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Inspection on 28/11/06 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 28th November 2006.

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 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

Discussions with service users and general observations during the process of the inspection, identified that there was a positive emphasis focused on social activities within the home and also within their local community, enabling service users to maintain contact and to have a positive presence within the community.Care plans provided in depth information relating to the specific care needs of the individual service user and the level of support and assistance required to promote their welfare and independence. Staff were observed to interact with service users in a positive and professional manner. Service users that were interviewed were complimentary with regards to staffs approach and support.

What has improved since the last inspection?

The previous inspection report identified one requirement, relating to the practice of wedging fire doors open. Unfortunately this practice was observed during this inspection and this will remain as a requirement within the contents of this report.

What the care home could do better:

The homes admission procedure should be reviewed to ensure that a confirmation letter is sent to the prospective service user or their representative, to confirm the homes suitability to meet the service users assessed needs prior to admission. Care plans should be reviewed on a monthly basis to reflect the changing needs of the individual service user. Medication practices were not robust to ensure the safety of service users.

CARE HOMES FOR OLDER PEOPLE Prestwood (Main House) Nursing Home Main House Prestwood Stourbridge West Midlands DY7 5AL Lead Inspector Dawn Dillion Key Unannounced Inspection 28 November 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 (Main House) Nursing Home DS0000022361.V316702.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.V316702.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 01384900 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.V316702.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 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.V316702.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 House was undertaken in 6.5 hours. The inspection methodologies that were used to establish the quality of care provided and the effectiveness of the management of the home, to promote quality, diversity and best practices entailed the examination of the records relating the homes policies and procedures. Four service users were interviewed to ascertain their views and opinions of the service provided and the level of support and guidance offered, to ensure that they were able to live a lifestyle, of their choice with regards to their cultural and specific care needs. Information was collated from comment cards received from service users and health and social care professionals. A tour of the property was also undertaken to ensure that the environment and systems in operation were safe and conducive in meeting the needs of the service user group. This unannounced Key Inspection also included a thematic probe, examining information provided to prospective service users prior to their admission to the home, to enable them to have a choice. The thematic probe also involved a close examination of contracts given to service users, the assessment of prospective service users and the home complaints procedure. These findings will be used as part of a wider study that the Commission For Social Care Inspection are carrying about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: Discussions with service users and general observations during the process of the inspection, identified that there was a positive emphasis focused on social activities within the home and also within their local community, enabling service users to maintain contact and to have a positive presence within the community. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 6 Care plans provided in depth information relating to the specific care needs of the individual service user and the level of support and assistance required to promote their welfare and independence. Staff were observed to interact with service users in a positive and professional manner. Service users that were interviewed were complimentary with regards to staffs approach and support. 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.V316702.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.V316702.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 and 5 Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. The quality in this outcome area is ‘good.’ This judgement is based on the examination of the homes Statement of Purpose, Service User Guide, the pre admission assessment process, records pertaining to service users who had recently been admitted to the home and contracts in relation to the terms and condition of residency. Prospective service users were provided with essential information prior to admission, to enable them to have a choice. Contracts relating to the terms and condition of residency were in place for a number of service users. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Statement of Purpose provided essential information, relating to the service and provisions provided at Prestwood House. The Registered Manager should ensure that the Statement of Purpose is reviewed, to provide up to date information relating to the fees chargeable and the text relating to the National Care Standard Commission. A Service User Guide was also available within the home; the Registered Manager should ensure that all service users are in receipt of their own copy. Service users comment cards received prior to the inspection identified that out of ten received, nine identified that they were not in receipt of a contract with regards to the terms and condition of residency. The examination of four files pertaining to service users identified three had received a contract. It has been identified, as a recommendation within the contents of this report, that contracts should be reviewed to provide information relating to the fees chargeable. The examination of four files pertaining to service users who had recently been admitted to the home, identified the undertaking of pre admission assessment, information obtained from this assessment provided the foundation for the development of the care plan and a risk assessment. The Registered Manager should ensure that a letter of confirmation, relating to the homes suitability, to meet the individuals identified needs, is sent to the prospective service user or their representative. The examination of care plans and discussions with service users confirmed that they had access to relevant healthcare services if and when required. Care plans identified service users religious needs and information located in the main entrance of the