Inspection on 12/12/07 for Priestley Rose

This inspection was carried out on 12th December 2007.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Priestley Rose 27/06/07

Priestley Rose 19/12/06

Priestley Rose 31/05/06

Similar services:

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

Aston Court Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Priestley Rose 114 Bromford Lane Erdington Birmingham West Midlands B24 8BY Lead Inspector Ann Farrell Key Unannounced Inspection 12th December 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 Priestley Rose DS0000067126.V355755.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. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priestley Rose Address 114 Bromford Lane Erdington Birmingham West Midlands B24 8BY 0121 373 0134 0121 386 5153 adrian@macccare.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) MACC Care Limited Mr Adrian Augustyn Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered to accommodate 45 older people. Registration category 45 OP. That the home may accommodate up to five service users between 60 - 65 years of age for the reason of nursing care. 27th June 2007 Date of last inspection Brief Description of the Service: Priestley Rose is a large two storey detached property that was built in the 1940s and has been extended and converted to provide accommodation for 42 elderly residents who require general nursing care. The home is situated on a main route into Birmingham City centre and there is easy access to bus routes. The home provides off street parking for a small number of cars and there is a small garden to the rear of the property, which is enclosed and accessible to wheelchair users. The home offers a choice of single or double rooms over the two floors that are equipped with call bell and wash hand basin. Recently a further three single bedrooms with en-suite facilities have been provided within the building. There are 3 lounges and one dining room over the two floors plus a well-equipped snoozlem room, which can be used for relaxation purposes. A passenger lift enables access to all areas of the home and there is a range of equipment for moving and handling residents who have mobility problems. In addition, the home has equipment to aid pressure relief for residents who may be at risk of developing pressure sores. A notice board was available on entering the home with a range of information including the inspection report, but the service user guide was not available. Therefore prospective residents and their representatives would need to request information about the services, facilities and fees Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of an inspection undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. The inspection was conducted over one day commencing at 8.30 am and the home/provider did not know we were coming. The manager was present for the duration of the inspection. Information for the report was gathered from a number of sources: on the day of inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home. There was conversation with managerial and care staff plus visitors and some residents. Some residents were unable to communicate their views verbally to the inspector so direct and indirect observation was used to inform the inspection process. Three residents who live in the home were’ case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Verbal comments were also received from residents, relatives and health professionals, which were all positive. One resident stated, “It has improved 100 ; It’s much Better”. What the service does well: Visiting was flexible enabling residents to maintain contact with friends and relatives at a time that suits them. Residents clothing was clean and well pressed, so respecting their dignity. Residents could take some furnishings, pictures, ornaments etc. into the home, so providing a more homely environment. Residents were able to follow their chosen religion, so meeting their spiritual needs. One of the residents stated they received communion regularly in the home. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 6 The medication system was of a good, standard so ensuring residents receive the medication prescribed to them. Feedback from visitors was good they stated the home was clean when they visited, the staff were polite and the manager was pleasant. They stated their relative, who is residing in the home, was happy and they had put on weight since they had been there. Residents stated they were happy and the food was good. Staff recruitment was of a good standard so ensuring residents were protected by the recruitment process. What has improved since the last inspection? Residents were well presented and there was greater attention to aspects of personal care, so resident’s needs were being met. One resident stated “It has improved 100 ; Its much better”. There has been a great improvement in the care planning and recording systems, so residents needs are identified and systems put in place to ensure they are met. Feedback from visiting health professionals was good. They stated staff referred appropriately so that a plan of care could be implemented for residents, they were very caring and willing to improve areas. This ensures residents health care needs are being met and outcomes improved for residents. Staff have undertaken a range of training and this is ongoing which provides staff with the skills and knowledge to care for residents. There had been an improvement in the quality of the meals and they are managed appropriately, so enhancing the dining experience for residents and ensuring they receive a nutritious diet. There had been improvements in the systems for dealing with concerns and complaints and suggestions from visitors were being actioned. This ensures an open approach and provides confidence to residents and visitors that their views are listened to. An activity co-ordinator had just been employed to develop a programme of activities and so provide appropriate activities and stimulation for residents. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 7 A new assisted bathing facility had been fitted and bathroom facilities up graded to enhance bathing facilities for residents. The sluicing facilities have been upgraded, so improving the arrangements in respect of infection control to reduce the risk of infection. Some new chairs, seating and pressure relieving equipment had been provided, so ensuring residents have a suitable equipment to meet their needs. Work had started on landscaping the grounds of the home, so improving the environment for residents. Health and safety arrangements had improved, so that people live in a safe home” 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. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 8 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 Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 9 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): 1,2.3.6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The collection of information about residents needs before they move into the home was satisfactory, so that staff can determine if prospective residents needs can be met. The information for prospective residents needs to be made available in accessible formats, so they have sufficient information to make an informed decision about moving into the home. EVIDENCE: The home admits residents for long-term care and respite care. At the time of visiting there was no information available about the services and facilities offered for visitors or prospective residents. This information should be available on entering the home to enable easy access so that informed decisions can be made about moving into the home. Also consideration should Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 10 be given to producing the service user guide in alternative formats to make it more accessible and meet the needs of residents in the home. The manager undertakes a pre admission assessment for all prospective residents to determine if the home is able to meet their needs and an assessment document was completed. These were found to be of a satisfactory standard, so ensuring staff have adequate information to determine if they are able to meet residents needs before they enter the home. This also provides confidence to the prospective residents and their relatives that their needs will be met when moving into the home. The home has developed a contract for residents entering the home. It was stated that it was not used for residents who were funded by Social Care and Health. On inspection it was noted that it did not provide full information about arrangements for fees. This will need to be addressed to ensure residents and their representatives are aware of the terms and conditions of their stay in the home. A copy of the terms and conditions of stay should be made available to all residents and a copy retained in their file in the home. Priestley Rose DS0000067126.V355755.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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements were in place to meet resident’s health and personal care needs and ensure their well-being. Medication systems were of good standard ensuring residents received the medication prescribed to them. EVIDENCE: Following admission to the home a nursing assessment and risk assessments were completed in order to obtain adequate information to write a care plan. Care plans should outline in detail the action required by staff to meet resident’s needs. On inspection of a sample of records they had improved considerably since the last inspection. Staff had undertaken a considerable amount of work on them and they were of a good standard generally. They indicated areas of resident’s preference were comprehensive in the main and gave staff detail of complications to observe for. In one case it was noted that the details of a residents dressing had not been included and in another case details that a resident was underweight had not been included. This was discussed with the manager to highlight the issue, so that all areas are Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 12 included in the future. The care plans were reviewed monthly and the information was of a good standard, so that it could be determined where there had been any changes in resident’s condition. There had also been an improvement in the quality of the daily records indicating the type of day the residents experienced and there was also the facility for care staff to record any areas of concern or action taken. The staff are to be commended on the hard work they have put into bringing the care plans up to a good standard. All residents were registered with a local GP practice and residents may choose from any of the local practices who visit the home. It was stated that there were regular visits by the chiropodist, dentist and optician and this was confirmed on the sample of records inspected. It was stated that staff would liaise with other health professionals as required and this was evidenced as there were records to demonstrate that the physiotherapist, dietician, speech and language therapist and the falls co coordinator had been involved in residents care. On discussion with some staff they stated the nurses were approachable. If they had any concerns the nurse would be informed and they would check the residents immediately, to determine what action was required. A specialist nurse was visiting at the time of inspection and she stated that staff had referred appropriately, a treatment plan had been agreed and staff were very caring. Whilst touring part of the home it was noted that bed safety rails were in place on beds. However, in some cases when used with pressure relieving equipment they were not of a sufficient height to prevent risks and risk assessments did