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Inspection on 26/04/07 for Prestwood (Main House) Nursing Home

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

This inspection was carried out on 26th April 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.

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

Prestwood Main House offers a high standard of care and service, is well organised, with a committed management team. Emphasis goes into involving the residents and their families in the process of care, ensuring a highly personal approach to meeting individual needs. Assessment procedures and care planning is of an excellent standard, offering detailed information on each resident`s progress in the meeting of objectives. The housekeeping and support services all contribute to the team approach, and are recognised by the management for their efforts. Maintenance of good staffing levels, staff training and development, are well established in safeguarding the interests of residents. Overall the attitude in meeting caring and organisational demands is highly commendable, with forward thinking, planning and application contributing to a good quality service.

What has improved since the last inspection?

The Home has demonstrated a commitment to caring for the elderly with very high standards, which need to be maintained. In addressing care standards` recommendations, the Home has demonstrated a robust and meaningful commitment to the ethos of continuing improvement of standards. Fire precautions, medicines administration, and records management have been reinforced.

What the care home could do better:

The achievements have been recognised, areas of detail will continue to play a part in the ongoing development and maintenance of an honest, solid and yet a homely service.

CARE HOMES FOR OLDER PEOPLE Prestwood (Main House) Nursing Home Main House Prestwood Stourbridge West Midlands DY7 5AL Lead Inspector Keith Jones Key Unannounced Inspection 26th April 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 (Main House) Nursing Home DS0000022361.V334634.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 (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prestwood (Main House) Nursing Home Address Main House Prestwood Stourbridge West Midlands DY7 5AL 01384 877440 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 Mrs Jayne Elizabeth Tatler Care Home 59 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (59) of places Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. OP Minimum age 60 years 2 beds for persons with a minimum age of 55 Date of last inspection 28th November 2006 Brief Description of the Service: Prestwood House is a registered care home of which provides residential and nursing care for older people, the home is also registered to provide a service for 2 people who suffer with dementia. The home is located in Stourbridge, Staffordshire, off the main A449 near to the village of Kinver. The three storey detached property is set within its own grounds, having idyllic views of the well-maintained gardens and the surrounding countryside. The home offers accommodation for 59 service users providing a combination of single and shared occupancy bedrooms, located on both the ground and first floor. En suite facilities are provided within a number of bedrooms. Bathrooms and toilet areas are situated throughout the home and are in close proximity to bedrooms and communal areas. The layout and design of the home facilitates service users who have a physical disability, having wide corridors and doorframes to accommodate wheelchair users, a passenger lift was also in place. Lounge and dinning areas were pleasantly decorated and equipped with essential furnishings and items to provide a comfortable area for relaxation or to socialise with fellow service users. 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 House is from £370.00p £570.00p per week. Prestwood (Main House) Nursing Home DS0000022361.V334634.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 Registered Care Manager and senior staff on duty. The last inspection report was discussed, and it was noted that outstanding requirements and recommendations had been, or were in the process of, being dealt with. The tour of the home was carried out in a relaxed, courteous and professional manner; those concerned expressed confidence in the friendly atmosphere. All the service users approached were highly complimentary of the care, service and attention they received from a willing, attentive care team. On the day of inspection there were 43 service users in residence, of which 33 were categorised as requiring nursing care, and 10 as residential. Service Users spoken with expressed their thoughts freely and spontaneously, most being very complimentary. Relatives who were present were equally complimentary of the approach to care, the freedom they enjoyed and the involvement that the manager and her staff encouraged. Everyone appeared comfortable and at ease with their surroundings. A review by random selection of the administrative and procedural systems confirmed solid practice and effective management. A full report was offered at the end of the inspection, with open discussion with the Registered Providers and Care manager. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. What the service does well: Prestwood Main House offers a high standard of care and service, is well organised, with a committed management team. Emphasis goes into involving the residents and their families in the process of care, ensuring a highly personal approach to meeting individual needs. Assessment procedures and care planning is of an excellent standard, offering detailed information on each resident’s progress in the meeting of objectives. The housekeeping and support services all contribute to the team approach, and are recognised by the management for their efforts. Maintenance of good staffing levels, staff training and development, are well established in safeguarding the interests of residents. Overall the attitude in meeting caring and organisational demands is highly commendable, with forward thinking, planning and application contributing to a good quality service. Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 6 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 (Main House) Nursing Home DS0000022361.V334634.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 (Main House) Nursing Home DS0000022361.V334634.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 Main 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 provider 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 (Main House) Nursing Home DS0000022361.V334634.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 reviewed Statement of Purpose and Service Users Guidelines reflect an expression of philosophy, and have been well established in representing the foundation on which the home operates upon. “To add life to years, not years to life”. It presents an excellent description of the home’s aims and objectives, mission statement and terms and conditions. All the requirements prescribed in Schedule 1 are addressed. The contract document reflects changed circumstances and conditions, including an identification of allocated bedroom agreed, and identifies current fee ranges. The Care Manager adheres to a strict admission policy of personal supervision of the pre-admission assessment. Case tracking of four residents’ files demonstrated the presentation of a highly personal approach to prospective residents and their relatives on pre-admission. A detailed assessment was examined and found to collect a profile of physical and psychological needs, and an understanding of cultural and environmental circumstances. An appraisal is made, and discussed, to ensure the home can satisfactorily meet those needs. Case tracking and discussion with service users confirmed that this standard continues to be well met. Following an assessment the senior carer 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 of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. 