CARE HOMES FOR OLDER PEOPLE
Preston Private Nursing Home Midgery Lane Fulwood Preston Lancashire PR2 9SX Lead Inspector
Val Turley Unannounced Inspection 20th September 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Preston Private Nursing Home DS0000006073.V303855.R03.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.V303855.R03.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) www.craegmoor.co.uk Parkcare Homes Limited Edward Poland Care Home 106 Category(ies) of Dementia (33), Old age, not falling within any registration, with number other category (55), Physical disability (18) of places Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The registered person may accommodate up to a maximum of 73 older people when not using those places designated for persons with a physical disability The total number of persons accommodated in the home at any one time shall not exceed 106 The home must not accommodate any service user under the age of 40 years 20/2/06 Date of last inspection 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 106 service users, male or female, with general medical needs, aged 40 years and over, and for those with dementia aged 50 years and over. The home is a purpose built single storey building and care is provided in four units, each with its own lounge/dining facilities and own kitchen area. There are ninety single bedrooms of which 23 have en-suite facilities, and eight double rooms of which one has an en-suite facility. 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, Preston and is relatively close to shops and local amenities. It is situated on a bus route into Preston town centre. Service users are encouraged to maintain their links in the community, and every effort is given to ensuring that relationships, hobbies and interests are pursued. Activities are organised by the diversional therapists and in-house entertainment and outings are organised for those service users who wish to participate. Relatives, friends and visitors are made welcome at the home. The home has small kitchen areas for the use of service users and visitors. Fees for the home range from £313 - £459 per week. There are additional charges for chiropody and hairdressing. Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection of a service takes place over a period of time and involves gathering and analysing written information. A site visit was also made to the home as part of the inspection process and this involved discussion, where possible, with the people living at the home, discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. A questionnaire was completed by the acting manager prior to the site visit, questionnaires had been completed by service users and comment cards had been completed and received from several relatives and three GP’s. These all provided information that was included in the report. As part of the inspection, the inspectors used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspectors to focus on a number of the service users living at the home. All records relating to those individuals were inspected and discussion took place with the service users and relatives where possible. What the service does well:
The home provided a comfortable, well-maintained environment for the service users, visitors and the staff working at the home. The garden areas were pleasant and accessible to the service users. The home was well run by an experienced manager with the support of a management team. The service had a good and thorough approach when admitting new service users to the home ensuring that the choice of home was suitable. Staff were described as being very supportive during the introductory period enabling service users to settle more easily. Care plans were in the main, detailed and outlined the support needs for each of the service users. The health needs of the service users were attended to and a range of health professionals provided a service to the home. Service users were also supported to attend out patient appointments. A health professional visiting the home on the day of the inspection stated that he was always impressed by the standard of care provided at the home. Medication in the home was well managed with records being maintained appropriately. Routines in the home were flexible and service users were able to determine their own routines. There was a good programme of activities in place and in addition to this service users were observed to organise their own activities and socialise amongst themselves.
Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 6 Staff were respectful in their approach to the service users, speaking to them appropriately and sensitively. One relative wrote ‘ my mother regards Preston Private as her home and all the staff are excellent with her.’ The service users spoken to generally described food as good and the questionnaires received confirmed this. Choices were available to meet the dietary needs and preferences of the service users. The homes complaints policy and procedure was displayed throughout the home and the complaints record within the home indicated that complaints were dealt with appropriately. The home had comprehensive policies and procedures in place to promote safe working practices and also protect both service users and staff. The management team had taken appropriate action to resolve any complaints or allegations made in respect of the home and put measures in place to prevent any re-occurrence. The staff team were mostly well established and had a range of experience and training. The home placed an emphasis on training and almost 50 of the care staff had achieved a nationally recognised qualification in care. Staff were recruited appropriately with all the necessary checks and references being undertaken. Action was being taken by the home to ensure that the use of agency staff was minimised and so provide continuity of care for service users. Training in health and safety issues was provided to ensure that the home was run as safely as possible for the benefit of both the service users and the staff. There were a range of quality assurance processes undertaken and the home underwent a full audit every three months to help ensure that high standards were maintained. Policies and procedures had recently been reviewed and updated and were about to be made available in the home. What has improved since the last inspection? What they could do better:
Care plans could, in some cases, include more detail to give staff clearer guidance as to how best to provide support to service users. Although the home was generally clean, there were some areas were the standard of cleanliness could be improved to provide a more comfortable environment for service users, visitors and staff and to also reduce any risks of cross infection. The pond in the central garden area of the home must be made safe to reduce as far as possible any risks to the safety of any service users accessing the garden. Risk assessments must also be undertaken on those windows opening on to the central garden area in respect of the need for window restrictors, so
Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 7 that both the personal safety of the service users is maintained as well as their personal property. 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 Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 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 Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 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): 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. The home had a good and thorough approach when admitting new service users ensuring as far as possible that the choice of home was suitable. EVIDENCE: Documentation for a number of service users was examined on each of the four units across the home. The information collected from this process indicated that the home had a good pre-admission process which enabled the home to identify the support needs of each the service users and determine whether the home could need meet those needs. The home had a Statement of Purpose and Service User Guide available for prospective service users and their representatives. These documents outlined the service the home was able to provide. Discussion with a number of residents and their visitors indicated that the staff at the home were very supportive during the introductory period, enabling them to settle more easily. Preston Private Nursing Home DS0000006073.V303855.R03.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 at least once during a 12 month period. 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. The service users individual health and personal care needs were met by the support staff. EVIDENCE: All of those service users files examined had a care plan in place that outlined the support needs for each of the individuals. In general all of the care plans across the home were detailed and provided staff with clear information to enable them to provide good support. The plans were developed from the preadmission assessments and were reviewed monthly to help ensure that changing support needs were recognised and attended to. There were some instances, however, were identified support needs had not been included within the care plans, especially in relation to specific dietary needs and specific support where a service user had a visual impairment. This information should be in place for all staff to refer to, especially any new staff or agency staff. It was noted that there was no record of relatives being involved in the development of the care plans. A number of comment cards received from family members indicated that they would like to be more involved and consulted regarding the care of their relative at the home and would like staff
Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 11 to be more available for discussion during their visits. The manager stated that this was an issue that was in the process of being addressed by the home. Evidence within the service users files, through comment cards and from discussion with service users and visitors to the home, indicated that the health needs of the service users were attended to appropriately. A number of community health professionals provided additional support to the home including district nurses, a dietician, a tissue viability nurse, a chiropodist and a dentist. Service users were also supported to attend out patient appointments. The health and well being of the service users was monitored through the care planning process and appropriate aids and equipment were provided. The medication within the home appeared to be well managed. Records were appropriately kept and handwritten entries on the Medication Administration Records (MAR sheets) were signed, witnessed and countersigned. The care plans included information and guidance regarding the service users privacy and dignity. Staff were observed to speak to the service users sensitively and spoke to them and about them respectfully. Service users had access to a pay phone and some had a phone installed in their own room. Information received on comment cards from service users and GP’s indicated that service users were able to see medical practitioners in private and on the day of the site visit, a visiting health professional was observed to visit service users in their own room. Preston Private Nursing Home DS0000006073.V303855.R03.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 at least once during a 12 month period. 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. Service users were supported to make choices and have control over their daily lives. EVIDENCE: The routines within the home appeared to be flexible and service users spoken to said that they could go to bed and get up at whatever time they wished. The care plans indicted that independent living was encouraged as far as possible to help service users retain their daily living skills. There was evidence around the home that service users were able to organise their own activities and socialise amongst themselves. The home employed 6 activities organisers and they arranged activities across the home. The activities timetable was displayed around the home. On the day of the site visit a quiz had been organised and this was obviously enjoyed by the service users who took part. The religion of each of the service users was recorded within the care plans and a number of ministers visited the home providing service users with opportunities to practice their faith if they wished. Staff were observed to knock on doors before entering a service users bedroom. Visitors were able to visit at any reasonable time and could visit service users in the privacy of their own rooms or one of the communal areas.
Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 13 The home provided information about external advocates and the preinspection questionnaire indicated that advocates were involved in the home. The kitchen at the home was well organised and clean. The chef was aware of service users individual dietary needs. Special occasions were celebrated and families were supported to help service users celebrate birthdays etc. The daily menu was displayed within the dining rooms and indicated that the diet offered was balanced and nutritious. Service users were encouraged to eat in the dining rooms but could also choose to eat within their rooms if they wished. Care plans included information about their individual food likes and dislikes. The service users spoken to indicated that the food was good and that choices were available. The questionnaires and comment cards indicated that there was a general satisfaction with the food at the home. The chef appreciated the difficulties of trying to produce food in such a large home that all service users would like, however, the kitchen was well stocked and was able to provide alternative meals and snacks should the service users request these. Preston Private Nursing Home DS0000006073.V303855.R03.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 inspected at least once during a 12 month period. 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. The home had good policies and procedures in place to protect service users. EVIDENCE: The homes complaints policy and procedure was displayed in each of the four units and within the reception area of the home. The home maintained a record of any complaints made and this indicated that they were dealt with and responded to appropriately with guidance being sought as necessary. Since the previous inspection two complaints had been made to the Commission for Social Care Inspection, raising a number of staffing issues and the home was in the process of resolving these. One allegation of abuse had also been reported and this had been referred to the Social Services department for investigation. The management of the home were keen to resolve any concerns raised about the home and had acted appropriately in response to any concerns. The home had a policy in place dealing with the protection of vulnerable adults and staff training records indicated that many of the staff had recently received training in this area. Additional policies including a whistle blowing policy and a policy dealing with the management of challenging behaviour were also in place helping to promote safe working practices and protect both service users and staff. Preston Private Nursing Home DS0000006073.V303855.R03.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 at least once during a 12 month period. 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. There were some areas within the home were the standard of cleanliness needed to be improved and some safety issues needed to be addressed. EVIDENCE: As part of the site visit a tour was made of the home. The home was well decorated and well maintained and enjoyed well kept gardens. A maintenance man was employed full time and a painter and decorator and a gardener on a part time basis. It was the responsibility of the staff on each of the units to report any repairs etc to the maintenance man who attended to these on a daily basis. Furnishings in the home were of a good quality and a great deal of effort had gone into these to create as homely an environment as possible. Service users bedrooms were personalised to reflect their interests and personalities. Residents were usually able to select the colour schemes on moving into the home.
Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 16 Easy access to the garden areas was possible for the service users and seating was provided for service users use. The area around the pond must be made safe to ensure that service users can use the area safely. Risk assessments must also be undertaken in respect of those bedroom windows that open onto the central garden area of the home with a view to ensuring that both the personal safety of the service users is maintained as well as their personal property. The home was generally clean and there were no unpleasant odours. It was noted that the standard of cleanliness could be improved in some areas, especially the bathrooms. The cleanliness of the small kitchen on each of the units needed to be improved. It was noted that the units in these kitchens were worn, making cleaning more difficult. The manager stated that the need to refurbish these kitchens had been recognised and planned. The cleanliness of crockery and cutlery could also be improved. The laundry in the home was well equipped and situated so that soiled laundry did not have to be carried through any food preparation or dining areas. The laundry itself was well managed to ensure that items were returned to their owners as quickly as possible. The home had appropriate policies in place to promote cleanliness and the prevention of cross infection. The Environmental Health Officer and The Fire Service had visited the home and no issues had been identified by them that the home needed to attend to to improve the cleanliness or safety of the home. Discussion with the manager indicated that they responded quickly to any complaints regarding the cleanliness of the home. Preston Private Nursing Home DS0000006073.V303855.R03.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 at least once during a 12 month period. 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 support needs of the service users were met by an experienced and welltrained staff team. EVIDENCE: The staffing rotas indicated that there were sufficient numbers of staff on duty. The manager stated that the numbers of staff on duty was determined by the needs of the service users. The home had a mostly well-established staff team with a range of appropriate experience and training. The manager stated that there was usually little use of agency staff so that service users benefited from a staff team who were familiar with their needs and the homes routines. A number of well established staff had recently left the homes employment and agency staff had been used to provide the necessary staff cover. Comment cards returned by staff and service users had reflected this change although the manager was hopeful that the staffing situation would stabilize soon with the expected employment of new staff. Recruitment processes within the home were thorough with all necessary checks and references being undertaken, ensuring as far as possible that service users were protected. Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed in the best interests of the service users. EVIDENCE: The registered manager is experienced and holds an RMN, an RGN, a Master of Business Administration and a Post Graduate Diploma in Management Studies. He is supported in his role by a deputy manager and by an external management team. The manager explained that the home had a number of quality assurance processes in place to ensure that the home ran well and met the needs of the service users. A total audit was undertaken every three months. The parent company Craegmoor Healthcare Ltd monitored the quality assurance processes in the home and provided additional support and guidance when this was necessary. The home had also achieved the Investors in People Award which is a quality assurance award accredited by an external body.
Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 19 Systems were in place to protect service users finances with clear guidance being provided through policies and procedures. These were also audited by the parent company. Discussion with visiting relatives indicated that they were happy with the arrangements in place. Information provided through the questionnaire completed by the home indicated that the systems and equipment at the home was serviced and maintained appropriately. Training had been provided for staff in respect of health and safety issues. The homes policies and procedures had recently been updated and were about to be made available in the home. Accident records were maintained in the home although these were not compliant with the Data Protection Act. The home should ensure that accident record book is of the correct format and that the records are stored appropriately. Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 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 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 X 3 X 3 X X 2 Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 21 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 OP19 OP19 Regulation 4(a) 4(a) Requirement The pond area in the central garden area must be made safe. Risk assessments must be undertaken in respect of the need for window restrictors on those windows opening onto the central garden area. Timescale for action 31/10/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP19 OP38 Good Practice Recommendations Care plans should include all of the service users support needs. The standard of cleanliness should be improved in some areas of the home. The recording of accidents and the storage of those records should be data protection compliant. Preston Private Nursing Home DS0000006073.V303855.R03.S.doc Version 5.2 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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