Inspection on 24/07/07 for Preston Private Nursing Home

This inspection was carried out on 24th July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Preston Private Nursing Home 11/12/08

Preston Private Nursing Home 29/05/08

Preston Private Nursing Home 20/09/06

Preston Private Nursing Home 20/02/06

Preston Private Nursing Home 15/06/05

Preston Private Nursing Home 13/01/05

Preston Private Nursing Home 12/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Preston Private Nursing Home Midgery Lane Fulwood Preston Lancashire PR2 9SX Lead Inspector Vivienne Morris Unannounced Inspection 24th July 2007 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.V340700.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.V340700.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 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.V340700.R01.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 20th September 2006 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 up to 106 people, 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 in Preston and is relatively close to shops and local amenities. It is situated on a bus route into Preston town centre. People living at the home 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 who wish to participate. Relatives, friends and visitors are made welcome at the home. The home has small kitchen areas for the use of residents and visitors. Fees charged as at 23rd July 2007 ranged from £400 - £500 per week. There were additional charges being incurred for chiropody, hairdressing, newspapers, magazines, physiotherapy and confectionary. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two regulatory inspectors from the Commission for Social Care Inspection conducted the unannounced site visit to this service over one day in July 2007. This visit formed part of the key inspection process. During the course of the site visit discussions took place with seven people living at the home, a relative and five 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. Comment cards were received from seven people involved with the service and their feedback is reflected throughout this report. The information provided by the home on the Annual Quality Assurance Assessment (AQAA) has also been taken into consideration when writing this report. There were eighty-seven people living at Preston Private at the time of the site visit, when the inspectors ‘tracked’ the care of four 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 not received any complaints about this service since the last inspection. However, three allegations had been received, which were all referred to social services under the safeguarding adults procedure. What the service does well: We spoke at length to several people living at the home. One person on short term care said, “I wish that I could live here permanently. It is clean, the food is good, my room is comfortable and the staff are brilliant”. 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. Staff were described as being very supportive during the introductory period enabling people to settle in to life at Preston Private more easily. Very well written care plans were in place for each resident, providing staff with clear guidance about how the needs recorded on the plan were to be met. The health care needs of people living at the home were attended to and a wide range of health care professionals provided a service to the home. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 6 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 quite happy with the care provided at Preston Private. 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 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. The diverse needs of people living at the home were appropriately met. The service users spoken to generally described food as good and the questionnaires received confirmed this. Relatives were welcomed to the home and advocates were appointed if a resident wanted someone to act on their behalf. The homes complaints policy and procedure was displayed throughout the home and the 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. A comfortable and, in general, well-maintained environment was provided for people living at Preston Private nursing home, in order to ensure that pleasant surroundings were available and so that the safety of residents was protected. The garden areas were pleasant and accessible to the people living at the home, with newly laid decking and very attractive seating areas. The policies, procedures and practices of the home ensured that infection control was promoted, in order to reduce the possibility of cross infection. An experienced and well-trained staff team met the needs of people living at the home, which was well run by an experienced registered manager and the support of a good management team. 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. 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. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 7 There was a thorough induction process adopted by the home and a wide range of training courses were available for staff, which were arranged in accordance with the identified needs of staff and residents. There was a wide range of systems in place to monitor the quality of service provided for people living at the home and the company conducted a full audit every three months to ensure that high standards were being maintained. Policies and procedures had been periodically reviewed and were made available in the home. What has improved since the last inspection? What they could do better: Care plans could have covered all the assessed needs of people living at the home, including their social care needs and leisure interests and could have been reviewed each month to reflect any changes to their needs so that staff were provided with current, up