Inspection on 15/06/06 for Preston Towers

This inspection was carried out on 15th June 2006.

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 Towers 19/11/08

Preston Towers 29/01/08

Preston Towers 22/01/07

Preston Towers 05/01/06

Preston Towers 16/09/05

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

CARE HOMES FOR OLDER PEOPLE Preston Towers Preston Road North Shields Tyne & Wear NE29 9JU Lead Inspector Suzanne McKean Key Unannounced Inspection 09:30 15th June 2006 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 Towers DS0000065402.V288940.R01.S.doc Version 5.1 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 Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Preston Towers Address Preston Road North Shields Tyne & Wear NE29 9JU 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) 0191 259 1828 0191 259 1828 Moorlands Care Homes (N.E.) Limited Mrs M Eeles Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (2) of places Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 25 residents receiving nursing care 28 residents receive personal care CSCI must be notified when either of the service users in the PD category no longer reside in the home Date of last inspection Brief Description of the Service: Preston Towers is a converted for use detached building set back from the main road in North Shields. The home is located within walking distance of local amenities. To the front of the building there are extensive lawns and garden areas and ample care parking is provided. The home has retained many original features such as mosaic-tiled floors in the hallway and high ceilings with original covings. Preston Towers is registered to provide personal and nursing care for up to fifty-three older persons. The current scale of charges is £356 per week. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection and took place over one day and involved two inspectors. Residents care records, staff rota, recruitment/training files plus additional statutory records were examined. The inspectors had informal and formal discussion with the manager, deputy, two staff, and three ancillary staff. Twelve residents and four relative were spoken to during the visit, six resident and one relative questionnaire was received prior to the inspection. There were nine requirements identified during the last inspection three of which have been fully met. Some of the requirements have remained outstanding however some have been adjusted to reflect the work that has been carried out. There have been additional requirements due to the areas looked at during this inspection. In total there are nine requirements and two recommendations from this inspection. What the service does well: What has improved since the last inspection? Individual care plans have continued to improve. Staff were more involved in planning and evaluating care and the plans this helps staff give residents the care they need. The resident in their questionnaires were positive about the service they received samples of their comments were “there is always someone there to listen and help” and “very good nursing staff, and good help form carers”. Staff and residents said that the improved deployment of ancillary staff had given care staff more time to meet the needs of residents. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 6 Meals are varied, well balanced and nicely presented offering good choice and nutritious food at all meals. All of the residents spoken to were pleased with the improvements to the quality and choice available. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 7 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 Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6 (intermediate care is not provided) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory pre-admission assessments are undertaken but this is not always reflected in the care plan. (See standard 7) EVIDENCE: The staff undertake detailed pre admission assessment and liaises with the residents and family prior to admission. Care plans had good information to ensure that the home can meet the needs of the prospective resident. The Manager is involved in the decisions and in the majority of instances visits the residents herself prior to their admission. Pre admission assessments are obtained from other professionals such as social workers, psychiatrists and health. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and social care needs of service users are being met but the records that support this care must improve. Medicines are managed effectively and residents receive their medication safely as prescribed and in line with safe practice guidance. The treatment room still requires some work to bring it up to the necessary standard. Residents feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Eight care plans were examined, they were inconsistent in the amount of information recorded. Assessment tools such as pressure care, nutrition, moving and handling, mental health and dependency were not completed consistently. Care plans are based on activities of daily living but not all the needs are identified for example social care plans. Periodic evaluations are Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 10 inconsistent. There is little evidence to suggest the ways in which residents are supported to make choices in their day-to-day lives. Contact with social and health professionals is good and staff were observed liaising with a number of professional visitors throughout the day. Residents have access to GP, Physiotherapist, Speech Therapist and Chiropodist. Residents said both on discussion