Inspection on 05/01/06 for Preston Towers

This inspection was carried out on 5th January 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 15/06/06

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 Unannounced Inspection 5th January 2006 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 Towers DS0000065402.V275872.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.V275872.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.V275872.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 16th September 2005 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. Preston Towers DS0000065402.V275872.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over three visits by two inspectors for a total period of 9 hours. It is the second unannounced inspection the home has had in this year. All of the core standards have been examined over the two inspections. It is therefore suggested that both reports are looked at to get the full picture of the home. Twelve residents and six staff were spoken to directly although more were chatted to briefly. Two relatives were also spoken to. Four care plans, records for medication, staff files and health and safety records were examined. There were ten requirements identified during the last inspection three of which have been fully met. During this inspection eight requirements have been made and one recommendation. Some of the requirements have remained outstanding however some have been adjusted to reflect the work that has been carried out. What the service does well: What has improved since the last inspection? The use of shared personal items such as toiletries and netelast knickers has ceased. All of the areas on which requirements were made at the last inspection have been improved however ongoing improvements must be made for them to meet the required minimum standards. Preston Towers DS0000065402.V275872.R01.S.doc Version 5.1 Page 6 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.V275872.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.V275872.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): Standard 3 was examined at the last inspection and was met. The home is not registered for and therefore does not provide intermediate care. EVIDENCE: Preston Towers DS0000065402.V275872.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, 9, Standards eight and ten were inspected at the last inspected and were met. Standards 7 and 9 were inspected at the last inspection and requirements were made. Although some improvements have been made to the care plans there is still work required to bring them up to the required standard. The medicines were being managed more effectively, however further improvements are necessary and the treatment room must be tidied, rearranged and all unused items removed. EVIDENCE: The care plans examined have been improved and there is evidence that additional information has been added to ensure that the residents changing needs are identified. However not all of the care plans seen were up to date and had the reviews carried out as planned. There are policies and procedures available for safe receipt, recording, storage, handling, disposal and administration of medicines. These were not being fully followed. The treatment room and medicine store cupboards were untidy, disorganised and although they had been cleaned changes to the room are Preston Towers DS0000065402.V275872.R01.S.doc Version 5.1 Page 10 required to ensure that adequate cleaning can continue. Controlled Drugs were examined and are now being recorded effectively. Medications received are recorded on the Medication Administration Records, and medicines for disposal are now also being recorded. The administration of medicine practice continues to require improvement and confirmation of the contract with a nominated waste management supplier must be provided to the CSCI. During a meeting with the Manager and Proprietor the training of senior care staff to safely administer medicines to those residents not receiving nursing care from the home was discussed. Evidence of the training to be provided and the support be given to the staff for them to undertake the role should be sent to the CSCI. Preston Towers DS0000065402.V275872.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): 14, 15 Standards 12 and 13 were examined at the last inspection and were met. Residents are supported to take part in a variety of social activities and this is offered one to one or group basis. However they are still not made aware of the social activities being offered it is difficult for them to make informed choices regarding participation. The home was not able to demonstrate that it offers the residents choice in their diet. EVIDENCE: Although menu’s are available not make known to residents and staff were not able to inform of what was to be served on a daily basis. During the first visit it was noted that kitchen staff were not available for the evening meal making it necessary for care staff to spend time in the kitchen. This was discussed during the meeting with the Proprietor and Manager and an adjustment to the ancillary staffing rota was planned to address this issue. The home has benefited from an activities organiser who takes responsibility for arranging activities to meet individual residents needs who has now left her employment the Manager reported that she is hopeful that a replacement has been found. Most activities take place on a one to one basis or as a group Preston Towers DS0000065402.V275872.R01.S.doc Version 5.1 Page 12 within the home. 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. Currently residents do not receive up to date information about leisure or social events happening in the home. Relatives spoken to during the visit confirmed that they were encouraged to visit and felt welcomed by the staff. The home 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. This did now promote the meals as a positive period of the day although it may be a very important issue for the residents. Hot drinks were offered at midmorning, and the residents are given a biscuit 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.V275872.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): Standards 16 & 18 were examined at the last inspection and were met. EVIDENCE: Preston Towers DS0000065402.V275872.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, 23, 26 The home is generally clean, tidy and free from unpleasant odours. The décor is in keeping with the style of the building and the communal rooms are spacious with good natural light. The bedrooms are personalised and comfortable and although a planned refurbishment programme should be undertaken as planned. However control of infection practices remain unsatisfactory and the action plan developed following the audit must be undertaken to ensure that improvement is made. 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. 