to date information. The people living at the home or their relatives could have been given the opportunity to be involved in the care planning process so that they could have made some decisions about the care that are to receive. The management of medications could have been better, to ensure that people living at the home were safeguarded against medication errors or drug misuse. Although alternatives to the menu were available, this was not clear enough for the people living at the home, to allow them a choice of meals served. Although the home was generally clean, there were some areas, which could have been better in order to provide a more pleasant environment for people using the service. The satellite kitchens on each house were looking worn and could have been in better condition to provide improved facilities for people using these areas. The Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 8 bath hoists on each house were ageing, with paint peeling off and rusted areas evident, which did not promote pleasant areas for residents to bathe. The training matrix could have been more detailed, showing specific dates of training, in order to easily identify when refresher courses were needed for staff. 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.V340700.R01.S.doc Version 5.2 Page 9 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.V340700.R01.S.doc Version 5.2 Page 10 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 excellent. 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 could adequately meet their assessed needs. EVIDENCE: The AQAA completed by the home and sent to the Commission provided a lot of good information about the process adopted before people were admitted to Preston Private. It showed that the needs of people wishing to live at Preston Private were assessed using a new format, so that the staff team were confident that they could provide adequate care and any specialised equipment required was obtained to meet the assessed needs of people moving into the home. The AQAA also showed that all necessary information was given to people on admission, in the form of a service users’ guide, so that they were aware of the facilities and services available, including fees and additional charges. This information was supported by examination of care records seen. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 11 The AQAA showed that emergency admissions were given all relevant information within 48 hours of moving into the home and that a full assessment was carried out on admission, so that the staff team could, with the involvement of the resident, plan the care required. This information was supported by the policies and procedures of the home. This information was supported by looking at the care records of one person who was admitted to the home as an emergency. The AQAA showed that prospective residents and relatives were invited to visit the home before admission and residents could stay in the home for a trial period before deciding on a permanent place, so that they could see what life was like at Preston Private. The home indicated on the AQAA that perhaps improvements could be made in communicating with residents and their relatives by introducing communication cards in the reception area, so that people could voice their opinion. The AQAA showed that all residents will have person centred care planning for improved individualised care and that they are to be involved in planning the service guide as part of ‘Our Voice’. The care of four people living at Preston Private was ‘tracked’ during the course of the site visit to this service, when we found that sufficient information had been gathered from a variety of sources about the needs of people before they were admitted to the home. This ensured that the staff team could adequately support each resident whilst living at Preston Private. One comment card received from a resident showed that they had been given enough information about the home before they moved in, stating, “My relative was shown round and given all the information necessary”. One relative spoken to told us that he knew what the fees would be before the resident was admitted, adding, “There were no surprises”. One resident spoken to said that he was happy with his placement, except that he wanted to move into a different room, but this was expected to take place on the day of the site visit. Discussions with a number of residents and their visitors indicated that the staff were very supportive during the introductory period, enabling people to settle more easily in to life at Preston Private. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 12 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. The health, personal and social care needs of people living at the home were not always reflected in the plans of care. However, the assessed needs of people were being appropriately met and people were treated with respect, their privacy and dignity being upheld. The management of medications could have been better to ensure that residents were adequately safeguarded. