as the occupational therapist for advice with aids to daily living. Out patient appointments had been accessed for specialist input and health monitoring tests. The care plans were recorded with clear daily statements of health and well being. Care plans had been updated regularly. Risks for potential pressure area damage had been assessed using the Waterlow score, nutritional needs had been assessed and weight checks were recorded. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 12 Chronic health conditions such as diabetes were monitored and there was evidence of regular blood sugar monitoring and eye tests. Referrals for podiatry checks were seen. Service users care plans included information about pain control and reviews had been recorded of pain control medication management. Medication management was examined, the storage facilities were satisfactory. The medication fridge temperature is recorded daily both minimum/maximum temperatures. The controlled drug storage facility was satisfactory and all stored medication was as recorded. The pharmacy had applied labels to the MAR sheets; this practice is to be discouraged. The home was asked to request individual lancet holding devices for their service users. This is in response to recent guidance issued by the Health Protection Agency, action was to be taken by the home to address this. Hand transcribed changes to medication were discussed; it is usual practice at the home to request secondary confirmation of telephoned instructions to change prescription doses. This is in line with the NMC guidance for registered nurses. The inspector was informed when telephoning the manager on 10.11.05, that the GP was expected and the MAR charts would be signed. Oxygen therapy was well managed. Bed rail checks must be diligently undertaken, one rail was identified at the inspection where the position of the rail appeared to be set too low. The Medical Devices Agency guidance for Bed Rail use is recommended; this can be accessed from the Internet. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 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 Preston Park House offers social opportunities for service users who if they wish to, can participate. Visitors spoken with confirmed that there are made to feel welcome. The communal dining facilities are very pleasant and the menu offers a choice of wholesome well-presented food. Service users spoke positively about the food. EVIDENCE: The home offers service users a range of social opportunities. Trips out are organised and there is an activities programme produced weekly and available to all service users. This year events have included the summer fete; this was reported to have been open to the public and was well-supported and raising £444. More recently a firework and Halloween event was held. On the day of the inspection the charity Donkey Sanctuary brought a small donkey around the home to meet the service users. This event was observed and was very well received by the service users. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 14 Service users are free to spend their time as they wish. Some choose to stay in their rooms and listen to music, read or watch television. The communal areas of the home are well used. The main lounge appears cramped at times with little space for visitors to sit in comfort or for equipment use such as the hoist. Day service users share the resident service users communal facilities. Service users are invited to eat together in the main dining room. The dining tables were nicely presented with linen tablecloths. The Main meal was chicken curry and rice; the alternative menus seen were salads. There was a choice of dessert. It was noted that attention had been given to provide plate-guards to assist independent eating and that soft diets were catered for, one lady waiting for her teeth to be repaired was pleased to be offered a more manageable soft diet. Day care service users join the resident service users for lunch. Lunch was observed to be well presented and the meal was unhurried. Drinks of water or squash were served with the meal. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 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 home investigates all complaints promptly. Company policies are in place to protect service users from harm. EVIDENCE: There had been two complaints made to the home since the last inspection. One was partially upheld and one was not upheld. Both complaints had been dealt with promptly and appropriately, both were now closed. No complaints have been made to CSCI. There are policies, procedures and staff training to promote good practice and the protection of service users from harm. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 16 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): 19,20,21,22,23,24,25,26 The home provides a clean and comfortable well-maintained environment for service users. Some areas are accessed by stairs/stair lift and service users need to be assessed as able to negotiate these safely in order to be accommodated in these rooms. EVIDENCE: The home is well maintained, warm and comfortable. Communal facilities are well attractively furnished. The main lounge is well used and can feel cramped when service users congregate there. Bedrooms can be personalised and were seen to be clean and comfortable. Windows are restricted above ground floor level. Hot surfaces in bedrooms are covered. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 17 There are assisted bathing facilities and these had been serviced. The passenger lifts between floors had been serviced, confirmation of the lift servicing was sent to CSCI post inspection. Equipment is available for care provision such as adjustable beds and pressure relieving equipment. Hoists are available for manual handling and these had been serviced. The home is well adapted for the client group. Infection control is well managed and there are good hand washing facilities for staff. The home has appropriate waste control management in place. The laundry processes were reported to be satisfactory and there is a dedicated laundry person to manage the process. The fire alarm sounded at 3 pm, during the inspection. All staff assembled and assisted a prompt unflustered fire alarm procedure; Service User safety and visitors on the premises were identified. Reassurance was given. This was all very well managed and a false alarm was identified. Well-done staff team! Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 18 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 There was sufficient staff on duty on the day of the inspection. The home has a skill mixed staff team who receive training to undertake their roles competently. EVIDENCE: Copies of the duty rota were presented to CSCI with the pre inspection information. These were discussed at the inspection and the worked rotas were examined this confirmed that all shifts had been adequately staffed. There is a trained registered nurse on duty at all times. Staff recruitment files were sampled and these were found to be well managed. One reference was identified that was outstanding, the Manager agreed to follow this up after the inspection. All CRB checks had been taken up and the receipt of POVA First e-mails was confirmed. Staff are encouraged to train and keep up to date. NVQ qualification is promoted with the home accessing company training resources. Of the twenty care staff, eight hold NVQ Level 2 or above and seven staff have commenced NVQ Level 2 training. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 19 Training during 2005 has included basic first aid, signs and symptoms, health and safety training, health and hygiene promoter updating, assertiveness training, equal opportunities training, food hygiene, infection control, abuse, bereavement and the process of aging. Also included was customer service training, fire brigade training for senior staff and manual handling assessor updating. The general handyman and gardener is the fire trainer for the home. Catering and domestic staff also receive appropriate training in food hygiene. The homes two cooks have received training for diabetes awareness. There is an induction programme for all new staff, which covers all the statutory instruction, and basic training for care. Examples were sampled and there was evidence of paid supernumerary time to allow fire and manual handling training and then a period of supervision until competence has been demonstrated and assessed. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 20 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): 31,32,33,35,36,37,38 The home is well managed in an open management style. The home is run with the service users best interests safeguarded by policy, practice and procedures. Attention to the health and safety of service users and staff is of a good standard. EVIDENCE: The homes Manager is supported by an experienced Deputy Manager and an Administrator. The Manager has made significant progress in her role and her input was evident and her management style appreciated by staff and service users. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 21 The company, Somerset care Limited; undertake quality assurance assessment of the home, survey had been made to assess service user satisfaction. The CSCI inspection received a good level of service user feedback, with 15 questionnaires returned. All records seen were stored appropriately and safely. Financial records seen were satisfactory and clear about the amounts paid to the home. All new service users are encouraged to have an appointed Enduring Power of Attorney in place. Servicing and maintenance records were sampled these included: Fire records: weekly fire alarm teats had been made and recorded. Routine inspections had been made for the alarm and the emergency light on 13.10.05 Fire instruction records demonstrated training in July August and September 2005. The Environmental Health Officer had visited on 24.2.05 and action had been taken inline with the repairs identified. Assisted baths had been serviced on 03.05.05. Hoists were serviced in 05.05. The Landlords Gas Safety Certificate was dated 04.05. The sit on weigh scales had been calibrated in December 04. Pressure relieving mattresses were serviced on 16.8.05. The home has a generator for back up, this is serviced annually. The home has waste removal contractual arrangements, which now include the removal of pharmaceutical waste. The periodic electrical installation checks were made in 2004. Not all portable appliances seen had PAT testing confirmation stickers. The passenger lifts servicing was confirmed by fax to CSCI after the inspection. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 22 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 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 3 3 X 3 3 3 2 Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP29 OP9 Regulation 19 (1)(b)(i) 13(2) Timescale for action Two references must be obtained 08/01/06 for all new staff. Lancet holding devices used 21/12/05 must be service user specific and sharp safe if used by staff. Single use sharp safe devices must be purchased if used by staff for multiple service users use. Telephoned prescription changes must be verified by a second person. Requirement 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 OP38 Good Practice Recommendations The Emergency lighting should be inspected on a monthly basis and be recorded. This is in line with the publication Fire Safety ‘An Employers Guide’ which is recommended by the Somerset Fire Service Safety Officers. DS0000003281.V254979.R01.S.doc Version 5.0 Page 24 Preston Park Nursing & Residential Home 2 3 OP38 OP38 All portable electrical appliances should be checked and PAT tested as required. Bed rail positioning should be checked in line with the guidance issued by the Medical Devices Agency. Preston Park Nursing & Residential Home DS0000003281.V254979.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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