and in questionnaires that the staff treat them with respect. During the visit staff were assisting the residents in an appropriate way and there were pleasant conversations between residents and staff throughout the day. There are policies and procedures available for safe receipt, recording, storage, handling, disposal and administration of medicines. These were being followed. The treatment room and medicine store cupboards were tidy, and more organised than at the last inspection although changes to the room are still required to ensure that adequate cleaning can be carried out. Controlled Drugs were examined were being recorded effectively. Medications receipt administration and disposal are recorded effectively. Medicines for disposal are now being removed using a nominated waste management supplier. The training of senior care staff to safely administer medicines is not yet complete. This will be to allow them to administer medicines to those residents not receiving nursing care. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s social needs are not being met fully and the home needs to address this, they maintain contact with family/friends/representatives and the local community as they wish. Residents are helped to exercise choice and control over their lives but this is not evidenced in care plans. Residents receive a wholesome appealing balanced diet. EVIDENCE: The home does not yet have an activities organiser in post. The activities are being provided by the care staff on an ad hoc basis and are not being recorded in the care plans. During the inspection visits there was little activity going on apart from residents sitting watching television or entertaining themselves in their own bedrooms or the lounge areas. The residents do not receive up to date information about leisure or social events happening in the home. From the six returned questionnaires when asked “are there any activities arranged by the home that you can take part in”, one did not wish to take part in any, 2 said there was usually enough, 1 said there always was, 1 said never enough Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 12 and one said sometimes enough. This suggests that the home should focus on resident choices when planning activities in the home and document the outcomes in the care plans along with the social assessment. Relatives spoken to during the visit confirmed that they were encouraged to visit and felt welcomed by the staff. The home still does not have the menu displayed very visibly although one was hanging at the entrance and a copy was provided on request. Residents are asked for their choice for lunch and tea daily, which is recorded and given to the kitchen staff. The food being served on the day was enjoyed by the residents who were complementary about it one said, “the food is nice”. Hot drinks were offered at midmorning, and the residents are given a biscuit, cake or fruit at this time. The staff confirmed that they do have biscuits mid afternoon and sometimes-fresh fruit is available. There was an ample supply of fresh frozen dried and tinned food. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are managed satisfactorily and the necessary action taken. The records of complaints and Protection of Vulnerable Adults referrals are kept to ensure that audits can be carried out. EVIDENCE: The home has a complaints policy and staff are clear about the procedure to deal with complaints, which is available in a number of places in the home. Residents and visitors said that they knew who to talk to if they were unhappy and had confidence that these would be dealt with, although in one instance some issues raised had not yet been resolved. The Registered Manager stated that all staff were aware of the whistle blowing policy and informing the Manager of any incidents or issues of which there are concern. Staff confirmed this. It was unclear from the training records which staff had completed Protection of Vulnerable Adults training. The complaint record was examined. There have been six complaints made since the last key inspection five of which were upheld, and one partially upheld. During the inspection a concern was raised by a relative, which is to be dealt with through the complaints process. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The residents do not live in a fully safe and well-decorated environment. There are good communal areas. There are suitable toilets and baths although not all of these are in use. The bedroom areas are personalised and comfortable. The home is clean and odour free. EVIDENCE: The home was generally clean, tidy and free from offensive odours. There are two lounges and one dining room on the ground floor. One lounge is a designated smoking area. Upstairs is a lounge with glass roof and residents can choose to have their meals there although this is very hot in the summer and is not used. All communal areas were generally clean and tidy, although some areas are now looking tired and worn and would benefit from a planned refurbishment programme. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 15 The corridor carpets on the first and second floor must be replaced; an immediate requirement was issued in respect of the second floor, which now has rucks in it making it a trip hazard. Although bedrooms are personalised and are kept clean there is a need for replacement of the majority of the bedroom furniture, which is now worn and damaged. Two of the bedrooms now have new carpets and all of the others now need replacement. This must be undertaken on redecoration of the rooms. An audit of those bedrooms of highest priority must be completed and sent to the Commission for Social Care Inspection. Carole Rutter the Communicable Disease Nurse carried out a very detailed and extensive audit, and a full report was provided to the home. The home has been working toward meeting the identified requirements. She will be revisiting the home in the near future to re-audit and the outcome will be monitored by Commission for Social Care Inspection. The requirement will therefore stay in place until then. There are three sluice rooms in the home two of which now has a disinfector. Domestic staff are now provided with uniforms in line with control of infection practices. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager ensures there are adequate numbers of staff on duty that have appropriate skills and experience to care for the residents. The recruitment processes in place protect residents. External and internal training takes place but there are insufficient records to clarify which staff have received training. EVIDENCE: Staffing rota and observation during the day indicated that the home is well staffed. During the visit the Manager was on duty and there were two Registered Nurses and five carers on duty (one of which was a senior carer). The home also had on duty a bed maker so that care staff could spend more time with residents. There is now good ancillary support. Three staff recruitment files, across all grades, were inspected and were satisfactory including application forms, references and CRB checks. There is a system in place to ensure that the qualified nurses are maintaining their NMC registration. Training files examined did not clearly detail what training staff had completed for induction, foundation, mandatory and NVQ training. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Quality systems are being established and developed but are not yet adequate to show that the resident’s needs and wishes are taken into account in the operation of the home or that there is a robust quality assurance system in place. Resident’s financial interests are safeguarded. Staff are not appropriately supervised. EVIDENCE: It was noted during the last inspection that some of the problems in the home and a number of the requirements identified during the inspection process should have been picked up as part of the routine quality assurance process Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 18 through regular audits of the care, documentation and environment. The manager is beginning to put into place audit programmes and has started to use resident questionnaires to make improvements. This is in the early stages and will be viewed at the next inspection to assess the progress. Residents personal allowance records were examined and were being completed appropriately. Signatures are recorded for purchases made and there is good recording of their balances with personal accounts in place as necessary. The Manager is not up to date with staff supervision although the annual programme has begun. She is planning to delegate some of the supervision to senior staff and has a plan in place for them to be brought up to date. The lack of detailed training records make it impossible to ensure that adequate health and safety training is being provided (moving and handling etc) see previous training standards. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 20 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 Requirement Care plans must be detailed, reviewed monthly and updated when the residents needs change. Outstanding The treatment room must be made fit for purpose. Information of the training and role and support of senior care staff administering medication must be provided to CSCI. Outstanding Residents must be given the information regarding the social activities being offered in the home. The resident care plans must reflect residents social care needs, choices and activities they have taken part in and their enjoyment. The home undertake a refurbishment programme Including: • Lounge chairs • Dining chairs with arms and skids. • Bedroom furniture • Bedroom carpets (except 2 as identified) • Corridor carpets DS0000065402.V288940.R01.S.doc Timescale for action 01/10/06 2. OP9 13 (2) 01/10/06 3. OP14 16 (2) n 01/09/06 4. OP19 16, 23 01/10/06 Preston Towers Version 5.1 Page 21 5. OP26 13 (3) 6. OP30 18 7. OP33 23 & 24 8. 9. OP36 OP38 18 (2) 18, 13 Outstanding The home must undertake the improvements as identified in the Control of Infection audit. A detailed action plan to address the issues must be provided including: • Hand-washing facilities • Effective cleaning of equipment & environment • Staff training • Audits The training records must be provided to show that staff are receiving adequate statutory and clinical training. The Registered Manager must put into place audit programmes and risk assessments and strategies to deal with untoward occurrences. Staff must receive adequate supervision at the necessary frequency. The Manager must ensure health and safety issues are addressed including training, health and safety audits (see standard 19). 01/08/06 01/10/06 01/09/06 01/09/06 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP19 Good Practice Recommendations It is recommended that the home that the home recruit an activities co-coordinator. It is recommended that the Proprietor look at putting in shading to make the glass roofed lounge on the first floor usable in warm weather. Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Preston Towers DS0000065402.V288940.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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