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) submitted by the home provided a lot of useful information. It showed that the care plans were person centred and that they were generated from the information obtained before admission. It showed that people living at the home could make some decisions about the care they were to receive in order to meet their individual assessed needs. However, four care plans were looked at during the site visit, which did not consistently reflect all the assessed needs of people living at the home, as determined from the information gathered before admission. The initial plan of care for one resident failed to include the need for the management of challenging behaviour and although the person centred plan of Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 13 care subsequently completed did refer to this assessed need there were no strategies built into the care plan to give staff clear guidance on how to manage this person’s behaviour. We sat in the lounge for a period of time as part of case ‘tracking’ this resident and found that he was not sufficiently supervised to ensure that people living at the home were adequately protected. The care plans examined had not been consistently reviewed on a monthly basis and any changes in the care needs of people were not always reflected, to ensure that up to date information was consistently provided. The plans of care seen did not include any social care needs, despite one person being a younger adult, who owned a motorised buggy and a computer and enjoyed going out. There was no evidence to show that the resident or their relative had been given the opportunity to be involved in the care planning process, despite the people case ‘tracked’ either having the ability to be involved in the process or having regular visits from relatives, who could take part. However, the information which was recorded on all four plans of care in relation to health and personal care needs was very well written, providing staff with clear guidance on how to meet the individual needs of people living at the home and evidence was available to show that this was followed through in day-to-day practice. The registered manager informed us that staff were going to receive specific training on the planning of person centred care, which we considered to be good practice. The AQAA also showed that the plans of care contained risk assessments and promoted independence and choice, so that people were aware of identified hazards and were able to make informed decisions about their lifestyle. It also showed that the home had medication policies in place and that audits were conducted, so that the management of medications could be closely monitored. Facilities were also available to enable people to self-medicate, if they so wished, so that they had some control over their lives. The AQAA showed that the new person centred care plans ensured that people’s privacy and dignity was respected with particular regard to personal care and that care staff were trained to meet the health care needs of people living at the home. Comments received back from people involved with the service were positive, showing that, in general, the care needs of people living at the home were met. One resident stated, There is always someone to either attend to you, or else to find another member of staff who can. All comment cards received from relatives showed that they were kept up to date with important issues affecting their relative. Records showed that a wide range of external professionals were involved with the needs of people living at the home, to ensure that their health care needs Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 14 were being met. People living at the home, who were spoken to felt that all their needs were being appropriately met. The management of medications could have been better. We found that hand written entries on the Medication Administration Records (MAR) had not always been signed, witnessed and countersigned, to reduce the possibility of any transcription errors. The receipt of medications had not always been recorded on the MAR charts and the Controlled Drug register did not co-incide with the number of Fentynl patches available for individuals in the drug cabinet, due to two patches prescribed for one person being stored with another individual’s supply. Where variable dose medications were prescribed the amount given was not always recorded, so that staff could monitor the amount of medication taken. However, MAR charts were signed appropriately, the reason for any medications not being given was clearly recorded and eye drops were dated on opening. It was established that the prescribed medications for one resident had been out of stock for a period of five days, which did not demonstrate that people were receiving their medications as prescribed. The plans of care included the need for privacy and dignity, particularly in relation to the provision of personal and nursing care, showing that people living at the home were respected. The practices observed in relation to the privacy and dignity of people living at the home was good. We observed that people were able to have a rest on their beds, should they choose to do so. Staff were seen chatting with residents when providing care and speaking in a friendly but respectful manner to them and any visitors to the home. Staff training included issues around privacy and dignity, so that they were aware of the importance of respecting people living at the home. One resident commented, “The staff are very kind and caring. They always respect my privacy” and a visitor said she was always welcomed into the home and that staff were friendly and showed respect. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 15 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 home consistently met residents’ individual needs, expectations and preferences and they were encouraged to maintain contact with friends and family. Residents received a wholesome diet, although choices of menu were not always evident. EVIDENCE: The AQAA showed that residents felt that their lifestyle matched their expectations and preferences and that the routines of the home were flexible, with family and friends involvement. This was supported by direct observation and speaking with people involved in the home. We sat for long periods of time in two of the lounges within the home. One lounge was quiet and relaxed and those using this area looked happy and well cared for, being able to move around as they wished. The other lounge was a hive of activity, with a lot of comings and goings. The