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Inspection on 12/12/06 for Prestwood (Coach House) Nursing Home

Also see our care home review for Prestwood (Coach House) Nursing Home for more information

This inspection was carried out on 12th December 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Six service users were interviewed during the process of the inspection, all of who were very complimentary with regards to the quality of care provided. The following comments were used to describe the staff: "They serve us well." "Nice and friendly." "The staff are marvellous." "Happy with the staff, they are nice." Staff were observed to interact with service users in a professional manner and communicated in a mode suitable to the individual. A friendly and warm atmosphere was present; the cleanliness of the home was of a high standard. All bedrooms were pleasantly decorated and reflected the individuals interest and character.

What has improved since the last inspection?

Three out of six requirements identified in the previous inspection report had been addressed. The Registered Manager confirmed that the worn enamel bath had now been repaired. A sample signature list of permanent and agency staff, that were authorised to administer medication was in place but was required to be reviewed to ensure that information was up to date. The previous inspection report identified that receipts should be maintained for financial transitions of service users monies. The Registered Manager informed the Inspector that the home no longer managed service users financial affairs.

What the care home could do better:

During the inspection of the premises a number of radiators were very hot to the touch. It has been identified as a requirement that radiators accessible to service users should be guarded to protect them from hot surfaces. The homes medication system was not robust with regards to the storage of medicines. The homes complaint policy was not accessible to service users. The home did not have a laundry or an appropriate sluicing facility, clothes and linen were laundered at Prestwood Main House, which was situated within the same grounds. In the interest of infection control this system was not suitable.

CARE HOMES FOR OLDER PEOPLE Prestwood (Coach House) Nursing Home Coach House Prestwood Stourbridge West Midlands DY7 5AL Lead Inspector Dawn Dillion Key Unannounced Inspection 12 December 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Prestwood (Coach House) Nursing Home DS0000022362.V318252.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. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prestwood (Coach House) Nursing Home Address Coach House Prestwood Stourbridge West Midlands DY7 5AL 01384 877111 01384 877900 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) Completelink Limited Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40), Physical disability of places over 65 years of age (40) Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. OP Minimum age 60 years PD Minimum age 60 years Date of last inspection 2 November 2005 Brief Description of the Service: Prestwood Coach House is a registered care home that provides residential and nursing care for older people, the home is also registered to provide a service for individuals who have a physical disability. The home is located in Stourbridge, Staffordshire off the main A449 near the village of Kinver. The two-storey property is set within its own grounds, some rooms having idyllic views of the surrounding countryside. The home is registered to offer accommodation for 40 service users, providing a combination of shared and single occupancy bedrooms, located on the ground and first floor level. En suite facilities are also provided. Toilets and bathrooms were located on both floors. The layout and design of the property facilitates service users who have a physical disability, having wide corridors and doorframes to commode wheelchair users. One lounge area and two dinning areas are provided, equipped with essential furnishings and items for comfort and relaxation. Staffing is provided on a 24-hour basis, to ensure the total support and supervision of service users. Service users have access to relevant healthcare services if and when required. The fee chargeable for the service at Prestwood Coach House is from £450.00p – £630.00p. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection of Prestwood Coach House was undertaken within 8 hours. The inspection methodologies that were used to gather information relating to the quality of care provided and the effectiveness of the management of the home, to promote quality, diversity and best practice involved the examination of the homes policies and procedures. Six service users were interviewed to establish their views and opinions, of the service provided and the level of support and guidance, offered to enable them to live a full and independent lifestyle with regards to their cultural and specific care needs. Three relatives were interviewed during the process of the inspection and also one relative whose mother was a former service user was also interviewed via telephone. Ten service users, six relatives and two General Practitioners comment cards were received, information contained within these cards have been incorporated within the contents of this report. Staff members were interviewed and a tour of the premises was also undertaken to ensure that the environment was safe and conducive in meeting the needs of the service user group. What the service does well: What has improved since the last inspection? Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 6 Three out of six requirements identified in the previous inspection report had been addressed. The Registered Manager confirmed that the worn enamel bath had now been repaired. A sample signature list of permanent and agency staff, that were authorised to administer medication was in place but was required to be reviewed to ensure that information was up to date. The previous inspection report identified that receipts should be maintained for financial transitions of service users monies. The Registered Manager informed the Inspector that the home no longer managed service users financial affairs. 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. The summary of this inspection report can be made available in other formats on request. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 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 Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were provided with essential information to enable them to establish whether the service provided at Prestwood Coach House would be suitable to meet their needs. EVIDENCE: Discussions with service users, relatives and the examination of three care plans confirmed that all prospective service users were subject to a pre admission assessment, prior to admission to the home. The Registered Manager informed the Inspector that a confirmation letter was routinely sent to prospective service users, in relation to the homes suitability to meet their assessed care needs. It as been identified has a Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 9 recommendation that a copy of the confirmation letter should be maintained on file. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement is based on the examination of care plans, risk assessments, discussions with service users, relatives and staff. There were some inconsistency with the review and monitoring of the delivery of care. The storage of medicines was not robust to ensure the safety of service users. Service users privacy was compromised. EVIDENCE: Three care plans were randomly selected for examination, information obtained from the pre admission assessment, provided the foundation for the development of the care plan and risk assessment. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 11 Care plans provided detailed information, relating to the care needs of the individual service user and the level of support, assistance and specialist equipments required to promote independence. There was no evidence of service user involvement in the development or review of care plans. A comprehensive wound care plan was in place for individuals suffer with pressure sores; records were maintained in relation to the current treatment and the healing process. Records also evidenced the intervention of a Tissue Viability Nurse and a positive emphasis focused on diet to promote healthy tissue growth. Risk assessments were in place for the individual service user, of which focused only on moving and handling, the use of bed guards and selfadministeration of medicines. One out of three care plans that was examined was partly out of date, the Inspector raised concerns that information maintained relating to continence/bowel movement for one service user, identified no bowel movement since 07/12/06. The Registered Nurse informed the Inspector that the information may not have been recorded and that they would review the situation the next day. The examination of one care plan identified that the last recorded bed bath was 14/12/06. The Registered Nurse confirmed that service users had a full wash every day and were offered a full bed bath once a week, which entailed having their hair washed. The Registered Nurse confirmed that this was the routine of the home. There was no emphasis focused on service user choice. Discussions with service users and information contained within the care plans confirmed that service users had access to relevant healthcare services and professionals for routine health screening. Information obtained from the pre inspection questionnaire and discussions with staff, confirmed that a number of service users within residence suffered with dementia. The home do not have a registration category for dementia care and staff that were spoken to, confirmed that they had not received training in dementia awareness. The Registered Manager is required to review the homes registration category and to ensure that staff receive the appropriate training, in relation to the care needs of the service user group. With reference to the homes medication system/practices, the monitored dosage system was used. The examination of the controlled drug cupboard, identified that it was secured to the wall with two screws, on physical examination of the cupboard, it was evident that it was not entirely secure. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 12 The Registered Manager should ensure that the controlled drugs cupboard is rag bolted to a solid wall as identified in the Misuse of Drugs (Safe Custody) Regulations 1973. A number of tubes of Daktacort cream were inappropriately stored on the shelf and should have been stored in the fridge. The Inspector raised concerns regarding the storage of Rectal Diazepam in the fridge, the manufactures instruction identified not to be stored above 25oC. As previously identified within the contents of the last inspection report, a signature list of staff authorised to administer medication was now in place, it as been identified has a recommendation that this list should be up-dated. There were no gaps identified on the medication mar sheet, the reasons for the non-administration of medicines were recorded. Discussions with two Registered Nurses confirmed that they had not received training relating to the safe handling of medicines and had not been ‘competency assessed.’ It as been identified has a recommendation that all staff who are responsible for the administration of medicines are ‘competency assessed.’ Interviews with service users confirmed that staff were very respectful of their privacy and informed the Inspector that their mail correspondence were delivered to them unopened. The locking device fitted to bedroom doors did not promote the total privacy of service users. The lock could be opened from the outside using a flat key. The Registered Nurse informed the Inspector that the nurse’s butch of keys did not include a flat key to operate the lock. Staff used a flat edge of any key to operate the locking device. The Registered Manager should ensure that an appropriate locking device as recommended by the Fire Safety Officer, is fitted to all bedroom doors as standard. A flat key should be obtained to ensure that staff have immediate access to bedrooms in the event of an emergency. The Inspection of the shared bedrooms identified that a privacy screen was provided. Privacy screening was required at the identified bathroom windows. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement is based on discussions with service users and relatives, the examination of information located on the activities board, observations during the process of the inspection and the examination of menus. There was a positive emphasis focused on social activities and pastimes to stimulate the individual service user. EVIDENCE: The daily routine appeared relaxed with service users having freedom of movement throughout the home. Service users confirmed that they were able to maintain contact with their family and friends who were welcome to visit the home at anytime. One service user informed the Inspector that he had access to the daily newspaper, if he wished and was also able to pursue his political interest if he wanted to. Service users that were interviewed confirmed that they were registered on the electoral roll. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 14 A board was located in the reception area identifying forthcoming events and activities for the festive season of which included a Christmas programme, weekly activities, Christmas party and music and movement. A number of service users also engaged in watercolour painting of which, were on display in the home. One service user informed the Inspector that there was “always something going on.” There was no evidence of service users meetings and it as been identified has a recommendation within the contents of this report that consideration should be given in establishing meetings with service users. There was very little emphasis focused on diversity in relation to the individuals’ religious of cultural needs. The home operated a four weekly menu; meals offered were varied and well balanced to meet the nutritional needs of the individual service user. An alternative choice was also provided to reflect the likes and dislike of service users. Care Plans incorporated a nutritional assessment and also identified service users who were suffering with pressures sores, requiring a high protein diet. Care plans also identified the necessary specialist equipment and adaptations to promote service users independence with eating and drinking. Service users that were interviewed confirmed that the quality and quantity of the meals provided was good. Discussions with the Cook confirmed his knowledge of specific service users dietary requirements. Ample fresh fruit and vegetables were in storage. The handle of the chest freezer was missing, making it difficult to gain access; the Registered Manager should ensure that this is replaced. Information located on the fire blanket and powder extinguisher located in the kitchen, identified that they had not been checked/serviced since December 2004. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 15 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 is based on the examination of information relating to the homes complaints procedure and files pertaining to staff working within the home. Systems in operation did not ensure that service users were able to make a complaint. The homes recruitment and selection process ensured that the appropriate checks were undertaken to ensure the protection of service users. EVIDENCE: The complaints policy was not accessible to service users, on the day of the inspection, staff on duty did not know where the complaints policy was located. Information relating to the complaints procedure was located within the Service Users Guide. The Registered Manager informed the Inspector that every bedroom had a copy of the Service User Guide. The Inspector did not observe this. Information contained within the Service User Guide relating to the complaints procedure should be reviewed to identify the timescale of when complaints will be addressed. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 16 Service users that were interviewed were not aware of the homes complaint procedure but informed the Inspector that they would share their concerns with a staff member. The Registered Manager should ensure that all service users are in receipt of a copy of the homes complaints procedure. The home had received one complaint within the last twelve months, the Commission For Social Care Inspection was aware of this. Three files pertaining to staff working within the home were examined, all evidenced the undertaking of relevant safety checks, to ensure the protection of service users. On the day of the inspection the Registered Manager was delivering Adult Abuse training to a number of staff. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 25 and 26 Quality in this outcome area is adequate This judgement is based on observations during the inspection of the property. The layout and design of the property was conducive in meeting the needs of the service users group; appropriate measures were required to ensure the health and safety of service users. EVIDENCE: Prestwood Coach House is located in Stourbridge, Staffordshire, the two-storey property is set within its own grounds, with some rooms having idyllic views of the surrounding countryside. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 18 The home offered a combination of shared and single occupancy bedrooms located both on the ground and first floor. All bedrooms were equipped with an en suite and a number of bedrooms were also equipped with a kitchenette. Bedrooms were spacious and were tastefully decorated and essential furnishings were provided. A compact lounge area was situated on the ground floor adjacent was a small dining area, an additional dinning area was also provided. Information obtained from the relatives comment cards prior to the inspection, identified concerns relating to the size of the lounge. The lounge was small and cluttered with furnishings. As previously identified bedrooms were very spacious and were equipped with soft furnishings and a table in some rooms, of which compensated for the small lounge. Adequate heating and lighting was provided throughout the property. The Inspector raised concerns about a number of radiators accessible to service users that were very hot to the touch. Radiators were fitted with a thermostatic control but were not guarded to protect service users from the hot surfaces. The Registered Manager should ensure that all radiators accessible to service users are guarded and a risk assessment should be developed and implemented with reference to radiators within the communal areas. The Registered Manager informed the Inspector that the radiators were low surface temperature. The Inspector acknowledged that the home was currently commissioning a new boiler. Bathrooms and toilets were located on both the ground and first floor, as previously identified within the contents of this report, privacy screening should be provided at the identified bathroom windows. The design and layout of the property was suitable for individuals who have a physical disability, having wide corridors and doorframes to accommodate wheelchairs users. Grab rails were fitted within the corridors and toilets; lifting aids were also in place. Records that were examined evidenced that lifting appliances were serviced/checked on a six monthly basis. Records of water distribution temperatures accessible to service users were maintained of which were consistent at 43oC. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 19 Cleanliness of the home was of high standard and the domestic team should be commended for their efforts. Discussions with a Registered Nurse confirmed that service users clothes and linen were laundered at Prestwood Main located within the grounds. There were no appropriate sluicing facilities provided within the home. In the interest of infection control, it as been identified has requirement that an appropriate sluicing facility should be provided. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 20 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 and 29 Quality in this outcome area is good. This judgement is based on the examination of staff rotas; discussions with service users, visiting relatives and information obtained from the relatives comment cards. Appropriate staffing levels were maintained to meet the needs of needs of the service user group. EVIDENCE: The home is registered to provide a service for 40 service users; on the day of the inspection 30 service users were in residence. Discussions with a Registered Nurse and the examination of staff rotas identified the 2 qualified nurses were provided for the morning shift with 6 care assistants. The afternoon shift consisted of one qualified nurse and 5 care assistants. One qualified nurse was provided at night with 2 care assistants. Information obtained from relatives comment cards and discussions with relatives on the day of the inspection, identified some concerns relating to the staffing levels. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 21 Service users confirmed that staff were always available when they needed them. The current staffing levels were sufficient to meet the needs of the service user group. The Registered Manager should review the staffing levels when there is an increase of occupancy. Relatives that were interviewed informed the Inspector that staff members were “lovely and friendly and provided an excellent service,” “Friendly and warm.” Three files pertaining to staff working within the home were randomly selected for examination; all provided sufficient evidence of appropriate safety checks prior to the commencement employment. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 22 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): 33, 35 and 38 Quality in this outcome area is poor. This judgement is based on the examination of the homes records relating to the delivery of care, policies and procedures and general observations. The management of the home was not consistent in ensuring that a quality service was delivered to the service users or that the staff team were provided with the relevant supervision and support. EVIDENCE: The Registered Manager was present intermittently during the process of the inspection. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 23 Interviews with staff confirmed that there was a distant relationship between senior management and the staff team, and that the care team obtained support from one another. Registered Nurses confirmed that they received annual appraisals but did not receive supervision during the year. Care Assistants were provided with supervision. The Registered Manager should ensure that all staff receives at least 6 supervision sessions per year. With reference to service users financial affairs the Registered Manager confirmed that the respective service users families managed this. Staff informed the Inspector that staff meetings were conducted 3 to 6 monthly; minutes of staff meetings were not available for examination. To monitor the quality of the service delivery, annual quality assurance questionnaires were distributed to service users and relatives. Discussions with the Registered Manager confirmed that information collated was presented in a report format. The Registered Manager should ensure that information collated from the quality assurance questionnaires is fed back to service users and to identify what actions would be taken to address information received. As previously identified within the contents of this report, care notes were not consistent to ensure choice and the appropriate delivery of care. Records and systems relating to the health, safety and welfare of both the service users and staff group identified the following: A fire risk assessment was in place dated December 2006. Weekly fire alarm tests were undertaken, the last recorded entry was 14/12/06. Records identified that the last fire drill was undertaken 07/11/06. Information on the fire blanket and powder extinguisher located in the kitchen identified that they had not been checked/serviced since December 2004. Water distribution temperatures were last recorded 18/11/06. There was no evidence of the chlorination of the water tank. Lifting appliances were serviced on a six monthly basis. Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 24 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 3 X X 2 2 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 2 X 2 Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 25 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(2)(b) Requirement To undertake and record pertinent risk assessments for each service user and review monthly. (02/11/05) For staff to receive refresher training in the administration of medicines to ensure that stringent recording takes place at all times. (Outstanding from 01/03/06). To ensure that care plans are reviewed on a monthly basis to reflect the changing needs of the service user. The bowel chart regarding the identified service user, stating that the last bowel action was on 07/12/06, should be addressed as a matter of urgency to ensure the health of the service user. To ensure that service users are given a choice to the frequency of baths and to refrain from the weekly routine. The registered person should ensure that staff receive training in dementia awareness. DS0000022362.V318252.R01.S.doc Timescale for action 23/03/07 2. OP9 13(2) 20/02/07 3. OP7 15(2)(b) 20/01/07 4. OP8 12(1)(a)( b) 20/12/07 5. OP8 12(2) 20/12/07 6. OP8 18(1)(c)(i ) 23/03/07 Prestwood (Coach House) Nursing Home Version 5.2 Page 26 7. OP8 21(1) 8. OP9 13(2) With reference to the condition 30/01/07 of registration, the home is not registered to provide a service for individuals with dementia and therefore should apply for a variation in registration. The registered person should 30/01/07 ensure that the cupboard containing controlled drugs is rag bolted to a solid wall as identified in the Misuse of Drugs (Safe Custody) Regulations 1973. The registered person should ensure that medicines are stored in accordance to the manufactures instructions. The signature list relating to staff authorised to administer medicines should be reviewed to provide up to date information. An appropriate locking device as approved by the Fire Safety Officer should be fitted to all bedroom doors. The registered person should ensure that staff have a ‘flat key to gain access to service users bedrooms in the event of an emergency. Privacy screening should be provided at the windows of the identified bathrooms. A copy of the homes complaints policy should be issued to each service user. Radiators accessible to service users should be guarded to protect them from hot surfaces. A risk assessment should be developed for radiators in the communal areas. In the interest of infection control a sluicing facilities should be provided. To ensure that all staff receive at least 6 supervision sessions per DS0000022362.V318252.R01.S.doc 9. OP9 13(2) 20/01/07 10. OP9 13(2) 30/01/07 11. OP10 12(4)(a) 20/05/07 12. OP10 13(4)(a) 10/01/07 13. 14. 15. OP10 OP16 OP19 12(4)(a) 22(5) 13(4)(a) 01/02/07 01/02/07 01/09/07 16. 17. OP26 OP36 23(2)(k) 18(2) 01/09/07 01/04/07 Page 27 Prestwood (Coach House) Nursing Home Version 5.2 19 20 OP38 OP38 year. To ensure that the water systems have been chlorinated. 23(4)(a)(c The powder extinguisher and fire )(i)(iv) blanket located within the kitchen should be serviced/checked. 13(4)(a) 01/03/07 25/01/07 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 OP29 Good Practice Recommendations A copy of the confirmation letter sent to prospective service users identifying the homes suitability to meet their needs should be maintained on file. For the home to ensure that the training agency identifies the relevant year that the training record represents, includes the date of each completed training event for each agency staff member and a nominated person within the nursing agency signs to authorise the training record. To ensure that service users are actively involved where possible in the development and review of their care plan. Staff responsible for the administration of medicine should be ‘competency assessed.’ The registered person should ensure that information collated from the quality assurance questionnaires is fed back to service users and to identify what actions would be taken to address information received. Consideration should be given in the undertaking of service users meetings. The handle of the freezer located in the main kitchen should be replaced. More emphasis should be focused on diversity to promote the quality of the service delivery. 3. 4. 5. OP7 OP9 OP33 6. 7. 8. OP33 OP15 OP12 Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Prestwood (Coach House) Nursing Home DS0000022362.V318252.R01.S.doc Version 5.2 Page 29 - 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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