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Inspection on 11/12/08 for Preston Private Nursing Home

Also see our care home review for Preston Private Nursing Home for more information

This inspection was carried out on 11th December 2008.

CSCI found this care home to be providing an Good service.

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

What has improved since the last inspection?

What the care home could do better:

Although the home was generally well maintained, there were some areas which were `tired` and `worn` looking, which could have been better in order to provide a more pleasant and safe environment for people using the service. The standard of cleanliness in some areas of the home could have been better in order to provide more hygienic conditions, particularly in the sluice rooms, some bathrooms and some dining areas.0

CARE HOMES FOR OLDER PEOPLE Preston Private Nursing Home Midgery Lane Fulwood Preston Lancashire PR2 9SX Lead Inspector Vivienne Morris Unannounced Inspection 11th December 2008 09:30 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 Private Nursing Home DS0000006073.V372791.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 Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Preston Private Nursing Home Address Midgery Lane Fulwood Preston Lancashire PR2 9SX 01772 796801 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) preston.private@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes Ltd Care Home 106 Category(ies) of Dementia (33), Old age, not falling within any registration, with number other category (73), Physical disability (18) of places Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 73) Dementia - Code DE (maximum number of places: 33) Physical Disability - Code PD (maximum number of places: 18) The maximum number of Service Users who can be accommodated is: 106 Date of last inspection 29th May 2008 Brief Description of the Service: Preston Private Nursing Home is owned by Craegmoor Healthcare, and is registered with the Commission for Social Care Inspection to accommodate up to 106 people who require nursing or personal care. The service provides care for elderly people; those with physical disabilities and also people whose care needs are associated with dementia. The home is a single storey building and care is provided in four units, each with its own lounge/dining facilities and own kitchen area. A lot of the single bedrooms have en-suite facilities, and there are some shared bedrooms for partners, friends or for those wishing to share accommodation The home is set in its own grounds and has extensive well maintained gardens and a parking area. Preston Private Nursing Home is located in a rural area of Fulwood in Preston and is relatively close to shops and local amenities. It is situated on a bus route into Preston town centre. Activities are organised by the diversional therapists and in-house entertainment and outings are organised for those who wish to participate. Relatives, friends and visitors are made welcome to the home. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 5 Fees charged as at 11th December 2008 ranged from £420 - £750 per week. There were additional charges being incurred for chiropody, hairdressing, newspapers, magazines and some outings. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. Two regulatory inspectors from the Commission for Social Care Inspection conducted the unannounced site visit to this service over one day in December 2008. This visit formed part of the key inspection process. Every year the provider completes an Annual Quality Assurance Assessment (AQAA). This is a selfassessment, which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. The self-assessment was completed and submitted, as requested. Some of the information provided in the assessment is included within this report. During the course of the site visit discussions took place with people living at the home, relatives and staff members. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. The inspectors sat in the communal areas of the home for periods of time observing the daily routines and activities, which took place. We sent comment cards to the home in advance of this key inspection, so that staff and people living at Preston Private could provide us with their views about the quality of service provided. Four staff members submitted completed comment cards, but none were returned from the people using the service. There were 56 people living at Preston Private at the time of our site visit. The inspectors ‘tracked’ the care of six of these people, not to the exclusion of others. The total key inspection process focused on the outcomes for people living at Preston Private and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had received two complaints about this service since the last key inspection, one of which resulted in a random inspection and the other was referred back to the provider to investigate using the home’s complaints procedure. In both instances the care homes regulations were met. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 7 What the service does well: When asked what the service does well the acting manager told us, ‘prospective service users are encouraged and invited to visit the home at any time. They are also given information packs and are offered a trial stay to enable them to make an informed choice of our home. The service had a good and thorough approach when admitting new people to the home, ensuring that the choice of home was suitable for their assessed needs and so that the staff team were confident that they could deliver the care required. The care plans seen were well – written documents, providing staff with clear guidance about how the needs of these people were to be appropriately met. A wide range of health care professionals provided a service to the home and residents were also supported to attend any external appointments. A health care professional was visiting the home on the day of the site visit, who was generally happy with the care provided at Preston Private Nursing Home. Daily