people using this area were enjoying a range of activities, both in small groups and on an individual basis with age appropriate music playing in the background. There was a friendly environment around the home and people spoken to were all happy living at Preston Private. Relatives spoken to said that they were Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 16 made to feel welcome to the home and were comfortable visiting people living there. One told us that he was always offered a meal, which he enjoyed, as the food was very good. We observed people being offered a wide range of choices throughout the day, although those spoken to were not aware of any choices of menu at lunchtime, and everyone was served with the same meal. The AQAA showed that people received a well balanced diet and were able to choose their meals. It was evident that alternatives to the menu were available, but those spoken to were either not aware of this or had forgotten. The new chef was keen to please and anxious that meals were enjoyed. He said that alternatives to the menu could be provided at lunchtime if asked for. However, he suggested adding more information to the menu sheet in order to remind staff and residents of the alternatives available. It was agreed that he discusses this with the main chef on his return from annual leave. We saw that cold beverages were served with lunch, but one lady said that it was only natural to have a good cup of tea after a meal, but she had to wait until later in the day. One relative said, “At Preston Private the food is of a high standard. This, I think has helped my relative to enjoy a good quality of life even though she was only given a few weeks to live. Seven months later she can get out in a wheelchair. She gets loving care and attention here”. We spoke with one person who was jovial in mood and on his way to attend the church service in one of the lounges. The AQAA showed that the home had a varied list of activities that residents were encouraged to join in and that summer or autumn fayres were held, which people living at the home confirmed they enjoyed. The AQAA showed that a green house had been erected for the use of residents, and that the fishpond had been drained, which had previously been recommended in order to protect the safety of people walking in the grounds. This area had been covered with decking to provide a nice outdoor seating area for people living at the home. Two activities staff were busy with residents in one lounge. They were encouraging people to join in activities, but were not forcing people to participate. We heard people being praised on a regular basis and one resident was enjoying dancing with a member of staff. People living at the home were accompanied outdoors on a regular basis and freedom of movement around the units was evident. One volunteer whose husband had passed away at the home visited every day to attend to the bird tables, to look after the flowers and to talk to the people living at the home so that they received some quality 1:1 time. One relative felt that the more able people living on the dementia care unit could be taken out on trips more often. It was pleasing to see old photographs of ‘times gone by’ displayed throughout the corridors of the home so that people were able to reminisce about the past. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 17 Staff were seen to respond to people in a sensitive manner and it was evident that the people living at the home were comfortable with staff presence. One unit had two pet cats, which the residents loved and which created a topic of conversation with the people living there. People were treated with dignity and in general staff paid great attention to detail, such as straightening a residents clothing when she sat down, making sure a hearing aid was switched on, ensuring that someone had their spectacles on so that they could read a newspaper and covering a ladies knees with her skirt when she sat down. However, two people were asleep in reclining chairs when a member of staff approached from behind and moved their chairs for no apparent reason, which startled them both, but the staff member did not explain her motive for this action. One lady had been transported in a wheelchair into one lounge. She then wanted to walk up the corridor. She was supported by one member of staff, but was very unsteady and perhaps would have been better being supported by two. The AQAA showed that the home’s policies protected people from financial abuse and that advocates were used as required, should someone living at the home wish to appoint an independent person to act on their behalf. One relative, when asked what the home does well stated, “The home gives loving care and attention to the people in their care. The staff are all friendly and make sure that the residents feel at home” and another said, “There has been a great improvement in activities, since the new OT started”. One resident commented, “They (the staff) always respect our lifestyle”. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 18 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. The policies and procedures of the home adequately protected people living there and complaints were managed appropriately. EVIDENCE: The AQAA showed that a clear complaints procedure was in place, which was displayed at the entrance hall and also within each unit. This information was supported by our observations on the day of the site visit. The AQAA also showed that people living at the home and their relatives knew how to make a complaint and that these were monitored and managed sensitively. Comment cards received and the people spoken to at the time of the site visit all indicated that they would know how to make a complaint, should they need to do so. One relative commented, “I was given information about how to make a complaint on commencement of my relative’s care” and another said, “There are notices about the home telling people how to make a complaint”. The AQAA showed that there had been eleven complaints received by the home in last twelve months, none of which were upheld. However, this information did not match the details provided within the complaints log examined at the home, as this showed that two of the complaints received had actually been upheld. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 19 The management of the home were keen to resolve any concerns raised about the home and had acted appropriately in response to any concerns made. The home had a policy in place for dealing with the protection of vulnerable adults and staff training records indicated that many of the staff had 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 to protect both service users and staff. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. In general the home was safe and well maintained, providing a clean, hygienic and homely environment for people to live in, although there were some areas that needed to be improved. EVIDENCE: The AQAA showed that there was a full time member of staff appointed who was responsible for the ongoing maintenance of the home and a part time painter and decorator also worked at Preston Private to ensure that the ongoing decorating programme was maintained. It was noted that it was the responsibility of the staff on each of the units to report any repairs needed to the maintenance man who attended to these on a daily basis. The AQAA showed that people living at the home or their relatives were given the opportunity to be involved in choosing colours for their bedrooms and this was confirmed by those spoken to at the time of the site visit. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 21 The AQAA showed that a green house had been erected so that people living at the home who enjoyed gardening maintain this leisure activity. The fishpond had been drained in order to protect the safety of the people using the garden and this area had been covered with decking, providing a very pleasant seating area for people to use during the better weather. At the time of the site visit a large amount of bedroom and lounge furniture was being replaced, which was pleasing to see, providing pleasant communal areas and private accommodation for those living at the home. It was pleasing to see that a lot of effort had gone in to personalising bedrooms for people living at the home in order to create homely accommodation for them to live in. We toured the premises during the course of the site visit and, in general, found the home to be clean, warm, free from hazards and unpleasant smells, providing a homely and safe environment for people to live in. The home was tastefully decorated and well maintained and enjoyed well kept gardens. Clinical waste was being disposed of correctly and staff had received training on infection control, to ensure that relevant policies were being followed in day-to-day practice. Everyone we spoke to who were using the service were happy with the environment in general, including the communal areas of the home and their private accommodation. However, certain areas, as identified below needed attention. Fernyhalgh The bathrooms on this house were in need of general cleaning, particularly the bath hoists and between the hoist stands and baths, so that a pleasant environment was provided for those living on this house. We noted that the bath hoist in one bathroom had holes in the seat to allow drainage of water. However, this poses a risk for male residents requiring to use the hoist, therefore the central holes needed to be filled in. Ladywell The cups and beakers in the satellite kitchen on this house could have been cleaner. Longsands The strip light in one of the bathrooms was out of order and therefore insufficient lighting was provided for residents wishing to use this facility, which posed a risk for people living at the home. Laundry department Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 22 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 and procedures in place to promote cleanliness and to reduce the possibility of cross infection. General The outside fence surrounding Ladywell unit was in need of securing, as it was unstable and could have posed a risk to people using the external grounds of the home. The satellite kitchens on each house were worn and therefore in need of refurbishment. The bath hoists throughout the home were ageing, with paint peeling off and rusted areas evident, which posed a risk to those using them. Therefore, the hoists were in need of refurbishment or replacing to protect the safety of those living at the home. Wall tiles were cracked in some bathrooms, which did not enhance the environment for the people using these facilities. Restrictors had been fitted to the bedroom windows around the central garden area, which protected the safety of people living in these rooms. We were told that plans were in place to fit restrictors to all the remaining windows around the home so that the safety of everyone was protected and security of the building would be increased. It is advised that the home makes sure that windows cannot be opened beyond the recommended distance, so that people cannot climb out through them and so that intruders cannot get into the home through an open window. Preston Private Nursing Home DS0000006073.V340700.