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. Prestwood (Main House) Nursing Home DS0000022361.V334634.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 The service users’ assessment provides the base from which care planning is formulated. It is recognised that this reflects an individual profile of needs, discussed fully with family. The home has a GP provision that visits the home frequently. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. The Inspector was impressed with the confidence and closeness within the Home of staff, residents and visitors, and the mutual respect that prevailed. There exists a straightforward, yet effective medicines administration system, accurately monitored and actioned. EVIDENCE: Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 11 Four case records were examined and found to offer a clear, well balanced, up to date and accurate appraisal of requirements. Reviews were done on a minimum of once a month, usually more often, as needs dictate. Case tracking of those three residents confirmed the depth of care planning supported by a solid foundation of organisation and quality services. All care plans and reviews were up to date and meaningful. A profile of the service user’s social, physical and psychological status offered an individual plan of care, based upon a model of daily living, to be implemented and frequently reviewed. Each service user’s health, personal and social care needs were seen to be 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. Records confirmed the intervention of a Community Psychiatric Nurse (CPN), for service users suffering with dementia, and facilitates training relating to dementia awareness and challenging behaviours. Residents were seen to have access to large keypad telephones, and mobile phones were becoming commonplace, and appreciated. A tour of the premises evidenced that there was a range of pressure relieving equipment, variable height beds, and examination of service user plans found that all are assessed in relation to pressure sore risk, falls risk and nutritional risk. The administration of medicines adheres to procedures to maximise protection to service users. The storage was secure with satisfactory added security for controlled drugs. A controlled drug register was examined and found to be in order. Staff training and updating on medicine administration is well in hand, involving all trained staff. Administration sheets are meaningful, which would be more effective with all service users’ photographs available. The outer door accessing the storage area would be better kept secure when not in use. Family and friends have relative freedom of visiting, those spoken to remarking on the importance of maintaining social contact. The Statement of Purpose clearly and openly states that the wishes concerning arrangements after death would be discussed and respectfully carried out, ascertained as soon as possible after admission. The spiritual needs of service users were recorded and observed by the staff with due respect. Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 12 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, with evidence in each resident’s file of meaningful profiling by the coordinator and senior care staff. 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. At pre-admission the service user’s personal interests and customs are determined, and where possible accommodated within the routine of the Home. That routine is seen as to acknowledge individuality, yet maintain a Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 13 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 Main employs an activity coordinator in 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. Weekly activity records, and regular family meetings constitute a good quality. A variety of social activities were provided on the day, the Activities Coordinator organised activities within the home and visits in the community. Evidence was clear in identifying events and results of efforts made. On the day of the inspection, a number of service users were engaged in painting, and general chatting. The home continues to operate an established open visiting policy, which was seen during the inspection. Relatives and friends are encouraged to maintain social links as part of the planning of care. Comments received from relatives confirm their appreciation and involvement with the progress of their loved ones health and social status. 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. Each individual is encouraged to be independent with regard to financial affairs with the assistance of their relatives. Anyone who is able and wishes to handle their finances, or self-medicate, they do so. Each service user has a lockable facility available in their rooms if they wished to handle their own accounts or medicines. On many other matters residents were complimentary over the level of choices, but respected the advice and guidance given by their nursing staff. The tour of the Home demonstrated a high degree of expressed individuality in each of the bedrooms inspected. It was pleasing to see the high standards of catering, to which all service users spoken to were complimentary of quality, frequency and quantity. A menu on a four weekly cycle offered a wholesome, varied and substantial choice. Individual preferences were recorded in assessment and conveyed to cook, who met with, and discussed their requirements. It was confirmed that the cook had been welcomed to meet with Service Users to understand their preferences. An excellent lunch was served during inspection, served in well 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. 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. A cleaning schedule was in place, which needed to be brought to be up to date and accurately reflect the observed standards. Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 14 Prestwood (Main House) Nursing Home DS0000022361.V334634.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 It is the clear policy that Prestwood Main House enables any staff member, service user, service user representative, or visitor to the home to lodge any complaint or concern they may have about any aspect of their service. The care manager showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. 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: The complaints procedure was presented within the Statement of Purpose and contract, displayed in reception, and identifies the registration details. The complaints file was examined and found to be satisfactory. There was no outstanding issue at the time of inspection. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. This process would be enhanced with a record and analysis of all complaints. Advocacy service is available to those who require it as indicated in the service user guidelines. Service users’ legal rights are protected by the systems in Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 16 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 care manager showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. 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. 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 (Main House) Nursing Home DS0000022361.V334634.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. This judgement was based on discussions with service users, staff and a tour of the premises. The home is well appointed to meet the needs of an elderly population of service users in providing a safe and comfortable environment. On inspection bedrooms were highly personalised, with most displaying service user’s own furniture, and with personal belongings. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. The overall environment was found to be safe for service user’s comfort within risk assessed limits. The domestic services in the home were seen to be of a very high standard, with no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection. Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 18 EVIDENCE: The location of Prestwood Main House is conducive for a care home, to meet the needs of an elderly population of service users. Communal areas are furnished and decorated to a comfortable standard to present a homely environment. A recent, clear Health and Safety Inspection was noted. External access is via a long and well-maintained driveway, set in beautiful pastoral countryside. Visitors, service users take advantage of very attractive gardens and grounds; pathways were safe and recently attended to, after a mild winter. On admission the provider or care manager assesses each individual service users’ needs for equipment and necessary adaptations. 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. Recent storm damage to the roof and ceiling in the basement lounge tea-bar was noted. Work was in progress to repair. Bedrooms were well maintained to meet service user’s personal preferences. On inspection most bedrooms were highly personalised, with most displaying service user’s own furniture, and personal belongings. It is the policy that on bedrooms becoming vacant, that each room is reappraised for redecoration, as confirmed during the Inspection. There is throughout a good standard of furnishing complimented with a variety of personal belongings. At the time of inspection several bedrooms were having old connecting doorways removed, and being generally upgraded, redecorated and refurbished. Communal space including the welcoming entrance hall is furnished in a traditional ‘stately’ style, yet presents a homely atmosphere. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. The lounge spaces allow activities to be presented in very pleasant areas of the home, with furniture and fittings of good quality. The dining areas are well furnished, and presented to provide a conducive environment to enjoy a good meal. Staff supervision is available throughout the day. Corridors are wide enough for wheelchair access, well lit and with sufficient handrails. The external and internal environment was well maintained and secure. Heating and ventilation were found to be satisfactory and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. The home presented a clean and pleasant, odour-free atmosphere, much to the credit of staff. To complement the presentation there were numerous floral and decorative displays. Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 19 Infection control figures highly within the staff induction and supervisory training programmes. Care and domestic staff were approached, and were fully aware of the importance of infection control. An effective call system is installed; care staff reacted speedily to tests, including the various dining and lounge areas. The Care Manager expressed a willingness to meet any reasonable demand for special needs. A locked facility and lockable bedroom doors were made available on request, following suitable risk assessment. The evidence seen on inspection of service user’s rooms, and on discussion with the individual service users and family, assured that this standard was well met. Sluice facilities are suitable to assist in control of infection. Notices regarding chemical handling the areas that store chemicals displayed appropriate COSHH posters and information charts. Kitchen presentation showed satisfactory standards of cleanliness, and evidence of sound food hygiene practices. The laundry was well organised and equipped to a good standard, meeting demands from the Main House and the Coach House annex. COSHH regulations were available and would be enhanced with posters clearly displaying, and relevant to, solutions in use. It was agreed with the Providers that a development plan for 2007/08 be drawn up and presented to CSCI. Prestwood (Main House) Nursing Home DS0000022361.V334634.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 enthusiastic Home Manager (RGN). Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 21 Bank coverage has been used occasionally to support shortages of care staff, 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 9 carers p.m - 1 trained 8 carers N.D - 1 trained 3 carers 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, 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. Three 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 (Main House) Nursing Home DS0000022361.V334634.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 very settled and enjoyed their positions, and were proud of the high standards of care given. Prestwood (Main House) Nursing Home DS0000022361.V334634.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 excellent The Registered Providers are office based on site, having a daily contact involvement with daily 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 Main House is held by residents, their relatives and the community alike. She is supported with a Home Manager, who has, in a relatively short period of time, established her professional impact upon the provision of high standards of nursing care. 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 responsibilities to an efficient care management team. Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 24 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 deputy, 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. Homely remedies, abuse management and managing challenging behaviour procedures 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 a member of staff recognised as a fire safety officer. Policies have been reinforced in accordance of requirements made at the last inspection. It was agreed that a fire officer inspection in the near future would be appropriate. 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 Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 25 and comfortable environment for elderly service users. This was confirmed by inspection of service agreements for gas supply, hoist maintenance, PAT and water supply. It was agreed that the Provider would take the necessary steps to ensure the system is Legionella free. 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 (Main House) Nursing Home DS0000022361.V334634.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 3 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 3 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 (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? None 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. Standard Regulation Requirement Timescale for action 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 4 5 6 OP19 OP16 OP24 OP26 OP38 Refer to Standard OP36 Good Practice Recommendations Supervision of carers is to be formally documented six times a year. That there is a review of fire precautions. A complaints book be established. A development plan be drawn up for 2007/08 That COSHHE signs and information be displayed in all areas involving the use of hazardous chemicals . Secure the access door to the medicines store. Prestwood (Main House) Nursing Home DS0000022361.V334634.R01.S.doc Version 5.2 Page 28 7 OP38 Ensure cleaning schedule in the kitchen is kept up to date. 8 OP26 That the water supply be checked for routine Legionella clearance Prestwood (Main House) Nursing Home DS0000022361.V334634.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 (Main House) Nursing Home DS0000022361.V334634.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. 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