home identified contact with the local churches. Discussions with the Deputy Manager confirmed that there were no service users within residence from the ethnic minority group. Information located with the homes Statement of Purpose stated “Prestwood as not had the requirement to serve a variety of ethnic communities.” “However, are committed to ensuring that no one is excluded on the grounds of his/her ethnicity, religion or culture.” The homes admission procedure enabled prospective service users to visit the home prior to admission, giving them the opportunity to view the premises and to meet existing service users and the staff team. The home also provided a Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 10 service for emergency admission, information of which was incorporated within the Statement of Purpose. It has been identified as a recommendation within the contents of this report, that the homes registration certificate should be reviewed to ensure that information is current, with regards the number of service users in residence diagnosed with dementia. The current registration identified two; information obtained from the pre inspection questionnaire identified four service users having dementia. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 11 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 (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. The quality in this outcome area is ‘poor.’ This judgement is based on the examination of care plans, risk assessments, medication practices and systems in place that promote the privacy of service users. The homes medication practices and procedures were not robust with regards to the safe handling, storage and administration of medicines. Care plans were in place for the individual service user but there was a need for more frequent reviews. EVIDENCE: Care plans were generated from information received from the pre admission assessment, which provided comprehensive information relating to the care Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 12 needs of the individual service user and the level of support required to maintain service users independence. Care plans also incorporated a risk assessment and where necessary, a detailed pressure care plan was in place for service users suffering with pressure sores. The Registered Manager should ensure that a risk assessment is developed and implemented for the use of bed guards for the identified service user. Albeit a matter of days, three out of four care plans that were examined were out of date. It has been identified as a recommendation in this instance, that care plans should be reviewed on a monthly basis to reflect the changing needs of the individual service user. Care plans also identified that service users had access to relevant healthcare services for routine health screening of which was recorded within service users files. Discussions with the Deputy Manager confirmed the intervention of a Community Psychiatric Nurse (CPN), for service users suffering with dementia. The Deputy Manager informed the Inspector that training relating to dementia awareness and challenging behaviours had recently been commissioned by the home. The home operated the Venalink Monitored Dosage System; the examination of the controlled drug cupboard identified that it was secured to the wall, with four screws. The Registered Manager should ensure that this cupboard is rag bolted to a solid wall as identified in the Misuse of Drugs (Safe Custody) Regulations 1973. The lids of boxes containing Paracetamols and Co-Codamol tablets of which were located together within the medicine cabinet had been removed. To ensure the robustness of the homes medication practices, promoting the safe handing and safe keeping of medicines. The boxes should be left intact to prevent tablets being placed in the wrong boxes. The examination of one service users file identified a letter of consent sent a relative from the home, giving permission for covert administration of medication, disguising medicines in food. This practice should not be encouraged and advice should be sought from the General Practitioner with regards to alternative methods. The Deputy Manager informed the Inspector that she had not received training in the safe management of medicines. It is recommended that staff who are responsible for the administration of medicines are ‘competency assessed.’ Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 13 The home maintained additional supplies of medicines for an identified General Practitioner. It as been identified has a requirement that this practice should cease and advice should be obtained from the Pharmacist Inspector for the Commission For Social Care Inspection or the homes dispensing Pharmacist. Discussions with service users and general observations during the process of the inspection identified that staff interacted and communicated with service users in a professional and respectful manner. Service users were very complimentary with regards to staffs approach and support. All personal care was delivered within the privacy of the service users bedroom or within the bathroom. To ensure the total privacy of service users, it as been identified has a requirement within the contents of this report that all bedroom doors should be fitted with a locking device as recommended by the Fire Safety Officer. The Deputy Manager informed the Inspector that some bedrooms were installed with a telephone; this service was available to all service users on request. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 14 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 (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. The quality in this outcome area is ‘good.’ This judgement is based on discussions with service users and staff, the examination of information located in the home, relating to social activities and events, observations and the examination of menus. There was a positive emphasis focused on the appropriate stimulation to meet the social needs of the service user group. The conduct of the home promoted service users choice and rights. EVIDENCE: The homes practices and procedures ensured that service users had the opportunity to exercise their choice. As previously identified within the contents of this report, care plans provided information relating to service users religious needs, service users were given the necessary support, to ensure that they were able to continue to practice their faith. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 15 A variety of social activities were provided, the Activities Coordinator organised activities within the home and visits in the community. On the day of the inspection, a number of service users were engaged in music and movement and also a game bingo. Information located on the notice board identified the following activities and entertainment provided: - shopping trips, visits to the local pub, garden centres, belly dancing, key organist, art and craft, hairdresser, morning prayer and holy communion. Discussions with service users and general observations during the process of the inspection, confirmed that service users were able to receive visitors at any time within reason. Service users confirmed that they were able to entertain their guests within the privacy of their bedroom or utilise the communal areas. The conduct of the home promoted service users choice and rights. A warm welcoming atmosphere was present. Service users had freedom of movement throughout the home with some limitations due to health and safety and to respect fellow service users privacy. Menus identified a well balanced diet was provided, an alternative choice was also reflected on the menu in view of the individuals likes and dislikes. One service user informed the Inspector that some meals were “not up to standard,” it as been identified has a recommendation that this should be monitored. Discussions with the Deputy Manager confirmed that there were no special dietary requirements with regards to cultural or religious needs. Care plans identified a nutritional assessment for the individual service user. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 16 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 (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. The quality in this outcome area is ‘good.’ This judgement is based on the examination of the homes complaint procedure, discussions with service users and information obtained from the pre inspection questionnaire. There was a complaints procedure in place. The homes recruitment and selection process ensured that the appropriate checks were undertaken to ensure the protection of service users. EVIDENCE: Information relating to how to make a complaint was located within the Statement of Purpose and the Service User Guide; the complaints procedure was located within the main entrance of the home. Discussions with service users and information received from service user comment cards confirmed that not all service users were aware of how to make a complaint. The Registered Manager should ensure that all service users are in receipt of copy of the homes complaints procedure. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 17 The Commission For Social Care Inspection had received one complaint within the last 12 months of which was not substantiated. The home also operated a suggestion box. The examination of staff files evidenced that all new recruitments were subject to the appropriate safety checks to ensure the protection of service users. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 18 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, 23, 24, 25 and 26 Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. The Quality in this outcome area is ‘adequate.’ This judgement has been based on available evidence including a tour of the home. The home was warm, comfortable and pleasantly decorated; there was a lack of emphasis focused fire safety. EVIDENCE: The home is located in Stourbridge, Staffordshire, off the main A449 near to the village of Kinver. The property was well maintained, the examination of records identified that the home had a ‘rolling programme’ for redecoration and future plans to provide alternative dinning room chairs. On the day of the Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 19 inspection the handy person was observed undertaking general maintenance of the property. Specialist equipment was provided within the home to promote service users independence, general observations by the Inspector, identified that staff used these equipments appropriately when assisting service users. Bedrooms that were inspected evidenced that service users were encouraged to personalise their bedrooms to reflect their interests and character. Bedrooms doors were not fitted with a locking device to promote the total privacy of service users or to protect their personal belongings. It as been identified has a requirement within the contents of this report that a locking device as recommended by the Fire Safety Officer should be fitted to bedroom doors. The home provided a large communal dining room, which had recently been decorated. Service users that utilised the ‘Butlers Pantry’ lounge did not have appropriate means of alerting staff if and when required. The Registered Manager should review the call system within this area. Sluicing facilities were provided; it is recommended that these areas be secured when not in use. The previous inspection report identified a requirement relating to the inappropriate practice of wedging fire doors open. During the process of this inspection, a number of fire doors were wedged open by either a piece of furniture or wooden wedges. It is recommended that after consultation with the Fire Safety Officer, alternative adaptations should be fitted to the fire doors. Prestwood (Main House) Nursing Home DS0000022361.V316702.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 Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is ‘good.’ This judgement has been base on the examination of records and discussions with staff members on duty. Staff were recruited appropriately to ensure the safety of the service users. Training provided for staff was relevant and benefited the service users at Prestwood House. EVIDENCE: The examination of the homes recruitment and selection process evidenced that staff were subject to appropriate safety checks to ensure the protection of service users. Files pertaining to staff working within the home that were examined, identified that insufficient documents were maintained with regards to the individuals identity. A recommendation has been identified within the contents of this report, that all staff records should be reviewed to ensure that the required documents are maintained. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 21 Records evidenced that staff had received mandatory training, discussions with the Deputy Manager identified that training had recently been commissioned for Dementia Awareness. The examination of minutes of staff meetings evidenced that they were well attended. Information obtained from the pre inspection questionnaire identified 45.3 of the staff team had achieved the National Vocational Qualification; it was projected that by August 2007, 66.7 of the staff team will have obtained this qualification. Staffing levels were satisfactory on the day of the inspection. Qualified nurses were responsible for each shift, over a twenty-four hour period. Ancillary staff and other carers supported them. Discussions with staff confirmed that their training needs were identified within their supervision sessions. Prestwood (Main House) Nursing Home DS0000022361.V316702.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): 31, 33, 36 and 38 Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. The quality in this outcome area is ‘poor.’ This judgement has been based on available evidence, including a review of records and discussions with staff. The management of the home was not robust to ensure the appropriate practices with regards to health and the safety of the environment. Prestwood (Main House) Nursing Home DS0000022361.V316702.R01.S.doc Version 5.2 Page 23 EVIDENCE: The Registered Manager was not present on the day of the inspection, the previous inspection report identified that she was an experienced, professional and of good character. General observations during the process of the inspection evidenced that service users were comfortable within their environment and that staff members were well supported within their respective roles. The management of the home was not robust to ensure the appropriate practices with regards to health and the safety of the environment. A number of requirements have been identified within the contents of this report relating to the safe handling of medicines and environmental factors to promote the health, safety and welfare of service users. Records for the monthly testing of the water temperatures were current only until September 2006. The Deputy Manager informed the Inspectors that the home had been experiencing problems with the mains water supply. The water temperature within the bathroom located on the ground floor, was tested, the temperature was 50oC. The maintenance person was informed at the time of the inspection. The Registered Manager is required to ensure that all water distribution temperatures accessible to service users are maintained at 43oC. The examination of records evidenced that door guards were checked on a monthly basis. As previously identified within the contents of this report fire doors were wedged open, preventing the closure of doors in the event of a fire. Prestwood House do not undertaken checks on the emergency lighting, the home had a generator of which was checked/serviced on contract. Information contained within the fire log were current, the Deputy Manager informed the Inspector that the Registered Manager was in the process of completing a service user risk assessment. The Registered Manager should ensure that the fire risk assessment incorporates information relating to the new fire regulations. With reference to quality assurance, the home distributed questionnaires to service users and relatives to establish their views and opinions with regards to the service and provisions provided within the home. Consideration should be given in distributing questionnaires to the stakeholders of the home. Records were maintained of accidents within the home, information of which was collated on a three monthly basis. Prestwood (Main House) Nursing Home DS0000022361.V316702.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 2 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 2 3 2 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 1 Prestwood (Main House) Nursing Home DS0000022361.V316702.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 OP38 Regulation 23 (4) Requirement Door wedges to be removed from all fire doors to prevent them closing to ensure the safety of the service users and staff. (Outstanding from 16/02/06) Locking devices as approved by the Fire Safety Officer should be fitted to bedroom doors. To ensure the safety of service users toiletries should be kept within service users bedroom or maintained securely. The registered person should ensure that service users occupying the ‘Butlers Pantry’ lounge have access to the nurse call alarm. The registered person should ensure that service users are in receipt of a copy of the service user guide. With reference to the homes assessment process. The registered person should confirm in writing to the prospective service user or their representative, the homes DS0000022361.V316702.R01.S.doc Timescale for action 02/01/07 2. 3. OP24 OP26 12(4)(a) 13(4)(a) 23/03/07 10/01/07 4. OP22 16(2)(c) 10/01/07 5. OP1 5(2) 01/02/07 6. OP3 14(1)(d) 10/01/07 Prestwood (Main House) Nursing Home Version 5.2 Page 26 7. OP9 13(2) suitability to meet their identified needs with regards to their health and welfare. The registered person should 10/01/07 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. To ensure the robustness of the homes medication practices, promoting the safe handing and safe keeping of medicines. Boxes containing Parcetamols and CoCodomal should be left intact to prevent tablets being placed in the wrong boxes. The home should cease from the practice of storing additional supplies of medication for the identified General Practitioner. Appropriate advice should be obtained from the Pharmacist Inspector, for the Commission For Social Care Inspection or the homes dispensing Pharmacist. A copy of the complaints procedure should be issued to each service user. In the interest of infection control spare toilet tissue should not be stored on the toilet cistern. Terry towels should be replaced with disposable towels within communal hand wash areas. The registered person should ensure that water distribution temperatures are maintained at 43oC. The practice of covert administration of medicines should cease. Advice should be sought from the respective DS0000022361.V316702.R01.S.doc 8. OP9 13(2) 10/01/07 9. OP9 13(2) 02/03/07 10. 11. OP16 OP26 22(5) 13(3) 01/02/07 02/02/07 12. OP38 13(4)(a) 10/01/07 13. OP9 13(2) 10/01/07 Prestwood (Main House) Nursing Home Version 5.2 Page 27 General Practitioner for alternative methods. 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 OP19 OP1 Good Practice Recommendations To promote the safety of service users, it is recommended that the sluice room should be secured when not in use. The Statement of Purpose should be reviewed to provide up to date information relating to the fees chargeable and the text relating to the National Care Standards Commission. The contract of residency should be reviewed to incorporate the fees charged. Consideration should be given in reviewing the homes registration certificate, with regards to the number of service users diagnosed with dementia. It as been identified has a recommendation in this instance, that care plans should be reviewed on monthly basis to reflect the changing needs of the service user. It as been identified has a recommendation in this instance, that the identified care plan should incorporate a risk assessment for the use of bed guards. It is recommended that staff who are responsible for the administration of medicines are ‘competency assessed.’ In view of the comment made by one service user with regards to the quality of meals provided, consideration should be given in monitoring the food offered. It is recommended that staff files are reviewed to ensure that the appropriated documents are maintained on file. The registered person should ensure that the homes fire risk assessment incorporates the new fire regulations. 3. 4. 5. 6. 7. 8. 9. 10. OP2 OP1 OP7 OP7 OP9 OP15 OP29 OP38 Prestwood (Main House) Nursing Home DS0000022361.V316702.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 (Main House) Nursing Home DS0000022361.V316702.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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