not specifically cover this area. This area will need to be reviewed and appropriate action taken to ensure residents remain safe. One entry some time previously indicated that a resident had a bruise to their eye and the GP was called. The records did not indicate any accident or incident and there was no evidence of any investigation to determine the cause. On discussion with the manager he stated it was not a bruise, but a dark patch of skin under the eye. Staff must ensure that when records are made they give clear descriptions, so that no confusion arises in the future. Some records in relation to pressure relief for residents indicated that it was undertaken regularly during the night, morning and early afternoon, but there were gaps during the evening time. This was discussed with the nurse at the time of inspection and also with the manager at the end of the inspection, so that action could be taken to address the shortfall and ensure appropriate pressure relief is undertaken over the 24-hour period to prevent the occurrence of pressure sores. Some of the care plans did not clearly indicate the arrangements for oral care especially for a resident who had a feeding tube. It was also noted that they had a “furred tongue”, which may suggest an infection or lack of oral care. These issues were discussed with the manager, so that they could be followed up and action taken to ensure all residents receive appropriate oral care as required. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 13 Some residents had diabetes and their blood sugars were monitored by staff in the home on a regular basis. However, there was no evidence that there was any monitoring of chronic diseases by medical professions such as diabetes, high blood pressure, asthma etc. in order to reduce the risk of complications. This area will need to be followed up with relevant GP practices, to ensure resident’s conditions are monitored effectively and any necessary action taken to prevent complications occurring. During inspection it was noted that staff were moving some residents from one area to another in recliner type chairs. Records indicated that less than half the staff had received training in respect of manual handling. This has implications in respect of manual handling and should be reviewed to ensure safety of staff and residents. At the last inspection concerns were raised about end of life care for a resident. The staff in the home have been working closely with a member of staff from one of the hospices and feedback from them indicated the staff were very willing and keen to improve outcomes for residents and support was being given to them. However, staff still require training in respect of syringe drivers and the manager stated that they were hoping to address this in the near future. Currently there are two residents in the home whose first language is not English. Currently the home relies on visiting relatives to communicate and use some basic signs. However, this can present some problems with communication. It was stated that they had advertised for staff with skills to communicate with the residents effectively, but they had been unsuccessful. The manager must ensure there are suitable communication systems in place for these residents to ensure their needs are met effectively. The medication was stored in a medication trolley within a locked room on each floor. Storage was observed to be clean and organized so that medication could easily be located. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. On inspection of the medication for the current month it was found to be of a good standard and all audits were correct. The temperature of the medication fridge was recorded regularly. However, staff will need to record the minimum, maximum and current temperature at lest once a day to ensure medication is stored within the correct temperature and is suitable for use. Residents were well presented and dressed appropriately for their gender, age, culture and time of year. Feedback from residents and relatives was positive. One resident stated, “Things have improved 100 ; its much better. On Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 14 discussion with relatives they stated their relative was putting on weight, the home was clean, they looked much better and had improved during the time in the home. They reported that their relative had told them they were very happy. This was very positive and staff are to be congratulated on the improvements since the last inspection. Resident’s privacy was observed and staff knocked on doors before entering. Residents were able to choose what to do and where to spend time. Residents who wished to spend time on their own in their rooms were able to do so and there were a number of areas where residents were able to receive visitors in private. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Visiting is flexible enabling residents to maintain contact with friends and relatives. The arrangements for meals were suitable for meeting both resident’s dietary and social needs. Arrangements for social activities need further development. EVIDENCE: Arrangements for visiting were flexible enabling relatives to visit at a time that suited them and residents to maintain contact with them. There were no rigid rules in the home. Residents were able to make choices and spend time as they wished e.g. they could get up; go to bed when they wished, they could spend time in their own rooms or in communal areas. Residents were able to bring personal items of furnishings etc. into the home to reflect their personal taste and interest and some bedrooms had been personalised providing a more homely environment. At the last inspection it was identified that there was very little in respect of activities or stimulation for residents and this remains generally unchanged. During the inspection there was no evidence of activities, residents sat in lounges or their