Inspection on 19/12/06 for Priestley Rose

This inspection was carried out on 19th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Priestley Rose 12/12/07

Priestley Rose 27/06/07

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 19th December 2006 08:00 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.V324678.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.V324678.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 240 6181 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 *** Post Vacant *** Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered to accommodate 42 older people. Registration category 42 OP. That the home may accommodate up to five service users between 60 - 65 years of age for the reason of nursing care. 31st May 2006 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 car parking for a small number of cars. There is a small garden to the rear and side 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. There are 3 lounges and one dining room over the two floors plus a well-equipped snoozelem room, which is 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. Currently the home does not have any written information about the services and facilities and information is provided verbally. A notice board is also available on entering the home with a range of information including the inspection report. Fees vary from £388 to £509 per week. Extra charges are made for hairdressing and chiropody. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork inspection was conducted over two days commencing at 8.00 on 19th December. The acting manager was available for the duration of the inspection. During the fieldwork the acting manager, a small group of staff and six residents were also spoken to. The feedback was varied with some stating they were happy living in the home whilst some raised concerns about staff attitude and the standard of care provided. Also there were a number of residents who were unable to communicate verbally. During the inspection process the inspector toured the home, sampled residents files and other documentation. Case tracking was used to determine care for residents from the time of admission to the home plus direct and indirect observation. A random inspection was undertaken in September 2006 when it was identified that many of the requirements from the last key inspection remained outstanding in respect of aspects of care. A complaint was also investigated in respect of the homes recruitment process and provision of food, which was found to be satisfactory and the complaint was not upheld. The home has been through a rather difficult time since the company took over earlier this year with a large number of existing of staff from all grades leaving the home over a short period of time. At the time of inspection the manager had terminated her employment and there appears to have been a lack of leadership within the home. A new manager had been appointed and had only been in post for approximately three weeks. The proprietors have received a number of complaints about aspects of care and staff attitude over the previous months, which have been investigated and some areas have been upheld. The proprietors are currently working to address the issues. Following this fieldwork inspection many requirements remained outstanding and further issues were identified. The Commission held a review and wrote the proprietors regarding areas of concern including aspects of care, medication, staff training, cleanliness and servicing of equipment. A meeting was held with the proprietors and they have agreed to suspend all admissions until there are improvements in the home. They have proposed an action plan indicating the strategies to be implemented to address the issues. Birmingham Social Care and Health are aware of this and they have stated they will undertake a review of all residents currently in the home. What the service does well: The home has taken over by a new organisation earlier this year who are committed to improving the environment and standards of care provided. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 6 Visiting was flexible enabling residents to maintain contact with friends and relatives at a time that suits them. The meals were of a good standard with residents stating they enjoyed them and they received adequate portions. On discussion with the majority of residents they stated the service was “alright” and they had no complaints What has improved since the last inspection? What they could do better: There has been little development since the previous inspections and many of the requirements still need to be addressed for the home to comply with legislation and meet resident’s needs. Staffing levels need to be consistently maintained at an appropriate level to ensure all resident’s needs are fully met Trained nurses need to extend their knowledge base and take more responsibility in order to support the manager and develop good practice that is implemented by care staff to ensure resident’s needs are met in the most appropriate manner. There needs to be a more pro-active approach to care with monitoring and early detection of any problems and referral to appropriate health professionals where appropriate to prevent further complications. The medication system needs to be more robust to ensure residents receive the mediation that has been prescribed by medical staff. The assessment and care planning process needs to be enhanced to ensure resident’s needs are identified and appropriate plans of action put into place to meet their needs. Records need to clearly indicate the care given and interventions undertaken. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 7 Systems need to be put into place to improve communication and ensure all staff are aware of residents needs and what action is required to meet them. Staff training is required to ensure staff have the appropriate skills and knowledge to care for residents and fully meet their needs. Records of the training completed by staff must be available to demonstrate the training completed. Staff recruitment procedures need to be more robust to ensure residents are protected by the procedure. The systems for dealing with concerns and complaints needs to be reviewed and a more pro-active approach taken to ensure residents are adequately protected and learning from complaints can be put into practice. A small minority of residents raised concerns about some staff’s attitude and the lack of response to requests which results in their basic needs not being met. Further improvements in infection control procedures, cleaning and odour control are required with staff training, practices and equipment to reduce the risk of cross infection. Further re-decoration/refurbishment and repairs need to be addressed to enhance the surroundings or residents. The quality assurance system needs to be developed and where residents or stakeholder’s identifies any issues must be taken to address them. 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.V324678.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.V324678.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The information about the services and facilities provided in the home has not been sufficiently developed to enable prospective residents and their representatives to make an informed decision about moving into the home. The admission assessment documents are not completed to a satisfactory standard and therefore it cannot be guaranteed that resident’s needs will be identified and met when entering the home. EVIDENCE: The home provides mainly long-term care for residents who are over 65 years of age requiring nursing care. The current proprietors took over the home earlier in the year and are in the process of developing systems and upgrading the home. Work in respect of information about the services and facilities is in the process of being developed for prospective residents and their families to enable them to make an informed decision about moving into the home. It Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 10 appears that prospective residents currently rely on verbal information and it cannot be guaranteed that they receive full information about the home. The home is also still in the process of producing a contract of residence. These should be given to all residents on admission so they are aware of the terms and conditions of residency relating to the home The staff liaise with social workers who may provide a written care plan for residents entering the home. The manager undertakes a pre-admission assessment of all residents before admission to determine if the home is able to meet their needs. Upon admission a nursing assessment is undertaken which includes risk assessments. On inspection it was noted that pre admission assessments had been undertaken, but in some cases it was not comprehensive. Also the assessment of admission to the home was not fully completed. In some cases the risk assessments gave conflicting information or were not completed appropriately and there was no assessment in respect of continence or mental health where it was identified as a problem. Where assessments are not completed appropriately it cannot be guaranteed that residents needs will be identified and met by staff or risks reduced adequately. Priestley Rose DS0000067126.V324678.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 poor. This judgement has been made using available evidence including a visit to this service. Improvements to care planning, communication and a more pro-active approach to care with early identification of problems and attention to detail are required to ensure resident’s needs are met in a timely manner. The medication system needs to be developed in order to ensure there are robust systems in place and all residents receive the medication prescribed by the G.P. EVIDENCE: When residents are admitted to the home a nursing assessment is undertaken and nurses draw up care plans for all residents, which outlines the action required by staff to meet resident’s needs. On inspection of a sample of records it was noted that they were of a generally poor standard and issues had not been followed up from the pre admission assessment They lacked detail, gave vague instructions, were based only on physical care, some aspects of need were not included in the care plan and a plan of care had not been developed for some areas until some months later. They had been reviewed monthly, but some of the evaluations lacked detail and care plans Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 12 had not been updated to reflect changes. There was no indication that residents or their relatives had been involved in drawing up the care plans to ensure they reflect individual’s needs and aspirations. Nurses and carers write reports in respect of the care residents receive. However, these records were poor and do not provide detail about the residents condition or the type of day they had. On viewing the records it was noted that personal care and baths/showers were not undertaken on a regular basis and this was confirmed on discussion with residents. A full review of care planning and recording needs to be undertaken and action taken to address the shortfalls. The home has a range of pressure relieving equipment for residents who are at risk of developing pressure sores. Staff had liaised with the tissue viability nurse and advice had been given. However, the advise in respect of two hourly turning was not complied with as night staff stated they turned residents every four hours and records indicated there was no pressure relief during the day. Also some of the nurses were not aware of the rationale for a waterlow assessment, which is used to assess residents at risk of pressure sores. Training will be required in this area to provide staff with the skills to meet resident’s needs in this area. Nutritional assessments are undertaken on admission to the home and reviewed on a regular basis and residents are weighed to determine their nutritional status. However, the scales had not been working for two months at the time of inspection, but have since been repaired. The dietician had seen some residents in relation to poor dietary intake and made recommendations, but they had not