Inspection on 29/05/08 for Preston Private Nursing Home

This inspection was carried out on 29th May 2008.

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

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 24/07/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Preston Private Nursing Home Midgery Lane Fulwood Preston Lancashire PR2 9SX Lead Inspector Vivienne Morris Unannounced Inspection 29th May 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.V362795.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.V362795.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 (55), Physical disability (18) of places Preston Private Nursing Home DS0000006073.V362795.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 24th July 2007 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 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. 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. 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. Fees charged as at 29th May 2008 ranged from £420 - £550 per week. There were additional charges being incurred for chiropody, hairdressing, newspapers, magazines and personal toiletries. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. Three regulatory inspectors from the Commission for Social Care Inspection conducted the unannounced site visit to this service over one day in May 2008. The pharmacist inspector also visited the home to assess the handling of medicines. 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. However, none were returned to us. There were seventy-two people living at Preston Private at the time of the 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 inspection and one allegation, which were all referred to social services under the safeguarding adults procedure. Three random inspections have been conducted since the last key inspection on 24th July 2007, due to concerns related to medication procedures and general care practices. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 6 What the service does well: 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. When asked what the service does well, the Manager of the home wrote on the self-assessment ‘Planned admissions have a full assessment. Any emergency admissions receive a full assessment within 24 hours, so that correct care and equipment can be identified’. The manager provided us with some examples to support her comments, including telling us that the Statement of Purpose had been updated, which was seen to be easily accessible within the home. Well-written care plans were in place for some residents, providing staff with clear guidance about how the needs of these people were to be met. There were no significant strengths in the way medicines were handled at this service. 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 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. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 7 The garden areas were pleasant and accessible to the people living at the home, with newly laid decking and very attractive seating areas. What has improved since the last inspection? What they could do better: When asked what the service could do better, the manager stated on the selfassessment, ‘Improve communication with relatives’ and she gave some examples of how the home plans to do this. Care plans could have been more specific, covering all the assessed needs of people living at the home, so that staff are fully aware of individual assessed needs. The plans of care could also have been consistently followed in day-today practice, so that residents received the care, which they required, including oral hygiene and pressure care. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 8 Everyone 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, which they are to receive. The health care needs of people living at the home could have been better managed so that residents received appropriate health care support and the communication systems within the home need to be reviewed so that relatives are informed of important matters affecting the residents. The service must ensure that all records relating to medication are accurate and updated promptly so that medicines are given as prescribed to protect the health of the people who live there. The service must review ordering procedures so that medicines do not run out and people always have the treatment they need to keep them well. Care plans relating to medication should also be more detailed so that staff have clear instructions to follow to make sure people get appropriate and consistent treatment. 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. The diverse needs of people living at the home need to be considered in a more structured way so that every one is given the same opportunities in order to promote equality and diversity. Complaints could have been managed more effectively so that a record was kept of all concerns raised and a thorough investigation conducted, monitored by the manager of the home, to ensure that a clear audit trail was evident. 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. On Durton unit there was a dirty toilet frame, which needed a thorough clean and there were holes in the bath seat on Fernyhalgh unit, which did not promote good health and safety practices. It was considered that the current domestic input into this large care home was insufficient, taking into account the size of the premises and the needs of the people living there. The satellite kitchens were looking worn and could have been in better condition to provide improved facilities for people using these areas. The bedrooms on Fernyhalgh unit looked ‘stark’ and ‘unwelcoming’ for the people living in them. The bathrooms and toilets were institutionalised and could have been more personalised, in order to promote a more pleasant environment for the residents. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 9 There were some concerns about the security of the building, particularly at weekend and in the evenings, which need to be addressed to ensure that the safety of people living at the home is consistently maintained. Although there were infection control policies and procedures in place at the home, these were not being followed in day-to-day practice and although staff had received relevant training in the control of infection it was clear that systems to control the spread of infection could have been better. The assessed needs of people living in the home were not consistently met. Therefore, the staffing levels could be reviewed so that staff are appropriately deployed to meet the needs of everyone living at the home, including domestic staff. The home should continue to provide training for staff, including National Vocational Awards and structured induction programmes so that all staff are appropriately qualified and trained to do the job expected of them in order to consistently meet the needs of people living at the home. The recruitment practices adopted by the home could have been better to ensure that the people living there were adequately safeguarded. The monitoring of the quality of service provided for people living at the home could have been better by conducting surveys for anyone with an interest in the service, by retaining minutes of any meetings held and by keeping accurate records so that clear audit trails could be conducted. The home could have been better managed by allowing the manager of the home some time to effectively operate the service in the best interests of the people living there. 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.V362795.R01.S.doc Version 5.2 Page 10 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.V362795.R01.S.doc Version 5.2 Page 11 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 aware of their 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. It showed that the needs of people wishing to live at the home were assessed and that any specialised equipment required was obtained to meet the assessed needs of people moving into Preston Private Nursing Home. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 12 The assessment showed that emergency admissions were given all relevant information within 48 hours of moving into the home and that an assessment was carried out on admission, so that the care needed could be planned. This information was supported by the policies and procedures of the home. The manager told us that prospective residents and relatives were invited to visit the home before admission and residents could stay there 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 their self-assessment that perhaps improvements could be made in communicating with residents and their relatives by introducing a communication book in the reception area, so that people could voice their opinions. 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 the home so that the staff team were aware of the needs of each individual. The social care assessment for two people living at the home was extremely detailed, giving staff a clear picture of their life history, which was considered to be good practice. However, the life history for another resident had not been fully completed, which showed inconsistency in record keeping. The admission of one resident to the home 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 their social care needs. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 13 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 poor. 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 met and the dignity of people was not consistently respected. Medicines were poorly managed and this placed the health and wellbeing of the people who live at the home at risk. EVIDENCE: The standard of care planning varied in detail and clarity. Not all assessed needs were incorporated into the plans of care and care plans were not always followed in day – to – day practice, which demonstrated that people’s assessed needs were not always being met. Some records seen were vague and contained contradictory information for staff, which did not promote continuity of care. However, other records contained some clear and comprehensive information, so that staff were, in general, aware of how to meet the assessed needs of some people living at the home. Records showed that some residents or their relatives were involved in Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 14 planning their own care so that they could have some say in how their care was delivered. When asked what the service does well, the manager wrote on the selfassessment, ‘we generate a comprehensive plan of care using the preadmission assessment. We use the care plan as a working tool and we make sure all staff understand it. Each plan is written clearly and includes risk assessments to maintain the safety of residents. The home promotes independence’, One of the care plans seen on Ladywell unit was presented in a new format, which generally contained some good information, but there were regular discrepancies noted and also some lack of recording of important details. A variety of risk assessments were in place across the four units to ensure that any potential risks were minimised as far as possible. Records showed that a range of external health care professionals had been involved in the care of the people living at Preston Private Nursing Home, such as district nurses, chiropodists, opticians and doctors, so that there was some input into the health care needs of people living at the home. However, a dentist had recently reported to the home that the mouth hygiene of one resident living on Ladywell unit was very poor and so had given instructions to the staff on how to improve the oral hygiene for this person. Although, a plan had been written in relation to mouth care for this individual the information provided did not co-incide with other instructions given to staff and although it was confirmed that staff cleaned the resident’s teeth once a day there was no evidence that full oral hygiene procedures were conducted. The daily records of two residents living on Durton unit who required mouth care showed inconsistency in how often this was completed and one care plan stated, “offer mouth rinses before and after eating”, but care staff spoken to knew nothing about this instruction. This showed that the plan of care was not being followed in day – to – day practice to ensure that the assessed needs of people were being consistently met. Care plans seen incorporated appropriate pressure relieving techniques and specialised pressure relieving equipment was provided for those requiring it, in order to reduce the risk of pressure sores developing. However, there was little evidence to demonstrate that positional changes were carried out for one immobile person living on Ladywell unit, although clear records of pressure relief were maintained for a resident on Longsands unit. Records showed that one resident on Ladywell unit had a wound, which had developed ten months previously, but advice had only just been sought from the Doctor so that appropriate investigations could be carried out. The daily records for some people showed that positional changes had sometimes been conducted. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 15 Daily records showed that personal care and catheter care was being provided at regular intervals on all units to ensure that the hygiene of people living at the home was maintained, although there were some significant discrepancies in relation to continence care for one resident living on Ladywell unit and another on Durton, which provided staff with conflicting information about these people’s needs. Appropriate care charts had been implemented, such as, those requiring their fluid intake and output to be monitored. However, there were some areas of concern in how these charts were being completed, as the chart for one resident was not accurate and those for another two sometimes showed a lack of fluids being given. Therefore, the health care needs of people living at the home were not always being met. A discussion took place with one relative of a resident whose care was ‘tracked’. She told us that she was very happy with the care received by her relative and added, ‘the staff are very caring and they are wonderful’. When asked how the service had improved in the last twelve months, the manager told us, ‘by teaching all staff about privacy and dignity. We involve residents and their relatives in planning care and we hold meetings every eight weeks’. We saw one care worker shaving the male residents in the lounge area with the same electric razor, which did not respect the privacy and dignity of people living at the home and which did not promote good hygiene standards. One health care professional said that she felt in terms of care that there was some inconsistency, as sometimes things were done but sometimes they were not. She also said that the staff were quite proactive in terms of pressure care, although there had been a lack of necessary equipment, such as aprons, gloves, wound swabs and urine specimen bottles. However she felt that this had improved of late. When asked what the service could do better, the manager wrote on the selfassessment, ‘by putting more information into our care plans, such as, more about people’s choices. To give staff training to teach them how to give support to residents and relatives at the end of life’. The pharmacist inspector assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager Christine Blezzard and other staff. The inspection took six hours. Medicines administration records appeared to be well completed however discrepancies were found that showed that some of these records were not accurate. Records of medicines disposal were incomplete so that some medicines could not be accounted for. A system of regular checks had been started by the service but these did not always identify errors. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 16 Some medication was not available so residents were not always able to have the treatment they needed with serious risk to their health. For example, one person had no blood-thinning medicine for two days increasing the risk of strokes. Another person was admitted to hospital with a condition that could be attributed to the lack of medication that had run out 16 days beforehand. Strong painkillers sometimes ran out or were not administered at the correct time and the records of one person showed that they had pain that could be the result of not receiving treatment when they should. The management of blood thinning medicines that need regular blood tests and prompt dosage changes was poor placing people at risk from strokes or haemorrhages that could be life threatening. On one occasion a dose increase was needed but this was delayed by 11 days leaving the person at risk of stroke. A sample of care plans for managing medication was checked, which were variable in the level of detail. For example, a care plan relating to specialist administration of medicines through a tube was relatively complete with instructions to follow. However, a care plan for managing a diabetic with have low blood sugar levels gave little information on the medicines to administer and management of that person’s condition. Care plans relating to medication should be reviewed so that people receive appropriate and consistent treatment. The seriousness of the concerns found at this inspection show that further training of staff is essential in order to protect the health and wellbeing of the people who live at the service. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home did not always consistently meet residents’ individual needs, expectations and preferences and the management of meals could have been better. People were encouraged to maintain contact with friends and family. EVIDENCE: When asked what the service does well, the manager wrote on the selfassessment, ‘We satisfy the social, cultural, religious and recreational needs of all residents, making the routines of daily life more flexible and varied to suit all residents’. People living at the home were able to access the local advocacy services, should they need someone to act on their behalf and information about how to contact this service was readily available within the home and within the information given to people during the admission process. We spoke at length with one resident who told us that she enjoyed a variety of activities within the home, including quizzes and bingo. Her care plan clearly outlined her interests and the home met her needs in this respect. This resident showed us a copy of the activity timetable within her room, which we also noted was displayed at frequent intervals throughout the home including Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 18 on residents’ bedroom doors. Two other people said, ‘There is nothing to do’ and, ‘There is very little going on. It gets quite boring’. One relative said that staff are very attentive to her mother, who rarely leaves her room and does not wish to become involved in any of the activities. The resident said that she has frequent visits from staff who pop in to spend a few