bedrooms with the television on and some stated they were Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 16 bored. An activity co-ordinator had just been employed and she was talking to some residents. On discussion with her she talked about arranging some activities, but was advised that she would need to undertake an assessment of residents needs and preferences initially, so that a suitable programme of activities could be implemented and residents are adequately stimulated. The hairdresser visits the home on a regular basis and ministers of various religions visit at residents request, so meeting residents spiritual needs. On discussion with one resident it was stated that the minister visited and gave communion on a regular basis. The home employs separate catering staff who provide breakfast, lunch and evening meal. A four-week rotating menu was available that provided a choice of two main meals. The menu also indicated alternatives were available if residents did not want either of the main choices. Staff are now asking residents their choices on a daily basis. On discussion with a number of residents they stated the food was good and they enjoyed it. It was noted from records and discussion with relatives that residents had put on weight since entering the home. Special meals such as diabetic and puree were catered for. However, there were some residents from an Afro Caribbean and Chinese background and consideration will need to be given to providing cultural appropriate alternatives to meet the needs of these residents. The dining room was light, airy and pleasantly decorated. Tables were laid appropriately with tablecloth, condiments etc. The meals were well presented, residents were treated respectfully and meals were not rushed. The inspector had lunch with the residents and found the meal to be a pleasant unrushed experience. Carers were observed to offer discreet and sensitive assistance to residents. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures need further development to ensure all complaints and concerns are properly dealt with and staff have the knowledge and skills to ensure residents are protected” EVIDENCE: The home has a suitable complaints policy and the manager was in the process of developing the safeguarding procedures. There was a copy of the local guidelines for safeguarding residents in the office and on the notice board in reception, so that information and contact details were available to every one if there were any concerns. On inspection of the safeguarding policy and whistle blowing policy some minor adjustments were required to ensure it was clear about the investigation of an allegation. The manager showed the inspector the record of complaints, which indicated no complaints had been received since the last inspection. There was evidence that relatives had made some suggestions and action had been taken based on their comments. This was positive as it showed a commitment to working with residents and their visitors to improve the service provided. The Commission received information about one referral that had been made to the adult protection unit via a social worker following concerns expressed by a relative. Similar concerns were raised with us. This is currently being dealt with under Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 18 the adult procedures. Care must be taken to record all concerns and complaints raised in the future with the action taken to address the concerns. On discussion with a sample of staff they were aware of their roles and responsibilities in order to safeguard residents. The information about staff training indicated that a number of staff still required training in this area and the training had been planed for later in the month. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 19 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): 19,21,23,26 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the home’s physical standards are on going, so improving the environment for residents. EVIDENCE: The home is registered to provide care for forty-five residents. On the days of inspection the home was warm, clean and odour free. There was a small garden to the rear of the premises with wheelchair access and some benches for residents to sit, when the weather permits. Some of the windows had been painted, but some remain outstanding and this will need to be addressed in order to improve the environment and extend their life. Work had commenced on landscaping the surrounding grounds. There is a mixture of single and double bedrooms. Three bedrooms have ensuite facilities consisting of toilet and wash hand basin and one has a shower facility. All bedrooms have a call bell to summon assistance if required and Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 20 wash hand basin. A sample of rooms were inspected and it was noted that the lighting required attention as some rooms did not have over bed lighting to enable residents to switch the light on, when in bed. Some of the commodes had been replaced, but it was noted that some seats were damaged and the foam was exposed and poses a risk of infection. An audit of all commodes should be undertaken and any damaged items replaced. The radiators are in the process of having covers fitted to protect against the risk of scalding. All bedrooms had two double sockets and a television aerial, so providing adequate sockets for electrical equipment. There were five communal bathing facilities, one of which is currently used for storage. A new assisted bathing facility has been provided in one of the bathrooms with toilet and wash hand basin, so enhancing the facilities for residents. There was a choice of bath or shower on each floor. There were a number of toilets situated around the home and partitioning had been provided to enhance privacy. Some of the toilets were not suitable for residents with mobility problems to access who require equipment, due