Inspection on 03/05/07 for Prestwood (Coach House) Nursing Home

This inspection was carried out on 3rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Prestwood (Coach House) Nursing... 12/12/06

Prestwood (Coach House) Nursing... 02/11/05

Prestwood (Coach House) Nursing... 01/06/05

Prestwood (Coach House) Nursing... 13/12/04

Prestwood (Coach House) Nursing... 19/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Prestwood (Coach House) Nursing Home Coach House Prestwood Stourbridge West Midlands DY7 5AL Lead Inspector Mr Keith Jones Key Unannounced Inspection 3 May 2007 09:00 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.V339247.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.V339247.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 completelink@btconnect.com 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 Jayne Tatler 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.V339247.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 12th December 2006 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.V339247.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted with the Care Manager, Home Manager, senior nursing and care staff. The last inspection report was discussed, and it was noted that there were outstanding requirements and recommendations from that visit had been, or are in the process of being dealt with. It is recognised that considerable attention to those requirements had been addressed. On the day of inspection there were 30 service users in residence, of which 29 were categorised as requiring nursing care. The current scale of charges range from £ 450 to £630 per week. There were four service users who were case tracked, and confirmed the establishment of a comfortable and well-run care home. A tour of the Home allowed free and open access to all areas for inspection. The opportunity was taken to speak with a number of service users, relatives and members of staff. Service users and staff took an active role in the inspection process and contributed to the subsequent report. The tour of the Home was carried out in a relaxed, courteous and professional manner; most of those approached expressed confidence in the atmosphere. Service users approached were generally complimentary of the care, service and attention they received from a willing, attentive care team. Relatives who were present were complementary of the approach to care, the freedom they enjoyed and the involvement that the providers, manager and her staff encouraged. A sampled review of the administration confirmed solid practice and effective management. A full report feedback was offered at the end of the inspection with open discussion involving the Registered Providers, Care Manager, and Home Manager. What the service does well: Prestwood Coach House offers a genuine commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carer and resident. The establishment of a professionally accountability towards effective assessment, detailed care planning and review of resident’s needs are meaningful and robust, in formulating a good standard of care. This highly personable attitude and approach to care is appreciated and welcome by residents and visitors alike. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 6 Maintenance of good staffing levels, staff training and development, are well established in safeguarding the interests of residents. The overall management style demonstrated a professional approach in maintaining an environment conducive to the care of the elderly. There is a constant appraisal and review process of facilities and services to maintain that environment, by the Completelink management. What has improved since the last inspection? 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.V339247.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.V339247.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): 1,2,3,4,5 The quality in this outcome area is good. This judgement is based on the examination of the homes policies, procedures, practices and discussions with management. The Registration Certificate reflects the approved status of the Home, and of the Service Users in residence. Prestwood Coach House ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. It is recognised that the Statement of Purpose represents the foundation on which the home operates upon, offering service users and their relatives the opportunity to make an informed choice about where to live, through the Service User Guide, offered to all residents. The Care Manager ensures that the admission process is a reflection of a joint understanding that residents are aware, and that staff are able to meet expectations to realise a comfortable transition. Following an assessment the senior/nurse assessor determines the suitability Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 9 of the application in view of the facilities available, and of the capacity of the home, to manage the individual and any special needs. The Home has demonstrated their commitment to promote a partnership of care, to meet the objectives of providing a home to meet individual needs. EVIDENCE: The Statement of Purpose continues to represent a description of the Home’s aims and objectives, philosophy of care and terms and conditions. The statement is frequently reviewed and updated to meet the contemporary situation, and to allow Service Users and their relatives the opportunity to make an informed choice about where to live. A separate service user’s guide serves as an easily readable summary of the Statement of Purpose and supporting information, widely used and distributed to inform all interested parties. Case tracking of four individual residents clearly identified that the Care Manager, Home Manager or her deputy, at the point of reference, conducts the pre-admission assessment. The documentation was examined and found to be comprehensive, providing a solid foundation for progressive care planning. This assessment is produced with the full involvement of service users and family, allowing them to influence the direction of care. The assessment initiates the process of care, each individual having a plan of care, which includes a daily living plan and longer-term goals and outcomes. Following an assessment the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual and any special needs. Likewise the applicants are informed in writing of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. Any special needs of the individual were discussed fully and documented, ensuring their individual needs would be met. Case tracking confirmed that a valuable exchange between service users and assessor took place and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. From discussions with staff and service users it was evident that prospective service users and their relatives are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. At all times relatives are involved in the process. Prestwood (Coach House) Nursing Home DS0000022362.V339247.