been included in the care plan and the kitchen staff were not made aware of any special requirements. At the last inspection it was noted that a residents body Mass Index was below 20, which puts them at risk due to poor nutrition. It was recommended that all residents be reviewed and where any issues identified appropriate action taken with referral to health professionals where required. It could not be evidenced that this had occurred and therefore this requirement remains and will be followed up at the next inspection. Failure to comply may lead the Commission to consider enforcement action. Other issues identified include: • Some residents were on fluid balance charts to monitor if they were receiving adequate fluid intake and these were not being completed. • All staff were entering residents room at 8am for a handover report, which impacts on their privacy. The manager discontinued this practice at the time of inspection. • Charts for monitoring resident’s bowel actions indicated that some residents had not had their bowels open for several days and no apparent action had been taken to address issues in relation to possible constipation. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 13 • • • • • • • Some of the bed rails did not have bumpers in place and the acting manager stated he had ordered them to ensure residents safety. Also some bed rails in use with beds with pressure relieving equipment were not high enough and may pose a risk to residents. Some walking frames had worn rubbers on the feet and may pose a risk to residents. An audit of all frames should be undertaken on a regular basis and rubbers replaced where necessary. There were incidents of unexplained bruising and no investigations had been undertaken to determine the cause of the bruising. Some residents were poorly presented e.g. no footwear, wearing damaged stockings/tights, hair not combed, teeth not cleaned and dirty finger nails. Drinks were not accessible to residents. Some residents did not have their spectacles on. It was noted that some staff cancelled the call bell before entering resident’s rooms. There is a risk that they may be delayed and resident’s needs would not be attended to if these procedures were followed. They should be cancelled at the point of origin. Systems need to be reviewed and strategies implemented to ensure more attention to detail and a more proactive approach to care of residents. Also communication systems in the home need reviewing to ensure all staff are aware of residents needs and recommendations of health care professionals are implemented in order to meet residents needs. All residents are registered with local G.P’s and records indicated visits by the G.P. However, there was no evidence of health checks for chronic diseases such as diabetes, asthma, hypertension etc. On reviewing the records of other health professionals visits it was noted that regular visits by the dentist and chiropodist had not occurred. At the last inspection some of the pressure relieving cushions and mattresses were noted to have “bottomed out” and are therefore not suitable for adequate pressure relief. This was not reviewed and has been carried forward. On reviewing records it was noted that staff were finding it difficult to manage the care of one resident and it was recommended that a referral should be made to the social worker and G.P. for advise and support. In addition, there are a number of residents with dementia and staff will need training in this area to provide them with the appropriate skills and knowledge to care for residents. The home uses a monitored dosage medication system and medication is stored correctly. The manager is in the process of obtaining GP agreement for the use of homely remedies. On inspection it was found that a number of areas needed to be addressed. Areas requiring attention include: Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 14 • • • • • • • • • • • The system for checking medication into the home is not fully robust, as they do not receive all prescriptions prior to the medication entering the home. The home has a responsibility to ensure they check all prescriptions, photocopy them and check medication against the prescription when it enters the home. A medication dose had been increased by the GP. The date of change had not been recorded, the increased dose had not been received in the home and staff were signing to indicate the increased dose of medication was being administered. Medication had been administered and not signed for. There was a period when they were without medication for 4 days for one resident A medication trolley with medication on show was found in the corridor and was unattended. Medication should be locked up at all times to prevent residents inadvertently gaining access and putting themselves at risk. The morning medication round was taking up to 11am to complete. This does not give enough time between rounds and this should be reviewed. Some codes had been used for the non-administration of medication and not explained. Some audits of medication were not accurate. Creams had been signed as administered by the nurse and she had not administered them so it could not be guaranteed that residents had received them. Also creams had no caps on the tubes and had not been dated when opened. There is a risk of bacterial contamination if not used within a specific time period. Eye drops were not dated when opened, as they should be discarded after month due to the risk of bacterial growth. The temperature of the fridge was outside normal limits for several months and no action had been taken to address it. On touring the home it was noted that bedroom doors did not have locks and there were no lockable facilities in some bedrooms for residents to store medication or valuables. There is a telephone in the reception area, but it does not provide privacy. Net curtains are provided to windows to enhance resident’s privacy. On discussion with residents comments were variable. Some stated they were satisfied with the care and one resident was observed to be laughing heartily with a member of staff. Some others raised concerns about the poor standard of care from staff plus the lack of response to calls/requests and attitude of some staff. Priestley Rose DS0000067126.V324678.