minutes with her, especially in the evenings. She also told us that she was very interested in sport and had Sky TV installed, in accordance with her plan of care. One relative spoken to said, “As far as care homes go, this is the best you can get, although I don’t think there is enough 1:1 supervision’. Another relative commented on how he was comfortable visiting the home and the policies and procedures confirmed that visitors are made to feel welcome. We saw that people were greeted in a respectful and warm manner, which enhanced the friendly atmosphere. One day-care resident arrived at the home by ambulance to spend the day with her husband, as she did one day each week. However, on arrival she discovered that her husband had been taken to a pre-booked hospital appointment and she had not been informed. Therefore, she spent the morning period sitting in the lounge waiting for her husband to return, which demonstrated that relevant information was not always passed on to the people living in the home, or their relatives. When asked what improvements had been made in the last twelve months the registered manager told us, ‘The fish pond in the main garden area has been drained and decking now covers this, making a nice shaded seating area’. We sat in the lounge areas of the different units for periods of time and we noted on Fernyhalgh that one resident was quite agitated, disturbed and noisy, continuously shouting for ‘help’. Staff occasionally spoke to this individual, asking what the problem was, but no diversional interventions were offered initially and a member of staff who told him, ‘you are annoying everyone else’, later took him to his bedroom, where he continued to call for ‘help’. Later, when this resident returned to the lounge he was given a drink and a hand massage. He was more settled with staff interaction, but this was not always possible as for periods of time the lounge was left without any staff members in it and at other times a none care worker was trying to supervise the lounge alone, which did not promote the safety of people using this area of the home. It was pleasing to see one care worker sitting and chatting to residents in a respectful manner about their leisure interests and about people who are important to them, providing them with something to discuss which is of interest to them. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 19 The specific diverse needs of one person living on Durton unit did not appear to have been addressed during her admission assessment. The home had not attempted to provide any other forms of communication for this resident who spoke very little English, which did not promote equality and diversity within the home. The nurse in charge of the unit said that the resident could make her needs known. However, examples given were open to confusion and misunderstanding by staff, which could result in detrimental effects for the resident, as nothing in the care plan provided guidance for staff about her methods of communication. Finding evidence of adequate nutrition for this resident was quite difficult and confusing. The care plan stated that some food the family brought in. Discussions with the chef indicated that whilst he has been shown how to cook one meal for this lady, other meals had been refused. We asked the nurse in charge to show us evidence of a meals input record, but there was nothing available to show that this resident was receiving adequate nutrition. One member of staff was seen providing care for a resident without speaking to them or explaining what interaction was being carried out, which did not promote good communication between staff and residents. We observed lunch being served in several areas of the home. The menu provided a well balanced diet and although there were no choices on the menu at lunchtime we were told that alternatives were available if requested. However, all residents spoken to were unaware that they could ask for an alternative to the menu at lunchtime if they did not like what was on offer. Staff said that although there were no choices available at lunchtime, there were choices at breakfast and teatime. On the day of our visit one resident told staff that she did not like two of the three main course food items on offer at lunch time, so she was served with the third item on its own, which does not confirm that alternative meals are offered if someone does not like what is on the menu. We noted that there was a choice of sweets on offer with yoghurt for those who preferred it to the dessert on the menu. People had the choice of eating in the dining rooms or taking their meals in the privacy of their own room in order to promote a flexible life style. Although independent eating was encouraged where possible staff were sensitive to residents’ needs and provided assistance were necessary. However, one carer was sitting on a chair arm whilst assisting a resident with their meal, which did not promote dignity of this person. Residents were able to eat at their own pace, without being rushed, which was pleasing to see. The plastic beakers in the kitchens on some units were discoloured and in need of replacing or thoroughly cleaning in the interests of people’s hygiene. On the day of the site visit one person living on Durton unit was eating three sausages for his lunch because he did not like the type of potatoes available and no alternatives were offered to him, although a carer did state that the kitchen would try to provide something different if asked. We were unable to Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 20 determine how proactive the staff were at trying to provide a more nutritionally balanced input for this resident. We spoke with a relative of this person, who told us that he had a very poor diet and may be better if there were choices available, particularly at lunchtime. The records of two people living on Fernyhalgh unit, whose care was ‘tracked’ showed a significant weight loss and yet the care plan for one of these people stated, ‘adequate dietary intake’, despite the pre-admission information and the daily records showing that the resident had a poor appetite and was refusing fluids. Residents spoken to said that the food was generally very good, one said, ‘I particularly liked the curries’ and another commented, ‘the food is very good. I always eat everything’. However, a number of people said that the amount of food served is often over facing because it was too big a portion. One visitor raised concerns about mail being left over the weekend at the reception desk for anyone to look at. She has seen birthday cards amongst this post, which presumably means that some residents may not be getting their cards on the right days, which does not protect people’s wishes and feelings. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The policies, procedures and systems within the home adequately protected the people living there, but the management of complaints could have been better. EVIDENCE: When asked what the service does well, the manager wrote on the selfassessment, ‘Preston Private has a clear complaints procedure, which is available in reception and on each unit throughout the home. Complaints are monitored and a complaints log is kept up to date by the manager’. The complaints procedure was clearly displayed around the home, so that people were aware of how to make a complaint, should they wish to do so. We looked at the complaints record and noted that not all complaints had been recorded within the complaints file. The manager was aware that one particular complaint had been received, but this had not been recorded to allow a clear audit trail. We noted that the outcome of another complaint was sketchy and did not include all the issues identified. The manager told us that someone else was dealing with it and had met with the resident’s family, but there were no written records of the meeting with the family and therefore the home or ourselves could not establish the outcome following the meeting. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 22 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 for dealing with the management of challenging behaviour were in place, in order to promote safe working practices and to protect both residents and staff. Staff spoken to were aware of what they needed to do should they be concerned about the treatment of a resident living at Preston Private Nursing Home. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 23 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 safe and reasonably well maintained, providing a clean and homely environment for people to live in, although there were some areas that needed to be improved. The management of infection control was not thorough enough to ensure that good hygiene standards were maintained. EVIDENCE: The manager told us on the self assessment that the home was safe and well maintained and 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 who also worked at Preston Private to ensure that the ongoing decorating programme was maintained. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 24 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 self assessment showed that people living at the home or their relatives were given the opportunity to be involved in choosing colours for their bedrooms, which was considered to be good practice and which allowed them some control over their lives. In general residents’ bedrooms were clean, tidy and personalised, some with pictures of family and friends on the walls and residents were able to easily reach their own things, which was nice to see. However, the bedrooms on Fernyhalgh unit were a bit stark and could have done with brightening up in order to enhance the accommodation for the people living in it. Pleasant communal areas were provided and we were told that some new carpets were on order and some lounge furniture was being replaced in order to enhance the environment for those living in it. 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, in general, nicely decorated and well-maintained and enjoyed well-kept gardens. Everyone we spoke to who was using the service was happy with the environment in general, including the communal areas of the home and their private accommodation. However, some areas of the home were looking ‘tired’ and ‘worn’, also certain areas, as identified below needed attention: Ladywell unit: • The satellite kitchen was generally clean and tidy although the kitchen units were worn and in need of replacing in order to promote good hygiene standards within the home. Durton unit: • One toilet frame on was in need of a thorough clean as it was dirty. Fernyhalgh unit: • There were holes in the bath seat of the hoist to allow drainage of water. However, these were a potential risk to the male residents using this equipment. The showerhead was missing from one of the shower cubicles, which restricted people from using this facility. DS0000006073.V362795.R01.S.doc Version 5.2 Page 25 • Preston Private Nursing Home General: • The toilets and bathrooms, in general looked institutionalised and not personal at all. Although these areas were generally clean, some were quite ‘scruffy’ looking and in need of redecorating. A visitor spoken to expressed some concern about the security of the building, as there was no longer a receptionist at the home. We were told and we observed that anyone could wander into the home unchallenged and a public footpath runs past the home, which could make this easy to do. The visitor told us that she herself had escorted two doctors to residents’ rooms when they were unable to find a member of staff. She also said that external doors were meant to be locked after a specific time in the evening, but said that this practice does not happen. When we discussed this issue with the manager she told us that an Administrator had been appointed. However, this will not address the problem at the weekends. 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. Clinical waste was being disposed of correctly and staff had received training on infection control. However, one relative told us that staff often attended to her mother’s personal needs without wearing protective clothing. She said that she had pointed this out on occasions, but that staff just ‘shrugged their shoulders and carried on’. We observed that one staff member carried an uncovered used commode basin down the corridor with one hand and she had a wet pad in the other, which showed that poor infection control measures were in place and that policies and procedures were not being followed in day – to – day practice. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 26 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 adequate This judgement has been made using available evidence including a visit to this service. The staff team was not always meeting the assessed needs of people living at the home. More staff could have been appropriately trained so that they were all competent to do the job expected of them and the recruitment practices adopted by the home were not robust enough to safeguard those living there. EVIDENCE: The home’s self-assessment showed that the skill mix of staff employed by the home was meeting residents’ needs. The Statement of Purpose told people that the staffing levels at the home were calculated in accordance with the assessed needs of those living at Preston Private. However, at the time of this visit to the service we found that the assessed needs of people were not always being met. Staff spoken to told us that they sometimes struggled with the workload and that there were not always enough staff on duty to meet everyone’s needs. Two residents spoken to also felt that there were not enough staff on duty to meet their individual needs and this was confirmed during our visit to the service. One member of staff told us that staffing levels were generally okay but that they could always do with more. We spoke with a visiting healthcare professional who indicated that the staff seem to always be under pressure and that she can’t always find staff when visiting the unit. She has been told on many occasions by people living at the Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 27 home that they ring the buzzers for help but staff are generally a long time in coming, if they come at all. One member of staff felt that the management should be more selective about who is admitted to the home. Some very dependant people are admitted and there isn’t the manpower to care for these people adequately. As the numbers of people living at the home have fallen then the number of staff have also been reduced, through natural wastage and some who have had their employment terminated. We spoke with two ancillary staff, who told us that there had been reductions in domestic hours, but that this was being addressed. However, it was noted that currently there was only one cleaner for the whole home at the weekend, which we considered to be inadequate, taking into consideration the size of the home and the needs of the people living there. We were told that, ‘When things get sorted out, there should be one cleaner for each unit at weekend’. However, we were still concerned about what evening and weekend domestic cover was organised by the company, to ensure that acceptable standards of hygiene are maintained. One of the nursing staff confirmed that there had been a reduction in domestic staff at the home, but felt that this was not having any impact on the standard of cleanliness of the unit in which they worked. Staff spoken to told us that there was no formal induction for new staff, although they are told basic things when they start. We were also told that there has been a reduction in staff over the past twelve months, particularly registered nurses, which sometimes makes the workload heavier and makes it more difficult to meet all the needs of people living at the home. Records seen did not show that a structured induction programme had been conducted for new staff to ensure that they were competent and confident to carry out their duties effectively. We spoke to a member of staff who thought that her recruitment process had been conducted in a thorough manner. We examined a high percentage of staff files, which were found to be very disorganised, with some paperwork being duplicated and some documents not being available to show that the recruitment practices adequately protected those living at the home. However, the home had obtained Criminal Record Bureau disclosures for those working at Preston Private, before employment commenced to ensure that they were fit to work with the vulnerable people living at the home. The company had not taken up authentic references in respect of those people recruited from overseas, but had accepted references, which the employees had brought with them from their country of origin. The home had not routinely verified the registration status of qualified nurses registered with their professional body to ensure that they were eligible to Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 28 practice. There were no work permits on file for three people recruited from overseas to ensure that they were able to work in this country. One nurse spoken with told us that he thought there was a problem with communication for some staff and that some could speak very little English. One resident told us that staff working at the home did not always fully understand what she says, but said staff are very kind and caring and that she could not fault them in that respect. Another relative said that staff were lovely and had been particularly attentive to her mother when she wasn’t well. She told us that her mother really enjoys the company of staff, although she does sometimes struggle to understand what they are saying, adding, ‘This is sometimes because of their strong accents’. The home’s self assessment told us that staff recruited from overseas attend English classes to improve their language skills and this was confirmed by the staff themselves, which was considered to be good practice in order to promote communication between residents and staff. Staff spoken with indicated they were completing a recognised qualification, had enjoyed it and spoke of how it had improved their care practices. The self assessment told us that there were thirty five care staff working at the home, of which twenty three percent had achieved this qualification in care and a training matrix was in place showing that staff were provided with core training as needed so that they could look after the people in their care. One member of staff told us what training she had done, which covered a wide range of topics, including all the core subjects. We spoke with two ancillary staff members about training, who confirmed that they had done basic training, but had not done any recognised qualifications, although they were able to speak about respecting privacy and dignity of those living at the home by knocking on room doors before entering. However, it would be useful for ancillary staff to be also included in recognised training programmes in relation to their role. Staff spoken to were aware of the assessed care needs of the people they were looking after. One member of staff felt that the care plans were better but they were clearly very new and she was struggling to find the right section to show us information. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 29 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is not always managed in the best interests of the people living there and their health, safety and welfare is not always protected. EVIDENCE: The manager of the home had only recently been appointed to the position, although she has worked at Preston Private Nursing Home for many years. Therefore, she is not yet registered with the Commission for Social Care Inspection. We spoke to a lot of staff about the management of the home. One person said that senior staff, particularly the nurse in charge, are very supportive and will answer questions and give information, as is needed. Another person working at the home felt that it was ridiculous that there was no receptionist for a Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 30 home of such a size and that the manager ends up accepting deliveries and dealing with enquiries when she could be using her time more effectively. A range of audits had been conducted, including an audit of accidents occurring in the home, from which an analysis was produced, but there was no evidence available to show that this information was used to prevent future accidents. One resident had fallen two weeks before our visit, but this had not been documented in the accident record. The manager told us that staff had been informed that all accidents must be recorded. The accident book was not being retained in line with data protection to ensure that confidential information was not disclosed. Personal allowance records and monies held on behalf of residents were examined and found to be accurate. A variety of environmental risk assessments and risks related to residents had been conducted, but some of the latter had not been dated, so it was not possible to determine when they had been implemented. Infection control policies and procedures were in place, but these were not being followed in day-to-day practice to ensure that adequate precautions were being taken. The infection control nurse was due to visit the home to provide some updated training for staff because of the recent lack of protective clothing and necessary equipment. A programme of routine maintenance was not in place, although ongoing decoration was evident and a range of internal checks were conducted and recorded to ensure that systems and equipment within the home were in good working order. The self-assessment told us that systems and equipment were serviced at regular intervals by outside contractors to protect the health and safety of both residents and staff. The manager told us that surveys had not been conducted recently so that people involved with the care of those living at Preston Private could express their views about the quality of service provided. She also said that there was no annual development plan for the home so that forward planning could be identified. Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 31 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 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 13 14 15 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 2 3 3 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 X 3 X X 2 Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 33 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 All residents or their relatives must be given the opportunity to be involved in the care planning process. The plans of care must be accurate and must include all assessed needs, providing clear guidance for staff as to how these needs are to be fully met. Staff must be fully aware of the assessed needs of those in their care. Previous timescales of 30/09/07, 01/04/08 and 29/05/08 not met. 2 OP8 12(1)(a) The health care needs of people living at the home must be consistently met, including appropriate pressure care, good oral hygiene and adequate fluid and dietary intake. External professional advice should be sought, as required for people living at the home, including those who have a significant weight loss, so that their health care needs can be met. Residents must be able to receive, where necessary, treatment, advice and other services from any health care DS0000006073.V362795.R01.S.doc Timescale for action 31/07/08 30/06/08 3 OP8 13 (1)(b) 30/06/08 4 OP8 13(1)(b) 31/07/08 Preston Private Nursing Home Version 5.2 Page 34 professional, including advice from a General Practitioner, to ensure that all health care needs are fully met. Previous timescale of 20/05/08 not met. 5 OP9 13(2) Medication records must be accurate to show that medicines are given as prescribed and can be accounted for at all times. Medicines must be given as prescribed and changes to medication must be accurately recorded and implemented promptly so that residents receive safe and effective treatment. This was to have been met by 01/04/08 7 OP9 13(2) Ordering procedures must be reviewed so that medicines never run out and residents are able to receive the treatment they need. This was to have been met by 01/04/08 8 OP9 18(1) Staff must be regularly assessed as competent in medicines handling and must receive training if necessary to ensure that medication is administered to residents safely. This was to have been met by 01/04/08 9 OP12 12(1)(b) Proper provision must be made for the supervision of residents, such as in the lounge areas, to minimise the risk of injury. DS0000006073.V362795.R01.S.doc 15/07/08 6 OP9 13(2) 15/07/08 15/07/08 15/07/08 30/06/08 Preston Private Nursing Home Version 5.2 Page 35 10 OP19 13(1)(c) Any unnecessary risks to the health and safety of people living at the home must be identified and so far as possible eliminated, including the security of the premises. Infection control measures adopted by the home must be consistently maintained to ensure that people living there are adequately protected. The recruitment procedure must be thorough enough to safeguard people living at the home, including: the home obtaining authentic references for prospective employees, work permits being obtained for staff employed from overseas and registered nurses being verified by the Nursing and Midwifery Council as being eligible to practice. An accurate record of