to restricted space, and this was confirmed on discussion with staff. This area will need to be reviewed to ensure suitable toilet facilities are available for all residents. All areas were individually and naturally ventilated and windows were provided with restrainers for safety and security reasons. Water from hot water outlets is regulated via the boiler thermostat, as there are no individual thermostats on hot water outlets. Some of the water was hot to touch in the opinion of the inspector. On inspection of the records of water testing they were found to be satisfactory. The manager must ensure the water that is stored and circulating is maintained at the correct temperature to reduce the risk of legionella and water from all outlets is maintained at 43 degrees plus or minus 1 degree. On touring the home it was noted that some of the doors were propped open and this may pose a fire hazard. If doors are to be kept open for any reason they must be linked into the fire alarm system. The stairs leading from the ground to first floor has a handrail along it, which provides partial enclosure and could pose a risk to some residents. This was identified at the time of registration of the home and remains unchanged. A risk assessment must be undertaken and action taken if a risk is identified in order to protect residents. Separate sluice facilities were situated on each floor and since the last inspection a sluice disinfector and disposal machine have been installed in one of sluices, so improving infection control procedures in the home. The manager was waiting for the racking to be fitted and the area to be redecorated. On inspection of the kitchen it was found to be orderly. Fridge, freezer and hot food temperatures had been recorded intermittently and were satisfactory, so ensuring adequate food safety. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 21 Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were adequate to meet resident’s needs. Robust recruitment procedures were in place; so ensuring residents were protected by the recruitment of new staff. EVIDENCE: There were forty residents in the home at the time of inspection. The manager works on a full time basis and is supernummary. Staff duty rotas indicated there were two nurses on each shift during the day with seven to eight carers in the morning and six carers in the evening. Overnight there was one nurse plus four carers. These levels appeared satisfactory to meet the current residents needs and feedback from residents and relatives was positive indicating that standards of care had improved. Separate domestic, laundry, catering, maintenance and administration staff supported care staff. A small number of staff files were inspected to determine the recruitment process and it was found to be of a good standard, so protecting residents when new staff are employed. There was no up to date record of nurse’s registration numbers. The manager will need to ensure that these are checked on a regular basis and records are retained in the home to demonstrate that they are registered to work as nurses. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 23 Approximately 25 of care staff had completed training to NVQ level 2, so providing them with the knowledge and skills to meet resident’s needs effectively. The manager is a qualified first aid trainer, one of the nurses is a qualified manual handling trainer and the manager from the organisations other home is a qualified trainer in respect of safeguarding. The services of an outside agency have also been secured to provide staff with a range of updated core training e.g. infection control, fire safety, basic food hygiene, dementia etc. Further dates have been identified for training to be provided to staff in order to provide them the skills and knowledge to care for residents. To date the home has used an induction programme that is based on the homes policies, procedures and routines. However, it does not meet the standards of the Social Skills Council, as it does not cover a number of standards. This needs to be developed further to ensure newly employed staff receive training initially to enable them to undertake their role effectively. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 24 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): 31,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The views and opinions of residents were sought and acted upon, helping to ensure that residents felt their voice was heard. Suitable systems were in place and the health and safety of residents was promoted and protected through regular maintenance and servicing of equipment. EVIDENCE: A manager has been registered with the Commission since the last inspection and he is currently undertaking the Registered Managers Award. He is a registered nurse with several years experience. Since the last inspection the manager has been undertaking an appraisal with individual staff and is to set up a system of formal staff supervision once this is completed. He has reviewed and updated all the policies and procedures. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 25 Staff meetings were held between one and three monthly, staff stated they could contribute to the meeting and if they were unable to attend a copy of the minutes were available in the staff room. This helps to improve team working and communication. The manager stated he hoped to have a staff meeting every month in the coming year. There was one meeting with relatives earlier in the year. There have not been any residents meetings, but he stated he talked to residents on a daily basis and this was confirmed thorough observation and on discussion with a member of staff. There was no evidence that these discussions took place and the manager may wish to consider how to evidence this. Staff felt they were now working as a team, they got on well and things had improved in the home. It was positive to hear that team working had improved as this can have a great impact on residents care. The home does send out questionnaires to relatives on a regular basis to gain feedback about the service and on inspection of them it was noted that feedback was generally good. However, the documents were not dated and it could not be verified when this occurred. The owner visits on a weekly basis and is writing reports on his findings in the home. The manager stated that he would be sending out questionnaires in the New Year and it was suggested that feedback should be sought from other stakeholders also to enhance the quality assurance process. The manager undertakes audits in respect of accidents in order to identify any trends to enable action to be taken. The manager stated the home does not hold personal money or valuables on behalf of residents and it was stated that families would be invoiced for any extra costs such as chiropody, hairdressing etc. Samples of records were inspected in relation to maintenance/servicing of equipment and were found to be up to date, so safeguarding resident’s health and safety in the home. The services of a company have been secured to assist with further developing risk assessments etc. to enhance health and safety aspects in the home. Priestley Rose DS0000067126.V355755.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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X 2 X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 13(4) 17(2) Requirement Suitable arrangements must be in place to ensure all bed rails are of a suitable height when pressure-relieving equipment is used on the bed, so reducing the risk of any accidents. Regular checks must be implemented in respect of the bed safety rails to ensure they are fit for purpose and suitable to meet resident’s needs, so preventing accidents. Timescale of 30/1/07 and 30/6/07 not met. Suitable communication systems must be in place to enable communication with residents whose first language is not English. All staff must ensure that all concerns/complaints are reported and recorded to ensure issues are addressed and learning is achieved in order to prevent further re occurrences. All staff must complete the core training to include basic food hygiene, infection control, DS0000067126.V355755.R01.S.doc Timescale for action 10/01/08 2 OP8 12(1) 10/03/08 3 OP16 22 10/03/08 4 OP30 OP18 18(1) 30/04/08 Priestley Rose Version 5.2 Page 28 moving and handling, fire safety, safeguarding etc, to ensure staff have suitable knowledge and skills to care for residents. 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 OP1 OP2 Good Practice Recommendations The service user guide should be made available to visitors and consideration should be given to providing it in alternative formats, so that it is accessible to all residents. Evidence that the people using this service or their representatives have been issued with a contract/statement of terms and conditions of residence at the point of admission to the home must be kept, so that it can be assured that they are aware of the terms of their stay in the home. Care must be taken when making any recording to ensure the clearly and accurately indicate the findings. All nurses should undertake training in respect of the use of syringe drivers to ensure they have the appropriate knowledge to manage them when required by a resident in the home. (Carried forward) A review of the arrangements for moving residents in recliner type chairs should be undertaken and appropriate action taken to ensure residents and staff safety. Systems must be in place to ensure all residents receive adequate oral care to prevent the risks of infection. Systems should be in place to ensure monitoring of chronic diseases such as diabetes, high blood pressure, asthma etc. to ensure residents health status is maintained and complications prevented. The minimum, maximum and current temperature of the medication fridge should be recorded to ensure all medication is stored within the correct temperatures and is suitable for use. A suitable activity programme should be drawn up based DS0000067126.V355755.R01.S.doc Version 5.2 Page 29 3 4 OP7 OP8 5 6 7 OP8 OP8 OP8 8 OP9 9 OP12 Priestley Rose 10 11 12 13 14 15 16 OP15 OP19 OP19 OP24 OP25 OP25 OP28 17 18 OP29 OP30 19 OP33 20 OP36 on resident’s interests and preferences to ensure they receive adequate stimulation. Arrangements should be in place to provide culturally appropriate meals to residents where appropriate. Windows that have been identified as needing painting are painted in order to enhance the environment and life of them. Continue with the programme of refurbishment, so the environment is enhanced. Undertake an audit of all commodes and replace any damaged items. Ensure robust systems are in place to maintain hot water at 43 degrees plus or minus 1 degree to reduce the risk of scalding Ensure lighting can be accessed from beds so that residents can use them if required at night. At least 50 of all care staff should be trained to NVQ level 2 in care to ensure they have the skills and knowledge to care for residents and ensure their needs are met. All nurses PIN registration numbers must be checked regularly to ensure they are registered and can practice as nurses. All new care staff should undertaken induction training that meets the standards of the Social Skills Council to ensure the have adequate skills and knowledge to care for residents initially. The quality assurance process should be developed further to include feedback from residents, staff and other stakeholders and an annual development plan drawn up demonstrating developments for residents and in the service. Formal supervision should be implemented with all staff in order to provide support, identify gaps in knowledge/skills and arrange suitable training. Priestley Rose DS0000067126.V355755.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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