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/poor. This judgement has been made using available evidence including a visit to this service. The meals offered are of an adequate standard, but menus need to be reviewed to include more variety and cultural options to reflect resident’s composition and meet their needs. There is a lack of activities in the home to provide adequate stimulation to residents. EVIDENCE: Visiting to the home is flexible enabling residents to maintain contact with family and friends at a time that suits them. Residents are able to bring personal items of furnishings etc into the home to reflect their personal taste and interest. Residents stated they may get up, go to bed and spend time as they wish. On discussion with some residents they stated they got up and went to bed when they wished. At the last inspection the activities co-ordinator had recently returned from sick leave after a considerable period of time. Although the member of staff remains working in the home she has changed her role and there is currently no activities co-ordinator. There are very limited opportunities for stimulation and this is an area that will need to be developed. On discussion with one resident he stated he was interested in model making and playing his musical Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 16 instrument that he had in the home. Others stated they did get bored at times and on touring the home many of the residents were sitting either watching the television or unoccupied looking into space. This are was discussed with acting manager. The hairdresser visits the home on a regular basis and ministers of various religions visit at residents request. The home employs separate catering staff who cover all three meals. There are three main meals, which includes the option of a cooked breakfast, lunch and evening meal. On inspection of menus it was noted that there was a fourweek rotating menu, there was a choice of meals but there was some repetition, there were no cultural options and the menus had been in use for some time. Diets currently include puree meals and diabetic diets. It appears that residents make their choices of meals a full week in advance, but it is difficult to decide what you would like to eat for a whole week in advance. The home does receive a supply of fresh vegetables and on discussion with residents they stated they enjoyed the meals. At the previous inspection it was recommended the menus and system of ordering be reviewed and this remains outstanding. Residents have the choice where to have their meals. There is a dining room on the ground floor adjacent to the kitchen. If residents wish to remain in their room’s food is transported to the first floor where it is stored in heated trolleys so residents receive hot meals. At the time of inspection the hot trolley was not working properly and this was changed. The inspector had lunch with residents in the dining room. Tables were pleasantly arranged to accommodate four residents. Staff were observed to be helpful, polite and provided assistance appropriately. The meal was hot, there were adequate portions and it was well presented. Priestley Rose DS0000067126.V324678.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 poor. This judgement has been made using available evidence including a visit to this service. The recording system for complaints does not demonstrate staff in the home deal with them appropriately and residents would not be confident that their views are listened to or acted upon. There is a lack of staff knowledge in respect of prevention of abuse procedures to adequately protect residents. EVIDENCE: The home has received ten complaints and the Commission have also received a further seven complaints since the last inspection. Three of the complaints received by the Commission were referred under adult protection procedures, four were referred to the proprietors to investigate and the Commission investigated one. The complaint investigated by the Commission was in respect of lack of Criminal Bureau Checks for new staff and problems with the food. On investigation the regulations were met and the home was addressing the areas satisfactorily. The other complaints were in respect of basic care and staff attitude. The proprietor was responded to those forwarded by the Commission and was investigating the last one at the time of inspection. From the information available it appears the in respect of care and poor staff attitude are founded and the proprietors are working to address the issues. One of the complainants has responded since receiving feedback indicating there had been improvements since the complaint was lodged. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 18 One adult protection issue was not upheld, one in respect of the use of bed safety rails was upheld and the third one is currently being investigated. The complaints received by the home were in respect of aspects of care and staff attitude, but the record in relation to these complaints were not completed appropriately and were not able to demonstrate to the inspector that they had been dealt with appropriately. The proprietors have taken these issues very seriously. Currently they have stopped all admissions to the home and have outlined an action plan to the Commission indicating the strategies they plan to address the issues. A meeting was held with staff and relatives. A comment box is available in reception area for any comments and they are also writing to relatives regularly asking for comments. In addition, they have introduced a staff incentive scheme and nominated staff each month will receive a bonus. At the time of inspection there was no copy of the Local Authority Vulnerable Adult Guidelines outlining the action to be taken in the event of any allegation of abuse. The manager will need to obtain a copy and ensure all staff are aware of the contents. Some staff have recently undertaken training in this area. However, on discussion with some members of staff they were not aware of the procedures and training will need to be provided for all staff to ensure they are aware of the prevention of abuse and the action to take in the event of any allegation. Priestley Rose DS0000067126.V324678.