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): 7,8,9,10 and 11 The quality in this outcome area is good. This judgement is based on the examination of four care plans, discussions with service users, staff, managers, general observations and the Home’s medication system. The care assessment, planning and review system is a highly organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with family. The provision of medicines administration is managed efficiently, although reinforcement continues to improve storage and administrative procedures. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. EVIDENCE: Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 11 Care records and case tracking clearly showed that this standard is well met, maintaining a high quality process of assessment. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process. A profile of the service user’s social, physical and psychological status offered an individual plan of care, based upon activities of daily living, to be implemented and frequently reviewed. Each service user’s health, personal and social care needs are carefully assessed in an individual plan of care that is reviewed monthly, including service users and relatives views, to reflect their changing needs. That review is more frequent, dependant upon the individual’s needs and clinical condition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. As is appropriate, a checking chart ensures that constant monitoring of high dependency residents is carried out. A daily report is maintained to control monitoring, and offer a very comprehensive account of care and service given. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of goals, care and evaluation. Case tracking confirmed the extent that the carefully prepared, and well-recorded care plans were appreciated by service users and relatives alike. Tissue viability, continence, psychological and special needs are assessed and documented, along with nutritional screening, hearing and sight tests as appropriate. The GP service is thorough and supportive; through this service, arrangements are made to provide professional support. Continence is assessed on admission and promoted within the plan of care, and there was evidence that service users nutritional needs, and weights were frequently reviewed. Care staff maintain all aspects of service users personal care, overseen by the trained nurse on a daily basis. The administration of medicines adheres to procedures to maximise protection to service users. The storage was secure with satisfactory added security for controlled drugs, within an air-conditioned room. The general storage facility is small in size and needs to accommodate pastes and lotions. A controlled drug register was examined and found to be in order. Discussions arose concerning the length of time from admission to full involvement in the blister pack system. The Care Manager is to review the procedures for medical prescription and dispensing from the supplier. Each service user has the opportunity of their own lockable facility in their bedrooms on request, and should be encouraged to be used by those people risk assessed to self administer. There Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 12 remains a need for surveillance on ensuring that medicines are taken by people who are determined competent to self administer their medicines. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. These policies are reinforced with a staff induction programme and supervised practice. Case tracking confirmed that the policies were implemented, with all service users spoken with being complimentary of the degree of respect given, by each and every member of staff. The inspector observed the free, courteous interaction between service users and staff based on a level of confidence of mutual trust and respect. There was also an observed knowledgeable, and positive attitude towards residents and feedback from the residents: “This is a lovely place to live, not my home, but the next best thing” and “ have found peace and contentment after years of insecurity and discomfort” Visitors revealed: “Excellent working relationships”, “We come and go as we please, there are no visiting restrictions”. Relatives have freedom of visiting, emphasising on the importance of maintaining social contact. Adequate privacy policies exist for all toilet/bathroom areas and bedrooms. Individual spiritual persuasions were documented and individual diversity respected at all times. Relatives are welcome to stay as long as they liked in times of stress, including overnight stay. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. Prestwood (Coach House) Nursing Home DS0000022362.V339247.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 The quality in this outcome area is excellent. This judgement is based on discussions with service users, staff and examination of records in relation to social activities undertaken and general observations during to course of the inspection. The home had a relaxed and welcoming atmosphere where people were encouraged to continue with their individualised lifestyle. The quality of activity and socialisation, monitoring and management was acknowledged. EVIDENCE: From talking to service users and staff it was pleasing to report a continuing daily routine that is flexible and non-institutionalised, offering choice for meal times, personal and social activities including recognition of varied religious needs. The issue of diversity was discussed with the manager and staff, and it was evident that individuals’ needs would be well researched, and met. At pre-admission the service user’s personal interests and customs are determined, and where possible accommodated within the routine of the Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 14 Home. That routine is seen as flexible; to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Discussions with service users and staff clearly identified a relaxed and informal atmosphere in which the service user’s needs