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. An experienced and well-trained staff team met the needs of people living at the home. EVIDENCE: The AQAA showed that the skill mix of staff employed by the home was meeting residents’ needs. This was confirmed by the examination of the staff duty rota. Although agency staff were utilised when needed to cover staffing deficits, wherever possible there was some consistency in the staff supplied so that continuity of care was promoted. The duty rotas were examined, which showed that staffing levels were adequate to meet the changing needs of people living at Preston Private. We observed a volatile situation on one of the houses, where we felt that one resident could have been more closely supervised to prevent further injury to other people living in this house. The manager confirmed that the numbers of staff on duty was determined by the needs of the people living at the home; to ensure that there were sufficient numbers of staff on duty with the right skills to meet all assessed needs. Comment cards received from relatives indicated that staff usually had the right skills and experience for the job. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 24 Staff were seen to be attentive to people’s needs, initiating conversation with them and explaining, in general what was going on. Residents were seen to be actively seeking staff out. One staff member waved ‘hello’ to a resident as she passed by. Staff were observed to move up and down the corridors to attend to people living at the home, ensuring that their needs were fully met. The AQAA showed that robust recruitment procedures were in place at the home to protect those living there, in line with equal opportunities. We examined four staff files and found that recruitment processes within the home were thorough and that all necessary checks and references had been undertaken, ensuring as far as possible that service users were protected. One person spoken to felt that there was a relatively high turn over of staff, although didn’t feel that there was an issue with the people working at the home, as they, “All look after the residents well” and one relative added, The staff are very good. They do a good job. The AQAA showed that only two members of staff had left the home in last twelve months and that the nursing bank linked to the home had increased during the last twelve months. The AQAA showed that thirty five care staff were employed at the home, with twenty one having achieved a recognised qualification in care, which was commendable as 60 of care staff were appropriately qualified to provide the care required and to supervise new care staff. The AQAA showed that all overseas staff routinely attended weekly English classes, which was considered to be good practice in order to promote communication between residents and staff. The AQAA also showed that all mandatory training had almost been completed for all employees and that the provision of training had improved during the last twelve months, with a wide range of courses now on offer, including safeguarding adults and equal opportunities, so that people living at the home were being protected. The AQAA showed that all new employees received induction training, in accordance withy skills for care, to ensure that they were aware of the policies and procedures of the home and so that they were competent to do the job expected of them before working alone. The AQAA showed that all catering staff had received safe food handling training and 80 of care staff had also received this training, which was commendable, to reduce the possibility of poor food hygiene practices. The AQAA showed that a training matrix was in place and that improvements had been made by providing training in accordance with the identified needs of Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 25 both staff and residents, to ensure that staff had the right skills to look after the people in their care. However, the training matrix needed to be more detailed to ensure that specific dates of training were entered, which would allow for easier planning of refresher training. A discussion took place with one relatively new overseas care assistant, whose command of the English language was good. She told us that she was well settled and happy in her work. She said that she would ask senior staff or colleagues if she is not sure of anything and that she had received training in mandatory topics. She told us that she had not been the subject of any racial discrimination whilst working at the home. We observed this member of staff supporting a resident with a happy and smiling approach. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 26 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 well managed in the best interests of the people living there. EVIDENCE: The registered manager has many years of experience and holds several relevant qualifications, showing that he has the skills and knowledge to effectively manage the care home, being supported in his role by a deputy manager and by an external management team. The manager explained to us that the home had a number of systems in place so that the quality of service provided could be closely monitored ensuring that it was effectively managed to meet the needs of the people living there. Records seen supported this information. The AQAA showed that quality assurance inspections were conducted and action plans were produced, so that Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 27 the quality of service provided could be closely monitored. A variety of audits were seen and a current business plan had been produced. A total audit trail was undertaken every three months. The company 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, showing that a recognised external quality board had also assessed the home. The AQAA showed that regular meetings were held with staff, residents and relatives to pass on any relevant information and to receive feedback on how the service is performing to meet the needs of the people living in the home. The AQAA showed that residents’ finances were safeguarded and it was evident that systems were in place to protect service users finances with clear guidance being provided through policies