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): 19,20,21,23,24,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Re-decoration and re-furbishment of the home has commenced in order to enhance the homeliness, but considerable work is required to provide residents with a safe homely environment. Aspects in respect of infection control, cleaning and odour management need to be addressed in order to reduce the risk of cross infection. EVIDENCE: The current proprietors took over the home earlier in the year when it was generally in a poor state of décor and maintenance needing total refurbishment. Since then new carpets have been fitted in all areas. They have also purchased some new furniture for bedrooms including drawers, bedside cupboards, chairs, counterpanes, curtains and there is a gradual replacement programme taking place. They have recently been working on the process of changing a ward area into two single and one double room and these were found to be of a good standard. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 20 There are 30 single rooms and six double bedrooms with wash hand basin and call bell, but the bedroom doors do not have locks to enhance privacy. A sample of rooms were inspected and it was noted that the lighting requires attention as some rooms do not have over bed lighting that works and in some cases there are two ceiling lights one of which does not work. It was also noted that some commodes were rusting; radiators were not covered and may pose a risk due to scalding. Some rooms had been personalised according to resident’s preferences. All bedrooms have two double sockets and a television arial. There are five communal bathing facilities, one of which are currently used for storage, but will need to be operational when the home is fully occupied so there are adequate facilities to meet resident’s needs. There is a choice of bath or shower on each floor. It was noted that the ground floor shower did not have a wash hand basin or toilet in the bathroom and the call bell was not accessible to the shower to summon assistance. There are a number of toilets situated around the home. However, some of them require partitioning from ground to ceiling to ensure residents privacy, some do not have a call bell accessible and some are not suitable for residents with mobility problems to access due to restricted space. All areas are individually and naturally ventilated and windows are provided with restrainers for safety and security reasons. Water from hot water outlets is regulated to protect residents from scalding, but water from some outlets was cool to touch and the heating in some areas was not adequate. On touring the home it was noted that some of the doors were not closing properly into the rebates properly and may pose a fire hazard. An audit should be undertaken and appropriate action taken. The stairs have a handrail along it, which provides partial enclosure, but it may pose a risk to some residents and this will need to be reviewed and appropriate action taken. Laundry facilities are situated on the ground floor. On inspection there were two washing machines and dryers. There was no lock on the laundry door and this may poise a risk if residents are wandering around the home. Separate sluice facilities are situated on each floor, but there was no sluicing disinfectors, there was shelving instead of racking for the storage of commode pots, urinals etc, which are not suitable for infection control procedures. Also in some of the areas tiles were damaged or missing and the areas needed decorating. Other areas that need attention to ensure adequate infection control procedures include: • • There were no paper towels and liquid soap in resident’s rooms for staff to wash their hands after supporting residents. Washbowls were found on floor in resident’s rooms. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 21 • • • • On occasions staff were seen walking around the home with gloves on. These should be removed after use and hands washed. The arrangements in place for barrier nursing need to be reviewed. Some areas of the home were not cleaned adequately e.g. raised toilet seats, commodes etc. There were also some isolated areas of odour that need to be addressed. It was recommended that the manager contact the Health Protection Unit in order to provide advice and undertake an audit to enable to home to improve its infection control procedures. There is a small garden to the rear of the premises with wheelchair access and some benches for residents to sit when the weather permits. The kitchen was clean and orderly; areas that require attention to ensure good hygiene practise include recording of hot food temperatures and dating all decanted foods with use by dates. Whilst touring the home it was noted that the cupboard for storage of cleaning chemicals had not been locked. All cleaning chemicals must be stored in a locked cupboard when not in use due to the risk to wandering residents. Also the domestic was using a vacuum cleaner and the cable was stretched along the corridor and could pose a trip hazard to residents walking along the corridor. Priestley Rose DS0000067126.V324678.