routines in the home were generally flexible and residents were able to determine what they wanted to do. There was a good programme of activities in place at the home, which covered both group and individual participation. Staff were respectful in their approach to the people living at the home, speaking to them appropriately and sensitively. Residents spoken to generally described the food as good. Relatives were welcomed to the home and advocates were appointed if a resident wanted someone to act on their behalf, to ensure that their wishes were respected. The home had comprehensive policies and procedures in place to promote safe working practices and also to protect both residents and staff. Staff had received training in the protection of vulnerable adults and were aware of what they should do if they were concerned about the treatment of anyone living at the home. A comfortable environment was provided at Preston Private nursing home, in order to ensure that pleasant surroundings were available for those living there. The garden areas were pleasant and accessible to the people living at the home, with patios and very attractive seating areas. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 8 Systems and equipment within the home were serviced at appropriate intervals to protect the health, safety and welfare of the people living and working at the home. A wide range of policies and procedures were available in relation to health and safety practices in order to protect those living at and those working at the home. The standard of service provided was being closely monitored by a wide range of audits and risk assessments being undertaken, as well as a variety of meetings being held and unannounced visits by the company taking place What has improved since the last inspection? The home’s self assessment showed us that a lot of improvements had been made since the last key inspection and this was confirmed as being correct through our observation of the daily activities within the home. The acting manager of the home gave us some good examples of how this had been achieved. In general the completion of documentation had improved, so that staff were given up to date information about the people in their care. The recording of information within the plans of care had improved since the last inspection, providing staff with accurate details about people’s assessed needs and how these needs were to be fully met. Those living at the home or their relative had been given the opportunity to be involved in the planning of their care and written information was more specific and person centred so that individual needs were being met. The care plans were being followed in day – to – day practice to ensure that people received the support which they expected. The provision of health care had improved, so that those living at the home were receiving appropriate pressure care, good oral hygiene and adequate fluid and dietary intake. The management of medications had improved since the last inspection to ensure that people living at the home were adequately protected from any possible medication errors or drug misuse. The acting manager had introduced a system of regular checks of medications so that any irregularities could be quickly identified in order to prevent serious errors from occurring that could affect people’s health. The management of meals had improved by those living at the home being offered a choice of menu, so that they can make some decisions about the food they eat. We noted that equality and diversity had improved for those living at Preston Private by one staff member being able to communicate with a resident in their Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 9 first language so that they were given the same opportunity as other people living at the home. The management of complaints was better than at the last key inspection because a record was now kept of all concerns raised and a thorough investigation was conducted, which was monitored by the acting manager of the home to ensure that a clear audit trail was evident. There had been some big improvements to the environment in general. A lot of areas had been redecorated and refurbished in order to provide more comfortable surroundings for the people living at the home. The deployment of staff had improved so that there were enough people on duty in sufficient numbers and with sufficient training and experience to meet the needs of the people living at the home. The provision of staff training had improved since the last inspection, so that the people working at the home were able to deliver appropriate care. The recruitment practices adopted by the service were much improved. Two staff files were examined, which showed that all necessary checks had been obtained by the home before people started to work there to ensure that those living at Preston Private were adequately safeguarded. The acting manager and her staff team had worked very hard to raise the standards in the home in order to provide an improved service for the people living there, which was pleasing to see. We raised some concerns at our last key inspection in relation to the security of the building as people had easy access to the home through a quiet reception area. This issue had been resolved on this occasion with the appointment of a receptionist who was responsible for greeting people as they entered the home and directing them to their requested destination. It was established that the doors of the home were secure when the receptionist was not at her desk, in which case people could gain access by ringing the door bell. What they could do better: Although the home was generally well maintained, there were some areas which were ‘tired’ and ‘worn’ looking, which could have been better in order to provide a more pleasant and safe environment for people using the service. The standard of cleanliness in some areas of the home could have been better in order to provide more hygienic conditions, particularly in the sluice rooms, some bathrooms and some dining areas. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 10 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 Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 11 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 Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 12 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 was not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed information had been gathered before people were admitted to the home to ensure that the staff team were confident that they could meet individual assessed needs. EVIDENCE: The self-assessment completed by the home and sent to the Commission provided us with information about the process adopted before people were admitted to Preston Private. This was confirmed to be accurate through examination of a careful selection of care records. The care of six people living at Preston Private was ‘tracked’ during the course of the site visit to this service. Sufficient information had been gathered from a variety of sources about the needs of people before they were admitted to Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 13 the home to ensure that each person’s individual needs could be fully met by the staff team. The social care assessments were very detailed, giving staff a clear picture of people’s life history and the admission process had been conducted in a person centred way, by staff finding out about things that were important to the resident, so that those working at the home could fully understand people’s needs. We saw that information about the service was easily accessible within the reception area of the home and within residents’ bedrooms. This enabled people to make an informed choice about where to live and also allowed them to refer to information, when they wished to do so. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 14 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. Peoples health and personal care needs were fully met, their privacy and dignity being respected at all times and the management of medications was good. EVIDENCE: Care plans seen had been developed from the information gathered before admission to the home and they were well written, person centred documents, which included details of peoples health, personal and social care needs. The care plans had been reviewed at least every month and any changes were reflected well, so that staff had up to date guidance about the people in their care. The people living at the home or their relative had been involved in the care planning process and records showed that a wide range of external professionals were involved in the care of people living at Preston Private to ensure that their health care needs were being fully met. We spoke to a visiting doctor who was at the home during our inspection, who said that she Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 15 had no concerns about Preston Private and that she felt the staff contacted her appropriately. We noted that some turn charts outside bedrooms had not always been completed by the night staff, although care records showed that peoples’ pressure care needs were being attended to during the night. Social care needs were recorded well in the care plans seen, showing that the leisure interests of people living at the home were taken into consideration. Those spoken to felt that their needs were being fully met and we saw that the plans of care were being followed in day - to - day practice. Staff spoken to were able to discuss the care of individuals well and knew what they had to do to meet peoples assessed needs. A wide range of assessments were in place so that strategies could be implemented to reduce any potential risks in order to promote the safety of those living at the home. We spoke to a relative of one of the people living at Preston Private who said that her mother was well cared for and that she had no concerns about the home. The resident was able to confirm this information, saying that most of the staff were very good although one or two were a bit hasty. We examined a selection of medication records and noted that there was a significant improvement in the handling of medications, so that people living at the home were adequately safeguarded against medication errors and so that their health care needs were being met. We spoke to two qualified members of staff, who both said they had undertaken recent medication training provided by Boots and that they had found this very useful. Detailed medication audits had been introduced so that any irregularities could be easily identified in order to protect the people living at the home. We noted a tube of eye ointment on a bedside table, which had been opened over a month ago and which related to a period when the person in this room was able to self medicate. Staff confirmed that they would remove this tube of eye ointment promptly to avoid any problems occurring. We observed staff attending to the needs of people in a respectful and dignified manner and those we spoke to told us that their privacy and dignity was consistently maintained. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The daily routines of the home were flexible and were planned around the needs of the people living there so that their social needs were being met. EVIDENCE: We saw the planned social programme for the Christmas period, which was full of seasonal activities and entertainment for those living at the home and their families. One resident told us that she was looking forward to spending Christmas at Preston Private, so that she could join in the festive fun. Care records showed which leisure activities people enjoyed and what their interests were so that staff could support people to maintain their interests whilst living at the home. It was established that the home employed activity co-ordinators to plan and implement a varied programme so that people living at the home were stimulated in order to prevent boredom. We saw these staff members providing a variety of leisure activities for people and some residents were seen reading newspapers or books whilst others were chatting to family or friends on the telephone. One