were paramount Prestwood Coach House shares the hours of the activity coordinator based at the Main House. Activities are seen as social activities, as an integral part of care. This is applied within the care planning process as an important aspect of care, as evidenced in examination of records and discussion with staff. An activity board and art display at the reception area identifies the social events of that week. Residents were keen to demonstrate their involvement in the daily life of the Home, having produced notices of meeting on the computers provided. Meetings arranged with family members were to be ‘resident led’ to a degree with active participation and organisation. Several residents were happy to show their past and present skills in artwork, some on display in their rooms, at the reception, or just held in a folder in their private rooms. Service users are encouraged to exercise choice and control over their life as far as is possible. Service users are actively encouraged to bring into the home personal possessions. The tour of the Home demonstrated a high degree of expressed individuality in each of the bedrooms inspected. It was pleasing to see the good standards of catering at Prestwood Coach House, offering a service to which all service users spoken to were complimentary on aspects of quality, choice and quantity. A menu on a four weekly cycle offered a wholesome, varied choice. Individual preferences were recorded in assessment and conveyed to cook. It was noted that the cook and his team were sharing their time with the Main House, and that new staff had been recently engaged. It was felt that every opportunity should be taken to engage the catering staff in meeting with the residents on a regular basis. A well-presented and welcome lunch was served during inspection, presented in pleasantly furnished and clean dining rooms. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of service users. COSHH notices were in evidence with cleaning chemicals secure, appropriate and under control. The process would benefit from COSHH poster displays in all areas dealing with chemicals. Prestwood (Coach House) Nursing Home DS0000022362.V339247.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, 17 and 18 The quality in this outcome area is good. The Home had a meaningful complaints policy, clearly identifying the CSCI as a resource to approach with a complaint or grievance. No complaints had been received via the Commission since the last inspection. Service users’ legal rights are protected by the systems in place. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. EVIDENCE: Service users’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. The complaints policy was seen and records examined. There were few complaints, which would be better dealt with through a ‘record of concerns’, to record residents and families concerns in a meaningful and effective manner. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. The overall policy of openness and transparency was acknowledged. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 16 All service users had received information on the procedure to complain, including reference to the CSCI. This process was evidenced on examination and case tracking as previously reported upon. Discussion with the Care Manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. The policy and procedure for handling issues of abuse was examined, and found to be satisfactory. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users. Booklets from the General Social Care Council’s Code of Conduct are given to all staff to help reinforce the induction and training programmes. Prestwood (Coach House) Nursing Home DS0000022362.V339247.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): 19,20,21,23,24,25,26 The quality in this outcome area is good. The external state of repair and maintenance is generally very good. The grounds are kept tidy, safe and are tended regularly, offering pleasing recreational areas for service users. The home is well equipped to meet the demands of the elderly, with appropriate movement and handling facilities, hand and grab rails, ramps and call alarms. The interior state of repair is at a high standard; bedrooms are well appointed, of a good size and accessible for wheelchairs and walking aids. Communal areas are furnished and decorated to a good standard to present a homely and comfortable environment. Service users live in a safe and well-maintained environment with a planned preventative programme designed to sustain the high standards. The home complies with the fire service requirements, staff receiving at least two fire lectures/drills per year. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and odour-free. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 18 EVIDENCE: External access is satisfactory for visitors. Service users take advantage of very attractive gardens and grounds; pathways were safe and frequently used throughout the summer. Garden furniture was being re-varnished by the maintenance man at the time of inspection. Internal access was facilitated with ample fittings of hand and grab rails in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home. The senior nurse confirmed a willingness on the part of management to meet any reasonable demand for special needs. Bedrooms were well maintained to meet service user’s personal preferences. It was pleasing to see that ongoing maintenance has continued to enhance the presentation of the Home with recent up-grades inspected, and found to be of a high standard. A development plan for 2007/08 is presently being drawn up and will be presented to CSCI on finalisation. There are 8 variable height beds available. All rooms were of a good size and accessible for wheelchairs and walking aids. On inspection bedrooms were personalised, with some displaying service user’s own furniture, and most with personal belongings. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration. Overall the attention to detail has not detracted from presenting a homely and comfortable environment. There is an active programme of replacing most ensuite baths with showers. The nurse-call alarm system was satisfactorily tested and service record checked. All personal electrical equipment where seen to be PAT tested. There is an adequate lighting, and bedside lamps are available where risk assessed. Radiators are required to be safeguarded, although one on a ‘ ‘blind’ corridor exceeded a comfortable temperature. It was agreed to provide a radiator cover immediately. Smoke detectors fitted and adequate electrical sockets available. TV and telephone points were available in each bedroom, equipped with large keypad telephones for service users personal use. A locked facility and lockable bedroom doors was available on request, following suitable risk assessment. Several service users spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Water supplies are to be checked to confirm protection from, and prevention of Legionella. Water temperature were randomly tested and found to be within normal limits. Each room was fitted with a tested fire/smoke alarm. Ventilation is by direct door and window airing. Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the home. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 19 All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. The conservatory was a particularly pleasant area for the service users and contained a number of books and games. There are two pleasant dining rooms, spotlessly clean and fresh smelling. Service users have the provision of sufficient and suitable lavatories and washing facilities within the home. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and odourfree. Only one area was identified as in need of attention, and this related to a bath in an assisted bathroom that had worn enamel. Adequate attention has been given to ensure maximum privacy within risk-assessed boundaries. There are adequate sluice facilities, each having suitable arrangements to assist in control of infection. Notices regarding chemical handling the areas that store chemicals displayed appropriate COSHH posters and information charts. It was recommended that all storerooms be safeguarded when not in use. Communal areas were equally well served with utilities. Servicing records of PAT testing, fire officer’s report and gas certificate were examined and found to be up to date and accurate. An awareness of health and safety issues was high on training and supervision priorities. The domestic services in the home were seen to be of a very high standard. The service users and relatives spoken to remarked that they find the environment always very clean and conducive. There was no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection. Procedures were in place for coping with soiled/infected linen with the provision of alginate bags to minimise handling and cross-infection. All laundry was transported to and from the Main House in a safe and well organised manner. A Control of Infection manual, policies and procedures are used as working documents in the home, and Infection control figures highly within the staff induction and supervisory training programmes. Chemical cleaners were used appropriately throughout the home, were seen to be secure and under COSHH recommended practices. The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. The kitchen however was unpleasantly hot at the time of preparing lunch, windows were seen to be shut, and in need of cleaning. A cleaning schedule was in place, which needed to be brought to be up to date and accurately reflect the observed standards. Prestwood (Coach House) Nursing Home DS0000022362.V339247.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): 27,28,29 and 30 The quality in this outcome area is good. Staffing stability has been maintained with consistent levels to ensure equilibrium between numbers, skills and qualifications, with a strong presence of long serving experienced staff. Care bank are occasionally used, with agreed overtime and flexible rostering to accommodate shortfalls. Completelink management have established a comprehensive procedure for interview, selection and appointment of staff. The thoroughness of staff selection has a significant effect upon the provision of cares to ensure protection of service users. All staff receive training in care issues within the home from a fulltime Training officer, Registered Nurses and external trainers. EVIDENCE: Three weeks of off-duty were examined, and showed adequate balance between skills, qualifications and numbers to provide a foundation for a good standard of care. The Care Manager works supernumerary and is supported by an able team of Registered Nurses and Carers, led by an experienced Home Manager (RGN). Bank coverage has been used occasionally to support shortages of care staff, Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 21 in tandem with overtime and flexible rostering to meet shortfalls. Agency carers are used, trained staff rarely. At the time of inspection the duty rotas confirmed a staff coverage as thus: a.m - 2 trained 6 carers p.m - 1 trained 5 carers N.D - 1 trained 2 carers These staffing figures presented at the time of inspection reflected a higher level than that approved as adequate to meet care needs. The catering, domestic and laundry hours were determined, and found to be appropriate for the size of the Home, and the needs of the residents. The Home has a full time activity coordinator (shared with the Main House), training manager and a care/management link manager. The care manager emphasised the home’s commitment to training and to achieving targets for NVQ level 2. The Registered Providers and Care Manager have established a comprehensive procedure for interview, selection and appointment of staff. This involves a standard application form to assess and profile, two references taken and CRB (enhanced) checks gathered before a contract is offered to successful candidates. The thoroughness of staff selection has a significant effect upon the provision of cares to ensure protection of service users. Service users are supported and protected by these practises and all new staff goes through an induction process that will ensure that they are going to be the right person for the home. All staff interviewed had a statement of terms and conditions. It is a declared policy that recruitment is based on equal opportunity. Two staff files were sampled and found to be well organised and up to date. Personal and training records were kept secure in accordance of the Data Protection Act 1998. Policy clearly states an equal opportunity position. The management are steadfastly committed to a learning environment. Staff induction programmes are comprehensive and well established; forming the base upon which in-service supervision and training are planned. Overall the evidence, demonstrated with the mandatory training planner, showed a comprehensive account of a meaningful and important schedule of training to meet internal and external demand. A training facility in the basement level was being used at the time of inspection, on abuse awareness. Staff records displayed an account of training that includes the General Social Care Council’s code of conduct, obtained to complement existing guides. Each member of staff has a ‘Employee Handbook’. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 22 Supervision is conducted by the Care Manager, which would be enhanced with delegated responsibilities cascaded throughout the staff, to include all staff. The process would be better organised to be placed on a planned, rather than a reactive basis. Staff interviewed were pleased, and satisfied with the professional foundation offered to them, through effective management. Each were settled and enjoyed their positions, and were proud of the high standards of care given. There were some comments received regarding the ‘isolation’ of staff at The Coach House, although there was no evidence to support that concern. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is good The Registered Providers are office based on site at the Main House, yet having a daily contact involvement with every-day and on going issues. The Care Manager Jayne Tatler offers a considerable resource of experience and skills, which are reflected in the high standing in which Prestwood Coach House is held by residents, their relatives and the community alike. She is supported with a Home Manager, who has demonstrated competence in running the Home, in establishing a solid professional policy profile, to achieve a high standard of set aims and objectives. The style of management was seen as by direct observation, and by discussion with service users, relatives and staff, and that a very open and positive attitude prevails, enhancing the home’s ‘family feel’ and homeliness. There was strong evidence of openness, inclusion and honesty in speaking with service users, relatives and staff in which day to day events and episodes were freely discussed. On-site inspections offered evidence of a management firmly in control, well organised and prepared to facilitate meaningful, delegated Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 24 responsibilities to an efficient care management team. EVIDENCE: The Care Manager has demonstrated competence in establishing a solid Statement of Purpose and policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. A qualified general nurse with a professional portfolio of practical and managerial experience, ably supported by a well qualified Home Manager, senior Nurses and experienced carers, whom represent an effective care management team Staff meetings are held regularly in which staff are encouraged to participate fully in the management and direction within the home. The inspector observed at first hand the confident interrelationship that exist, not only between management and staff, but also between staff and residents. The Care Manager has reinforced the presence of quality assurance with a monthly audit of standards, and regular review of risk assessments. There was strong evidence of openness and honesty in speaking with service users, relatives and staff, in which day to day events and episodes are freely discussed. Evidence was secured to confirm a quality monitoring system has been introduced, based upon audit of standards, care plans and feed back from service users and relatives. Standards are discussed at staff meetings, daily reports, direct observation involvement and one to one staff meetings. The procedures manual was randomly examined, and found to offer a very comprehensive reference. Movement and Handling, restraint management and infection control were examined and found to be informative and up to date. Fire safety remains high priority for all staff evidenced in routine maintenance checks, regular fire drills and frequent staff training sessions organised by the training officer. Discussion with the Care Manager indicated that supervision sessions and individual training programmes are areas that with continuing improvements, will enhance the desired impact on quality of service. A sample of administrative, maintenance and care records were examined and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly service users. This was confirmed by inspection of service agreements for electric supply, hoist maintenance, PAT and water supply (to be confirmed). It was agreed that the Provider would take the necessary steps to ensure the system is Legionella free. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 25 Accidents were seen to be addressed, risk assessed, actioned and recorded in an effective way, with access to Riddor if needed. No serious accidents have been recently reported. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of service users. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 26 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 4 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 X 3 3 3 Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? 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 OP19 Regulation 13(4)(a) Requirement Radiators accessible to service users must be assessed for the risk they present to the people that use the service, and action taken to minimise any identified risk. Timescale for action 01/06/07 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 3 Refer to Standard OP15 OP25 OP25 Good Practice Recommendations The handle of the freezer located in the main kitchen should be replaced. The window located in the kitchen be repaired and kept clean. To repair or replace a bath in an assisted bathroom which had worn enamel. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 28 4 5 6 7 8 9 10 OP38.3 OP36 OP26 OP19 OP16 OP24 OP9 That storeroom areas be secure when not in use. Supervision of all staff is to be formally documented six times a year. That the water supply be checked for routine Legionella Clearance That there is a review of fire precautions. A complaints book be established. A development plan be drawn up for 2007/08 That a review of storage space for security of medicines, and of the length of time taken to introduce new admissions to the Administration of medicines system. Prestwood (Coach House) Nursing Home DS0000022362.V339247.R01.S.doc Version 5.2 Page 29 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.V339247.R01.S.doc Version 5.2 Page 30 - 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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