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 poor. This judgement has been made using available evidence including a visit to this service. A considerable amount of staff training is required to ensure staff have the appropriate skills and knowledge to care for residents. Staff recruitment procedures need to be more robust to ensure residents are adequately protected. EVIDENCE: Currently there are thirty-nine residents in the home. The acting manager works on a full time basis and is supernummary. Staff rotas indicated there are two nurses on duty during the day with six to seven carers during the morning and five carers in the evening. There is one nurse overnight and four carers on duty. However, these levels are not always achieved due to staff sickness and absence and agency staff at utilised when ever possible. In addition, to nursing and care staff there is separate domestic, laundry, catering, maintenance and administration staff. A small number of staff files were inspected to determine the quality of the recruitment process. Although an application form, references and Criminal Record Bureau Check (CRB) had been obtained a number of the references were from friends, colleagues or family. In some cases it stated a verbal reference had been obtained and there was no record of the conversation. This is not appropriate, as at least one reference should be obtained from the previous employer or manager to determine their suitability to undertake the Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 23 job. Also there was no record of interview. It was noted that some staff who had been employed by the previous company did not have a CRB check on file. An audit of all staff files will need to be undertaken and action taken to address any shortfalls to ensure the recruitment process protects residents. There is a good cultural mix of staff to reflect the current resident group There has been a large staff turnover under the previous manager and there was no evidence of induction training for new staff to ensure they have the skills to care for residents initially. A large number of staff have not undertaken the basic core training in respect of manual handling, infection control, basic food hygiene, fire prevention and lack knowledge in these areas. Priestley Rose DS0000067126.V324678.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 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A lack of leadership in the home has resulted in poor management systems and poor outcomes for residents. Prompt servicing and maintenance of equipment will enhance resident’s health, safety and well-being. EVIDENCE: The manager terminated her employment at the home approximately one month prior to the inspection. At the time of visiting an acting manager had been in post for approximately one month. He is a registered nurse with several years experience. He stated he hopes to start the training for the Registered Managers Award in the New Year and apply to the Commission for registration. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 25 A quality assurance process is to be developed in order to monitor standards in the home and implement processes to enable improvement. The proprietor visits the home regularly, but does not write a report on the conduct of the home, which is required under the regulations, and this will need to be addressed. Formal staff supervision is yet to be developed in order to monitor staff progress and review training needs. The home does not hold personal money 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 meeting health and safety standards with the exception of the following: • • • • • • There was no evidence that the call bell system had been serviced. Some pressure relieving mattresses and profiling beds had been serviced. An audit will have to be undertaken to determine if any still require servicing. There was no evidence that wheelchairs had been serviced. Risk assessments were not comprehensive or had not been reviewed in respect of chemicals, fire and the environment. In house testing of fire point’s, emergency lighting and hot water temperatures had not been undertaken. There was no up to date gas safety certificate for the equipment in the kitchen. Priestley Rose DS0000067126.V324678.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 1 1 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 3 1 X 3 1 1 1 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 1 X 1 Priestley Rose DS0000067126.V324678.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 OP1 Regulation 4 Requirement Timescale for action 30/03/07 2. OP1 5 3. OP2 5(1)(b) 4. OP3 14 The registered person will need to enhance and develop the statement of purpose. Timescale of 30/11/06 not met The registered person will need 28/02/07 to develop and enhance the service users guide and ensure it is in line with the updated regulations of September 2006. Timescale of 30/11/06 not met The registered person must 28/02/07 develop the contract of residence, provide a copy to all residents or their representatives and retain a copy on their file ensuring it is in line with the updated regulations of September 2006. Timescale of 30/8/06 not met The registered person must 28/02/07 ensure all nursing assessments are comprehensive and fully completed to include risk assessment for bed safety rails, falls, continence and mental health where appropriate. Timescale of 30/7/06 not met Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 28 5. OP3 18(1) 12(1) 6. OP7 15(1)(2) 7 OP7 17(2) The registered person must 30/03/07 ensure staff undertake training in respect of continence management where necessary and ensure appropriate continent management programmes are implemented. Timescale of 30/8/06 not met The Registered Person must: 30/03/07 • Ensure a robust system of care planning is in operation, which is comprehensive, holistic and provides detail as to how resident’s needs are met. • The care plan should also include a night plan of care. • When drawing up care plans the resident or relative’s involvement must be sought. • Care plans must be regularly reviewed in a meaningful manner and updated to reflect the residents’ changing needs. Timescale of 30/8/06 not met The Registered Person must 30/01/07 undertake a review of the recording systems in respect of nurse’s daily records and carer’s records and implement robust recording systems. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 29 8 OP8 12(1) 17(2) 9 OP8 12(1) 13(1) 10. OP8 12(1) 23(2)(c) The Registered Person must 30/01/07 ensure: • Where it is identified that a referral to a health professional is required staff make the appropriate referral • Staff implement advice given by health professionals. • Where it is required to monitor residents fluid balance, bowel movements etc. accurate records are maintained, they are monitored by staff and action taken where problems are identified. The registered person must: 30/01/07 • Ensure there is a proactive approach to care. • Ensure there are systems in place for early identification of concerns with appropriate follow up and referral to health professionals as required in order to prevent complications. • Liaise with the G.P. regarding monitoring of chronic diseases. Timescale of 19/6/06 not met • All residents are given the opportunity to see a dentist, optician and chiropodist on a regular basis and records are retained in the home. The registered person must 28/02/07 ensure a full audit is undertaken of pressure relieving cushions and mattresses and replace any that have bottomed out Carried forward from 30/6/06 not assessed. Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 30 11 OP8 12(1) 12(4) 18(1 ) 12 OP8 13(4) 17(2) 13 OP8 12(1) 14 OP8 12((5)(b) 15. 16. OP8 OP8 12(1) 3712(1) The registered person must ensure: • All staff are aware of how to approach and interact with residents and how to deal with challenging behaviour providing training in these areas where required. Timescale of 30/6/06 not met • All staff must undertake training in respect of caring for residents with dementia. The Registered Person must: • Undertake an audit of all walking frames and replace any worn rubbers. • Audit all bed safety rails and ensure they are of a suitable height. • Ensure regular checks of walking frames and bed rails and records are retained. The Registered Person must undertake a review of the communications systems in the home and take action to address any shortfalls ensuring all staff are aware of residents needs and how to meet them. The Registered Person must take action to address issues brought up at the time of inspection in relation to staff attitude. The registered person must ensure call bells are answered at the point of activation. The registered person must ensure that where any bruises are noted on residents a full investigation is undertaken and appropriate action taken to ensure there are no reoccurrences and the Commission informed. Timescale of 19/6/06 not met DS0000067126.V324678.R01.S.doc 30/06/07 30/01/07 30/01/07 30/01/07 21/12/06 21/12/06 Priestley Rose Version 5.2 Page 31 17. OP8 12(1) 12(2) 18. OP8 12(1) 13(1) 19. OP9 13(2) The registered person must 30/01/07 ensure all residents receive assistance with personal hygiene to meet their preferences and needs. The registered person must 30/01/07 undertake a review of all current residents in the home and where there BMI is under 20 a referral is made to an appropriate health professional Timescale of 30/6/06 not met The registered person must 30/01/07 ensure there is a fully auditable and robust medication system to include: • The correct administration and recording of all medication. • All codes must be explained. • The home must have a robust system for checking that medication entering the home is what has been prescribed. • Review the current arrangements in respect of creams to ensure they are prescribed, the administration is recorded, they are dated when opened and discarded after specified time period. • Regular staff audits should be undertaken. Timescale of 19/6/06 not met • Eye drops are dated when opened. • The date is recorded when a dose of medication is changed and adequate supplies obtained. • Systems are in place so that the home is not without medication for any residents. • Ensure the drug fridge DS0000067126.V324678.R01.S.doc Version 5.2 Page 32 Priestley Rose 20. OP10 12(1) 12(4) 21 OP10 12(4) 16(2) 16(2)(m) (n) 22. OP12 23. OP15 16(2)(i) temperature is maintained within normal limits. • Medication should not be left unattended around the home. • Review the medication rounds for timing. The registered person must ensure systems are in place to maintain residents dignity with attention to detail to include: • The use of socks, stockings, slippers/shoes. • Oral care. • The use of spectacles. • Accessible drinks. • Hair combed and neatly arranged etc. The Registered Person must ensure arrangements are in place for residents to make and receive phone calls in private. The Registered Person must ensure all residents have access to a range of recreational activities to meet their needs, preferences; past lifestyles and cultural backgrounds and records are retained in the home to demonstrate this. Timescale of 30/7/06 not met The registered person must: • Ensure menus are reviewed with residents and cultural options included. • Review the current arrangements for ordering meals. Timescale of 30/6/06 not met 30/01/07 30/03/07 30/05/07 28/02/07 Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 33 24. OP16 22 25. OP18 13(6) 26 OP19 16(2)(j) 27. OP19 23(2)(b) 28. OP19 23(4) 13(4) The registered person must: • Ensure a comprehensive record of complaints to include the date, nature of the complaint, the investigation, outcome and resolution. • Develop a system to enable learning from complaints. Timescale of 20/6/06 not met The Registered Person must ensure: • All staff have training in relation to adult protection procedures and clearly understand their role. • The whistle blowing policy is reviewed and updated. • A copy of the Local Authority guidance in respect of Protection of Vulnerable Adults is obtained. The registered person must ensure: • Hot food temperatures are recorded daily. • The use by date is recorded on decanted foods. The Registered Person must draw up a plan of re-decoration and refurbishment and forward it to the Commission Timescale of 30/6/06 not met The registered person must ensure: • All doors close properly into the rebates. • A review is undertaken in respect to of the safety of the stairs and appropriate action taken. Timescale of 30/6/06 not met 30/01/07 30/03/07 30/01/07 28/02/07 28/02/07 Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 34 29. OP21 23(2)(b) (j)(n) 12(4) 30. OP24 16(2)(c)1 2(1)23(2) (c) 31. OP25 23(2)(p) The registered person must 30/03/07 ensure: • All toilets are fully partitioned from ceiling to floor. • A call bell is accessible to all toilet and bathing facilities. • A toilet and wash hand basin is fitted in the ground floor shower. • Review the suitability of