resident was delivered an unopened letter by Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 17 staff and another was given the option of having her hair done whilst the hairdresser was on site, showing that people were given a variety of choices and that their privacy was respected. People living at Preston Private told us that regular trips out are offered and that these are enjoyed by those taking part. One resident said, “I enjoy playing bingo and listening to the entertainers who come here”. We saw some small group activities taking place, but also staff members sitting with other people giving them individual support, whilst talking to them in an appropriate manner, which was good practice. The service users guide contained information about how the home met the spiritual needs of people living there and what arrangements were in place for people to visit the home. One resident spoken with told us that he was happy living at the home. He was reading a newspaper and said that he liked to walk in the grounds of the home, which he could manage to do himself. He said that there are activities provided, but he chose not to participate. This resident told us that he was going to be at his families for Christmas. He said that he enjoyed the meals at the home, but that some were better than others. He also said that the staff were very kind and considerate. The daily routines of the home were seen to be flexible and people living there were offered a variety of choices throughout the day, so that they had some control over their lives and were allowed to exercise choice. The home had two resident cats, which were a topic of conversation and those living at the home enjoyed them being around. However at 10.30am we visited one of the lounges where eight people were sitting in chairs around the TV and all were sleeping, which showed that there was not much going on for these people. We spoke with another resident who said that she was happy living at the home, but there was a tendency to get bored. ‘I just tend to sit and mope. Anyway the food is good, but I don’t know yet what we are having for lunch. We don’t know until it arrives’. Another resident commented, “the staff are excellent. There has been a lot of decoration going on, which makes the place brighter and my bedroom has been redecorated. There are a lot of things in the pipe line for December. I like the activities, particularly the bingo”. We observed one of the activity staff escorting one elderly person to the activity area in a reassuring and kind manner giving clear explanations and ensuring that there was sufficient light for the lady to walk from one area to another, which was very good practice. We saw staff interacting well with visitors, making them feel included in the daily lives of the people living at the home. Relatives spoken to said that they felt comfortable visiting the home and one added, “the staff are so friendly. They make us very welcome when we visit”. At the time of our site visit to Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 18 the service there was information readily available about access to advocacy services, so that people could use an independent person to act on their behalf, should they so wish. We saw lunch being served, which was an enjoyable experience for the people living at Preston Private. It was pleasing to see staff sitting with the people they were assisting, engaging in conversation with them about everyday things, whilst encouraging them to eat their meals in a supportive manner. The menu offered a variety of nutritious meals, with choices being available on each occasion. Staff spoken to were very familiar with people’s food preferences, which was supported by the information contained in the plans of care. We sampled a cooked meal, which was found to be fresh, well cooked, tasty and appetising. At lunch time we saw one member of staff communicating with a resident in the resident’s first language, which was very good practice. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Complaints were being managed well and people living at Preston Private were safeguarded by the robust policies, procedures and practices adopted by the home. EVIDENCE: A clear accessible complaints procedure was prominently displayed at the home, which was also included in the service users guide, so that people were aware of how to make a complaint should they wish to do so. We examined the complaints register and found that complaints were being dealt with appropriately with a full investigation being conducted by the acting manager. When asked what the service does well, the acting manager told us, ‘new employees have the appropriate checks before they start work at the home. The Protection of service users is of paramount importance and any complaints are immediately and effectively dealt with through the company’s complaints procedure. We have regular contact with local social services and advocacy services to ensure that service users are provided with necessary protection. All relevant policies and procedures are in place, including equal opportunities; whistle blowing; complaints and safeguarding vulnerable adults. We have the ‘no secrets policy implemented and the home manager is on call 24 hours a day, seven days per week. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 20 Three of the four staff who submitted comment cards said that they would know what to do if a person living at the home, their relative, advocate or friend had any concerns about the home; one staff member said that they would not know what to do. We spoke to four members of staff who said that they would know what to do should they have any concerns about anyone living at the home. One of these people was a relatively new member of staff who said that they had received a lot of training in relation to safeguarding vulnerable adults. This person was also aware of the whistle blowing policy and how to access relevant phone numbers to report a safeguarding issue. Records showed that a high percentage of staff had received relevant training in relation to all aspects of the protection of vulnerable adults. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The home was warm and comfortable providing a pleasant and environment for people to live in. However, the cleanliness and maintenance of some areas could have been better. EVIDENCE: During the course of our site visit to this service we toured the premises, viewing a random selection of private accommodation and all communal areas. We noted that the environment had improved dramatically since our last visit to the service. A lot of areas of the home were cleaner and had been redecorated. New furnishings had been supplied and evidence was available to demonstrate that more had been ordered. These improvements provided more pleasant surroundings for people to live in, which was commendable. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 22 The home was warm, comfortable, and safe and fit for purpose. A friendly and homely environment was evident and people looked happy in their surroundings. People living at the home were able to bring a range of their own belongings with them, so that their individual rooms were personalised and homely. People spoken to were content with their bedrooms and said that they were cleaned regularly. The premises were clean and, in general, pleasant smelling, so that an agreeable environment was provided for those living at the home. Clinical waste was being disposed of in the correct manner and infection control policies and procedures were available at the home, so that staff were aware of how to reduce the possibility of cross infection and therefore protect the people living at the home. Although it was evident that a lot of investment had been made to improve the environmental standards at the home, which was pleasing to see, some areas of Preston Private were still in need of upgrading so that the home is of a good standard throughout for the people living there. Staff spoken to all remarked about the level of investment put into the building and they felt that a lot of improvements had been made for the people living at the home. All bedrooms seen were clean and pleasant smelling, providing a comfortable environment for the people living at Preston Private. However, the standard of cleanliness and decoration in the bathrooms and some dining areas could have been better. Some bathrooms were in need of refurbishment and several sluice rooms were in need of a thorough clean as were some of the commode basins. Although some areas of the home had been tastefully decorated and refurbished, attention to detail and the finishing touches was needed, so that people living at the home were provided with even more comfortable surroundings in which to live. We viewed the laundry department and noted that one washing machine was out of order. We were told that it had not been working for quite some time. However, due to the current occupancy of the home, this was not causing a problem. There was also a leak in the laundry department under the cupboards. The source of this needs to be identified and rectified in order to prevent those working in the department slipping on wet surfaces. Evidence was available to demonstrate that new bedding, cutlery, cruet sets, drinking glasses and coffee tables had been ordered, which was pleasing to see The acting manager was aware that the satellite kitchens were in need of refurbishment. These areas of the home were found to be cleaner than when we visited previously, but the furnishings were old and worn looking, so needed replacement in order to promote hygiene standards and safety within the home. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including a visit to this service. The needs of people living at the home were being met by the number and skill mix of staff on duty and the recruitment practices adequately protected these vulnerable adults. EVIDENCE: The acting manager told us, ‘we maintain staffing levels to meet residents’ needs. All staff are employed under safe and robust recruitment standards with all appropriate checks being carried out before they start work. All staff receive manual handling, fire and induction training before commencing care duties. All new staff are mentored by an experienced care staff member and staff are supervised, giving them opportunities to air their views about any concerns or worries they may have or any training they require. We have regular staff meetings and there is an ‘open door’ policy, giving staff access to the manager at any time’. A staff rota was in place, showing which staff were on duty at any time of the day or night. At the time of our visit to the home there were fifty six people living there. The numbers of staff on duty and the qualifications and experience of the staff team together ensured that the needs of these people Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 24 were being consistently met. Staff spoken to were all very positive and pleased with the improvements being made in the home. All said that there were adequate numbers of staff on duty to meet the needs of the people living at Preston Private. Two staff members who submitted comment cards indicated that there were always enough staff to meet the individual needs of all the people who use the service. The other two said that there were usually or sometimes enough staff to meet people’s needs. All new employees had been guided through a detailed and structured induction process and a wide range of training was provided for all staff, so that they were able to carry out the duties expected of them and so that people received a good standard of service. Staff spoken to felt that sufficient training was provided, including mandatory courses and learning relevant to the specific needs of the individuals in their care. Three staff files were examined, which showed training that each had undertaken, by retention of training certificates. At the time of our visit to the home there were a high percentage of staff working at the home who had achieved a recognised qualification in care and others were in process of obtaining this award to ensure that a sufficient number of staff were adequately qualified to look after the people in their care. The records of two people working at the home were examined, so that recruitment practices could be assessed. We found that robust recruitment practices had been adopted by the home and that all checks and references had been obtained before people started work, so that people living there were adequately protected. All four staff members who submitted comment cards said that their employer carried out checks, such as CRB and took up references before they started work and that their induction period covered everything they needed to know to allow them to do the job well. These staff members also said that training is provided, which is relevant to their role and helps them understand and meet individual needs and helps them keep up to date with new ways of working. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 25 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 good. This judgement has been made using available evidence including a visit to this service. The home was being managed well so that the health, welfare and safety of the people living and working there were protected. EVIDENCE: The acting manager and her staff team had worked very hard to raise the standards within the home and this was evident by the general improvements noted and by the good practices observed on the day of our visit. All staff spoken to said that they were very pleased with the approach of the acting manager and felt that the home had improved a great deal since she had arrived. The thirteen requirements made at the last key inspection had been appropriately addressed and only one requirement was made on this occasion, which is commendable. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 26 One staff member said, “a lot of changes have been made for the better under the new manager. The home is now being brought forward and we(the staff) are now receiving clear guidance as to what needs to be done and what we need to do to achieve this”. Staff spoken to were aware of how to access the policies and procedures or to obtain further information, as was needed. Surveys were conducted annually in order to obtain the views of people who use the service. We were told that surveys were soon to be conducted for stakeholders in the community, who have a professional interest in people living at the home, such as General Practitioners, so that their views are sought as to how the needs of people are being met. A variety of audits had been conducted so that the service could be closely monitored and monthly reports were presented by the company following their visits to the home so that any shortfalls could be identified. A variety of meetings had been held, with minutes retained, so that information could be passed on and so that people could voice their opinions and discuss any relevant topics in order to improve the standard of service provided. There was a system in place which allowed people living at the home access to money if they wanted it, which was subsequently reimbursed by families using an invoice system. Receipts of expenditure were retained so that those reimbursing the home could see what had been spent. A random selection of service certificates were examined, which showed that systems and equipment within the home had been appropriately checked by competent people to ensure that they were safe for use.Accident records seen were completed appropriately and were being retained in line with data protection in order to promote confidentiality within the home. We raised some concerns at our last key inspection in relation to the security of the building as people had easy access to the home through a quiet reception area. This issue had been resolved on this occasion with the appointment of a receptionist who was responsible for greeting people as they entered the home and directing them to their requested destination. It was established that the doors of the home were secured when the receptionist was not at her desk, in which case people could gain access by ringing the door bell. A new staff member said, “I love working here. I had an induction at the beginning to show me what I had to do. I have done all the mandatory training. I did this within the first two weeks of starting and more training is planned. I couldn’t start work until all the checks on me had taken place”. Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 27 Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 28 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 2 X 3 X 3 X X 3 Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 29 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. Standard OP31 Regulation 8 (1) Requirement A person must be appointed to permanently manage the care home on a day to day basis. Timescale for action 30/06/09 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 OP19 Good Practice Recommendations Consideration should be given to the refurbishment of the satellite kitchens, some bathrooms and toilets within each unit in order to enhance the environment and to protect the safety of people using these areas. The standard of cleanliness within some bathrooms and some dining areas should be improved, so that more pleasant areas for bathing and for dining are provided for those living at the home. The standard of cleanliness of the sluice rooms and some commode basins should be improved in order to promote good hygiene practices within the home. The broken washing machine should be repaired and the source of the leak in the laundry department needs to be identified and rectified so that people working there are protected from possible slips and trips. DS0000006073.V372791.R01.S.doc Version 5.2 Page 30 2. OP19 3. 4. OP26 OP26 Preston Private Nursing Home Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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. Extracts may not be used or reproduced without the express permission of CSCI Preston Private Nursing Home DS0000006073.V372791.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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