all accidents, which involve residents, must be maintained in line with data protection guidelines, including accidents involving residents falling. Previous timescale of 20/05/08 not met. 31/07/08 11 OP26 16(2)(j) 30/06/08 12 OP29 19(4) (a)(b)(c) 30/06/08 13 OP38 17(1) Schedule 3 31/07/08 Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 36 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 Refer to Standard OP3 OP7 Good Practice Recommendations All documentation for each resident should be fully completed. Vague statements and conflicting advice should be avoided within the care records and the plans of care should be followed in day - to - day practices to ensure consistency in care and to make sure that all assessed needs are being met. Care plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. The wishes and feelings of residents should be taken into consideration so that their dignity is consistently protected, including providing personal care in private areas of the home. Everyone admitted to the home should be given the same opportunities, including those who are from a different culture and who are unable to easily speak the English language, so that equality and diversity is promoted within the home. Staff communication with residents should be improved so that a comfortable, relaxed environment is promoted. Staff should keep relatives of residents informed of important events affecting their well-being, such as hospital appointments and personal mail should be passed onto people as soon as is practicable. When residents show agitated behaviour some form of diversional therapy should be offered so that all their needs are being met. The diverse needs of people should be taken into consideration before admitting someone to the home who is unable to speak the English language sufficiently enough DS0000006073.V362795.R01.S.doc Version 5.2 Page 37 3 OP9 4 OP10 5 OP12 6 7 OP12 OP12 8 OP12 9 OP12 Preston Private Nursing Home 10 OP15 to communicate with staff and other residents. Staff should ensure that people living at the home are made aware that they are able to have alternatives to the menu, if they so wish and they should be routinely offered a choice of meal, so that they can make some decisions about the food they eat. It should be determined if people prefer smaller meal portions so as not to over face them and therefore promote their dietary intake. The diverse needs of people should be taken into consideration before admitting someone to the home who requires a special diet that cannot be prepared by the home. It is recommended that staff sit appropriately with people when assisting them with their meals in order to promote dignity. The plastic beakers in the satellite kitchens need to be thoroughly cleaned or replaced in order to maintain good hygiene standards. Complaints should be better managed by ensuring that all complaints received are recorded and investigated thoroughly with a clear outcome, so that a structured audit trail can be easily followed. The following items need attention: • 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. • A showerhead in one shower cubicle on Fernyhalgh unit was missing. A toilet seat on Durton unit was dirty and in need of a thorough clean in order to promote cleanliness within the home. Consideration should be given to the refurbishment of the satellite kitchens, bathrooms and toilets within each house in order to enhance the environment and to protect the safety of people using these areas. The bedrooms on Fernyhalgh unit should be made more personalised and brightened up to improve the accommodation for the people living in it. Some areas of the home were looking ‘tired’ and ‘worn’ and in need of decoration. It is suggested that a full audit of the premises is conducted and areas needing freshening DS0000006073.V362795.R01.S.doc Version 5.2 Page 38 11 OP15 12 OP15 13 OP15 14 OP16 15 OP19 16 OP19 17 OP19 18 OP19 Preston Private Nursing Home 19 OP27 up are prioritised. It is recommended that staffing levels be reviewed to ensure that there are always sufficient numbers of staff on duty, with relevant experience and qualifications, so that all the assessed needs of people living at the home are fully and appropriately met. It is recommended that domestic staff input be reviewed and organised so that there are sufficient numbers of domestic staff to ensure that hygiene standards and the cleanliness of the home can be constantly maintained. The language skills of people working at the home should be assessed and where necessary extra learning provided in order to improve the communication between staff and residents. Care staff need to continue to undergo National Vocational Qualifications so that at least 50 achieve this award. It is recommended that ancillary staff also be enabled to achieve a National Vocational Award specific to their role. Staff files should be more organised so that a clear audit trail can be carried out in order to ensure all documents required are in place. All new employees should receive a formal and structured employment period so that they are aware of what is expected of them and so that they are able to deliver the care required by the people living at the home. Systems and processes adopted by the home should be reviewed to allow the manager sufficient time to effectively operate the service in the best interests for the people living there. The system in place for monitoring the quality of service provided should be improved, so that the management of the home is able to determine if the service is meeting goals for the people living there. This monitoring should include obtaining the views of residents, relatives, staff and stakeholders in the community, the results of which should be published. Minutes of staff meetings, residents and relatives meetings should be retained. Audits should be extended so that strategies are put in place dependant on the results of the audits. Risk assessments should be dated so that people can identify when they have been conducted and so that effective reviews can take place. 20 OP27 21 OP27 22 OP28 23 24 OP29 OP30 25 OP31 26 OP33 27 OP33 Preston Private Nursing Home DS0000006073.V362795.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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.V362795.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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