and procedures. Information provided through the questionnaire completed by the home indicated that the systems and equipment at the home were serviced and maintained appropriately. Records checked at random showed that this information was correct in that systems and equipment had been serviced in accordance with manufacturers recommendations. The homes policies and procedures had been periodically updated and were made available within the home and records showed that training had been provided for staff in respect of health and safety issues, to ensure that people living at the home were protected. We observed two occasions where improvements could have been made in relation to the moving and handling of residents. It is advised that the registered person ensures that all staff members receive in depth moving and handling training in order to protect the people in their care. One recently appointed member of staff said that he was happy with his job and felt well supported by the management team. Another stated that she too felt well supported and looked interested in her work and the people she was supporting, speaking to them in an appropriate manner. This staff member said that she would be happy to see a relative of hers being cared for in Preston Private. Records showed that the fire service had visited in February 2007, when it was highlighted that the evacuation plan was not sufficient and that there was a need to nominate sufficient staff to implement procedures. However, the evacuation plan had been rewritten in March 2007. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 28 The Environmental Health Officer had recently visited the home and had made several requirements to be addressed within four weeks to ensure that the health, safety and welfare of people living at the home was adequately protected. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 29 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 14 15 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 X X 2 Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered person must ensure that residents or their relatives are given the opportunity to be involved in the care planning process and that the plans of care include all assessed needs, providing clear guidance for staff as to how these needs are to be met. Timescale for action 30/09/07 2. OP9 13(2) The registered person shall make 31/08/07 arrangements for the safekeeping, accurate recording and safe administration of medicines. (Previous timescale of 31/05/07 not met). The registered person must ensure that all parts of the care home are kept clean, including bathrooms, the laundry department and drinking vessels in the satellite kitchens. The registered person must ensure that suitable lighting is provided in all parts of the care home to which residents have access, including bathrooms. DS0000006073.V340700.R01.S.doc 3. OP19 23(2)(d) 31/08/07 4. OP19 23(2)(p) 31/08/07 Preston Private Nursing Home Version 5.2 Page 31 5. OP38 13(4)(c) 6. OP38 16(2)(j) The registered person shall 31/08/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, including the securing the fence surrounding Ladywell house. The registered person must 31/08/07 ensure that the requirements made by the Environmental Health Officer (EHO) are addressed within the timescale stipulated on the EHO’s report, in order to maintain satisfactory standards of hygiene within the care home. 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. 4. Refer to Standard OP7 OP12 OP12 OP15 Good Practice Recommendations The plans of care should be reviewed and updated as required on a monthly basis, to ensure that current information is provided for staff. Staff should ensure that people living at the home are made aware of any actions to be taken before interventions take place, so that residents are not startled. Adequate support should be provided for people when mobilising to reduce the possibility of falls. Staff should ensure that people living at the home are made aware that they are able to have a choice of menu at lunchtime and they should be routinely offered a choice of meal, so that they can make some decisions about the food they eat. It is recommended that people living at the home be offered a hot beverage following their meals, to promote an enjoyable dining experience. DS0000006073.V340700.R01.S.doc Version 5.2 Page 32 5. OP15 Preston Private Nursing Home 6. 7. 8. OP19 OP19 OP19 9. 10. 11. 12. OP19 OP27 OP30 OP38 The cracked wall tiles in the bathrooms should be replaced in order to provide more pleasant surroundings for people using these facilities. The central holes in the bath hoist seat on Fernyhalgh house should be filled in order to protect the safety of male residents living in this building. Consideration should be given to the refurbishment of the satellite kitchens within each house and the refurbishment or replacement of the ageing bath hoists, in order to enhance the environment and to protect the safety of people using these kitchens and bath hoists. It is recommended that advice be sought to ensure that windows do not open further than relevant guidance in order to protect the safety of people living at the home. The registered person is advised to ensure that people living at the home are adequately supervised in order to reduce the possibility of volatile situations occurring. The staff-training matrix should be more detailed; to include dates of training so that future planning and refresher courses needed could be more easily identified. It is advised that the registered person ensures that all staff members receive in depth moving and handling training in order to protect the people in their care. Preston Private Nursing Home DS0000006073.V340700.R01.S.doc Version 5.2 Page 33 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. 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