the toilets for residents with mobility problems and take appropriate action. The registered person must 28/02/07 ensure: • Locks are provided to bedroom doors. • Lockable facilities are provided for all residents in their bedrooms. • Damaged commodes are replaced. • Damaged furniture is replaced. Forward an action plan to the Commission. Timescale of 30/6/06 not met The registered person must 28/02/07 ensure: • All lighting is satisfactory to meet resident’s needs and a light can be accessed from the bed. • An audit of windows is undertaken and replaced where necessary. • Covers are provided to radiators. Forward a plan of action to the Commission Timescale of 30/6/06 not met Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 35 32 OP25 23(2)(p) 33. OP26 13(3) 34. OP26 13(3) 35. OP26 23(2)(k) 36. OP26 13(4) 37 OP26 16(2)(k) The Registered Person must ensure all areas of the home are adequately heated and hot water is maintained at 43 degrees centigrade plus or minus 1 degree. The registered person must: • Provide a sluicing disinfector in sluices on each floor. • Provide suitable racking in sluices. Forward a plan of action to the Commission. Timescale of 30/6/06 not met The registered person must ensure suitable hygiene conditions in the home to prevent the risk of cross infection to include: • Staff hand washing facilities in resident’s rooms. • Washbowls must be stored appropriately after use. • Review the arrangements for barrier nursing. Timescale of 20/6/06 not met The Registered Person must ensure that all areas are cleaned effectively and kept clean at all times. Timescale of 20/6/06 not met The registered person must ensure all chemicals are stored in locked cupboards when not in use. Timescale of 19/6/06 not met • Ensure the cable from equipment such as vacuum cleaners etc. do not pose a trip hazard to residents. The Registered Person must ensure all areas are odour free at all times. 30/01/07 28/02/07 28/02/07 30/01/07 21/12/06 30/01/07 Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 36 38 OP27 18(1) 39 OP28 18(1) 40 OP29 19 41. OP30 13(5) 17(2) 42 OP30 16(2)(i) 17(2) 43 OP30 13(3) 17(2) 44 OP30 23(4)(d) (e) 17(2) 45 OP30 13(4) 17(2) 8 46. OP31 The Registered Person must ensure there are adequate staff on duty at all times to meet residents needs. The Registered Person must ensure that at least 50 of care staff are trained to NVQ level 2 in care. The Registered Person must ensure: • An audit of all staff recruitment files is undertaken and CRB checks obtained where they are not in place. • A robust recruitment procedure with two written references, one being from the previous employer. The registered person must ensure all staff undertake training in respect of manual handling and records are retained in the home. The registered person must ensure all staff undertake training in respect of basic food hygiene and records are retained in the home. The registered person must ensure all staff undertake training in respect of infection control and records are retained in the home. The registered person must ensure all staff undertake training in respect of fire prevention and two fire drills each year and records are retained in the home. The registered person must ensure there is at least one first aider on each shift and records are retained in the home. The Responsible Provider must ensure the appointment of a Registered Manager. Timescale of 30/9/06 not met DS0000067126.V324678.R01.S.doc 30/01/07 30/12/07 28/02/07 30/01/07 30/03/07 28/02/07 30/01/07 30/04/07 30/03/07 Priestley Rose Version 5.2 Page 37 47. OP33 25 48 OP33 26 49. OP35 17(2) Sch 4 50. OP36 18(2) 51. OP38 13 (4)(a) 52. OP38 12(1) 13(4) The registered person must ensure a quality assurance system is implemented including feedback from all stakeholders and an annual development plan is drawn up. Timescale of 30/11/06 not met The Registered Person must ensure systems are in place for a report to be written each month following visits to the home. The registered person must ensure all valuables held in the secure facility are recorded. Carried forward from 20/6/06 as not assessed. The registered person must ensure that care staff receive formal supervision at least six times a year and records are retained in the home. Timescale of 30/8/06 not met The registered person must ensure: • All fire points and emergency lighting is tested on a regular basis in house and a record is retained in the home. • The nurse call system is serviced regularly and records are retained in the home. • There is an up to date gas safety certificate for kitchen equipment. Timescale of 30/6/06 not met The registered person must: • Undertake an audit of all wheelchairs and ensure they are serviced on a regular basis. • Ensure all residents who use wheelchairs on a regular basis are referred for an assessment. Timescale of 20/7/06 not met DS0000067126.V324678.R01.S.doc 30/12/07 30/01/07 30/01/07 30/06/07 30/01/07 30/01/07 Priestley Rose Version 5.2 Page 38 53. OP38 13(4) 23(4) 17(2) The Registered Person must ensure: • • Risk assessments are reviewed and updatd where necessary. Hot water temperatures are tested regularly and records are retained in the home. 30/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3. Refer to Standard OP8 OP26 OP29 It is recommended that a record of interview is retained in the home and exit interviews are undertaken for staff who leave employment. It is recommended the tissue viability nurse be contacted for advice regarding the servicing of profiling beds and pressure relieving mattresses. Good Practice Recommendations It is recommended that all staff undertake training in respect of tissue viability commensurate with their position. It is recommended the manager liaise with the Health Protection unit regarding management of infection control. 4. OP38 Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 39 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. Extracts may not be used or reproduced without the express permission of CSCI Priestley Rose DS0000067126.V324678.R01.S.doc Version 5.2 Page 40 - 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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