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.V275872.R01.S.doc Version 5.1 Page 15 During the first visit the electricity failed on the ground floor and it was reported that this was a common occurrence, the heating also failed for a period resulting in additional heaters being required for particular areas of the home. The random temperature recordings were provided as required and were satisfactory however the risk of this re-occurring must be determined and appropriate remedial action taken to address any long-term problems. Carole Rutter the Communicable Disease Nurse carried out a very detailed and extensive audit, and a full report was provided at the last inspection visit. The audit suggested a large number of very serious problems including both practice and environment. The action plan to address the issues raised must be developed and undertaken as a matter of urgency and staff training must be provided to support the improvements in practice. There are three sluice rooms in the home only one of which has a disinfector and the plan to provide one for each floor should be followed as part of the control of infection plan. Domestic staff should be provided with uniforms in line with control of infection practices and it is advisable that care staff are encouraged to change into their own clothes after their work and into uniform in the home prior to starting work. Preston Towers DS0000065402.V275872.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 The home did not have adequate qualified nurses and care staff employed to allow them to cover the rota within their normal working hours. Measures have been taken to address this, there effectiveness will be assessed at a follow up visit. The allocation of ancillary staff was not in line with the needs of the home resulting in care staff spending time in preparing meals for the teatime meal. EVIDENCE: At the first visit it was noted that the home does not have enough permanent nursing staff employed to fill the staffing rota this is resulting in the nurses working additional hours to cover the shortfall. Also the home is not using agency cover in sufficient numbers to assist with this. The staffing rotas show that there is a lot of late reporting of sickness by staff resulting in the inability to cover shifts adequately. On meeting with the Proprietor it was confirmed that two additional qualified nurses had been appointed although their final checks were awaited before they could receive their induction and commence work in the home. Also two care staff are being recruited. Preston Towers DS0000065402.V275872.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, 38 Although the Manager has worked in the home for some time and she is experienced in care home management there are concerns that some of the issues raised should have been addressed by the Manager as part of the Quality Assurance process and as part of her Management systems. The new proprietor is fully involved in making the changes necessary to improve the service. The failure to allocate domestic and catering staff at the necessary periods of the day suggests that staff deployment was not primarily to meet the needs of the residents. Water temperatures are being monitored however action is not being taken to ensure that the water being provided at the high risk resident area are being regulated to the required 43 degree centigrade. Preston Towers DS0000065402.V275872.R01.S.doc Version 5.1 Page 18 EVIDENCE: It was noted that some of the recent problems in the home and a number of the requirements identified during the inspection process could and should have been picked up as part of the routine quality assurance process through regular audits of the care, documentation and environment. As a result of the concerns raised in this and the previous inspection the inspectors met with the proprietor to discuss the concerns. He was able to identify immediate action necessary and begin planning the improvements for the less urgent but important requirements. It is acknowledged that some of these issues may have occurred due to recent staff shortages and staff being over-pressured to cover the staffing rota resulting in a failure to keep up to date with routine tasks and completion of documentation. There are also instances where some of the recent problems should have had strategies in place to minimise the disruption to the home. An example of this is a recent failure of a washing machine, which resulted in the manager taking home washing when this should have been done in a more appropriate way through contracts with a laundry services. The water temperature monitoring and recording is now being carried out, however where they are recording temperatures in excess of 43 degree centigrade in high risk / patient access areas no action is being taken to regulate it. Preston Towers DS0000065402.V275872.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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Preston Towers DS0000065402.V275872.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 Timescale for action 30/03/06 2. OP9 13 (2) 3. OP14 16 (2) n 4. OP15 16 The care plans must be detailed, reviewed regularly and updated when residents needs change. Outstanding The administration and recording 30/03/06 of medicines must be undertaken to the required standard. • Confirmation of a waste management supplier must be provided. • 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 30/03/06 information regarding the social activities being offered in the home. The home must provide the 30/03/06 residents with a balanced diet in sufficient quantity and quality in both food and fluids to meet their needs. The menus must be made available for both resident’s and staff to view. DS0000065402.V275872.R01.S.doc Version 5.1 Preston Towers Page 21 5. OP19 16, 23 6. OP27 18 (1) (a) 7. OP31 23 & 24 7. OP26 13 (3) 8. OP38 13 (6) The home must provide the CSCI with an updated refurbishment programme identifying priorities and time scales. Including: • Lounge chairs • Dining chairs with arms and skids. • Bedroom furniture • Bedroom and communal areas carpeting as necessary • Heating to be adequate in all areas of the home • The Electricity systems to be examined and remedial action taken to ensure continues unbroken supply Outstanding Adequate care and ancillary staff must be provided in adequate numbers and at such times to ensure that the residents are safe and well cared for. The Registered Manager must put into place audit programmes and risk assessments and strategies to deal with untoward occurrences. 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: • Provision of laundry equipment • Provision of the additional hot wash sterilisers • Hand-washing facilities as necessary as per audit • Effective cleaning of equipment & environment • Staff training. • Domestic staff provided at necessary times in the day • Ongoing audits The home must have in place a system for taking appropriate DS0000065402.V275872.R01.S.doc 01/07/06 30/04/06 01/06/06 01/08/06 01/04/06 Preston Towers Version 5.1 Page 22 action when water temperatures in resident areas require adjustment. Outstanding RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations It is recommended that the home that the home recruit an activities co-coordinator. Preston Towers DS0000065402.V275872.R01.S.doc Version 5.1 Page 23 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.V275872.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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