Inspection on 27/06/07 for Priestley Rose

This inspection was carried out on 27th June 2007.

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 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 27th June 2007 08:30 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.V343698.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.V343698.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@maccare.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 Not Registered Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Priestley Rose DS0000067126.V343698.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. 19th December 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 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 snooze 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. Since the last inspection the staff have developed information about the services and facilities to enable prospective residents to make an informed decision about moving into the home. A notice board is also available on entering the home with a range of information including the inspection report is available. Fees vary from £388 to £670 per week (inclusive of nursing element) depending on facilities. Extra charges are made for hairdressing, chiropody, taxi, newspapers etc. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over two days commencing at 8.30am and no one from the home was aware of the inspectors visit prior to arrival. This was the first statutory key inspection for 2007/2008. The manager was present for the duration of the inspection. Information to inform the inspection included a tour of the building plus inspection of a sample of resident’s files and other documentation in relation to the management of the home. Case tracking was undertaken in respect of three residents, which included discussion with the resident where possible, inspection of their room, any equipment used to meet their needs plus records in respect of care, medication, accidents, finances etc. to determine care from the time of admission. During the visit the manager, five members of staff, two relatives and approximately nine residents were spoken to. Information was also obtained from the manager prior to the key inspection and feedback was sought through comment cards from health professionals and relatives. The response on the day of inspection was mixed with some residents stating the staff and food was satisfactory. Others stated some of the staff were good, but some were bossy; the food was variable and it depended on who was cooking it. 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 can take some furnishings, pictures, ornaments etc. into the home, so providing a more homely environment. Residents are able to follow their chosen religion, so meeting their spiritual needs. One of the residents stated he received communion regularly in the home. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Consideration should be given to providing the service user guide in alternative formats to make them more accessible to residents. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 7 There needs to be a more pro-active approach to care with monitoring of residents conditions, early detection of any problems and referral to health professionals where appropriate to prevent complications and meet residents needs. Once health professionals have visited robust systems need to be in place to ensure that the instructions are implemented and residents health care needs are met. The assessment and care planning process needs to be further 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. Also systems need to be in place to ensure all staff are aware of their contents and the action required to meet residents needs. Staff training is required to ensure staff have the appropriate skills and knowledge to care for residents and fully meet their needs. The quality and standard of meals must be reviewed and action taken to improve them, so residents receive well cooked meals of their choice with appropriate cutlery and condiments. Consideration should also be given to the provision of cultural diets to meet the needs of residents from minority cultures. The systems for dealing with concerns, complaints and allegations must be reviewed and a more pro-active approach taken to ensure residents are adequately protected and learning from complaints can be put into practice to prevent re-occurrences. Feedback indicated that some staff were bossy and abrupt and resulted in residents basic needs not being met. Action will need to be taken to address the issues to ensure residents are treated with dignity and their needs met. Appropriate action must be taken in respect of items missing from resident’s rooms to provide confidence to residents that their property is safe and they are adequately protected. Further improvements in infection control procedures, cleaning and odour control are required plus staff training to reduce the risk of cross infection. Residents should be consulted about the gender of staff they prefer to assist with personal care, to ensure their dignity is respected. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 8 The arrangements for activities must be reviewed and action taken to provide a suitable range of activities to meet residents needs and preferences, so providing adequate stimulation. On Discussion with some residents they stated they did get bored at times. 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.V343698.R01.S.doc Version 5.2 Page 9 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.V343698.R01.S.doc Version 5.2 Page 10 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): 1,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information was available to enable residents or relatives to make a choice about whether the home is suitable for their needs. The collection of information about residents needs before they move into the home has improved to determine if staff can meet their needs and this provides assurance to prospective residents on entering the home. EVIDENCE: The home admits residents for long-term care and respite care. Since the previous inspection they have developed a service user guide and statement of purpose to inform residents or their representatives of the services and facilities available, so enabling them to make an informed choice about moving into the home. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 11 It was noted that copies were available in each resident’s bedroom. On inspection it was found that the statement of purpose contained the same information as the service user guide. The manager is advised to review this and update the statement of purpose to reflect the information set out in the Care Homes Regulations. Also consideration should be given to producing the service user guide in alternative formats to make it more accessible to residents. 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 is 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. There is still no contract available to inform residents or their representatives of the terms and conditions of any stay. The information provided by the manager indicated that it is their plan to produce this in the future. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There had been some areas of improvement in the arrangements for planning care and assessing resident’s risks, further improvements are needed to ensure all residents’ needs are met in a consistent and appropriate manner. Residents health care needs are not consistently met in an effective manner and there needs to be a more proactive approach to care and follow up to ensure residents well being is maintained. Medication systems had improved so ensuring residents receive the medication prescribed by health professionals. EVIDENCE: When residents are admitted to the home a nursing assessment is undertaken and a care plan is drawn up for all residents, which outlines the action required by staff to meet resident’s needs. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 13 On inspection of a sample of records it was noted that there had been improvements since the last inspection; they were well organised and had all relevant documents in place, so information could be accessed more easily by staff or anyone inspecting. However, they still lacked detail in some areas, were based on physical aspects of care only and some areas of need had not been included in the plan of care. There was no evidence that residents had been asked about any preferences in respect of the gender of staff who attend to their personal care. The home has a number of male carers and this will need to be explored with residents and a cross gender policy drawn up to ensure residents needs are met according to their preferences and their dignity maintained. The care plans had been reviewed on a regular basis, but the reviews lacked detail and did not indicate where changes in care were required. For example health professionals had visited and given advise and it had not been incorporated into the plan of care e.g. in relation to thickeners in drinks, which are used to prevent choking. One resident was prescribed nutritional supplements, the medication chart, care plan and review all indicated nutritional supplements were taken, but the fluid charts did not indicate they were taken by the resident and staff stated the resident did not like them and in fact the residents did not have a nutritious diet. In another case the physiotherapist had visited a resident and provided advise regarding exercises. These had been incorporated in to the plan of care, but it could not be evidenced through records or discussion with staff that they were being implemented. This indicates that the resident’s care was not being implemented, monitored and reviewed appropriately, so that interventions were not implemented to ensure residents well being and needs were met. Following an adult protection referral in December 2006 social workers and nurses from the Primary Care Trust undertook reviews of all the residents. A number of recommendations were made that staff had to follow up. On inspection it was noted that these had only partially been followed up and areas such as referrals to physiotherapist, occupational therapist and wheelchair services had not been undertaken. It was concerning as it indicated that residents health needs had not been met. On reviewing care plans/daily records it was noted that areas of concern had been identified and not followed up appropriately. Residents who had a poor appetite were not having their food intake monitored. Also where fluid balance charts were retained to monitor fluid intake there was no evidence that they were totalled at the end of the shift to determine if residents had received a sufficient fluid intake. In some cases care plans stated residents should be turned two hourly and turn charts indicated that they had not taken place as directed and on discussion with a resident they stated they were turned approximately every four hours. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 14 In one case a resident had a feeding tube, which required attention each day and on discussion with the resident they stated that staff had not done anything with the tube, in order to maintain its patency. Whilst touring the home it was noted that residents were better presented and clothing was clean and well pressed. Feedback from relatives indicated that clothes were kept clean and well pressed and residents looked tidy. In some cases oral care, nails and hair was attended to, but this was not consistent even though staff had signed charts to indicate it had been undertaken. In some cases bed rails were used on beds for residents safety and pressurerelieving equipment was also in use, but the bed rails were not sufficiently high enough to reduce the identified risks. This will need to be reviewed and also a system of regular checks should be implemented in respect of the bed rails to ensure residents safety. At one stage it was noted that a resident was transferred from a wheelchair to a lounge chair and the brakes had not been secured on the wheelchair, so putting the resident at risk of an accident. Some of the wheelchairs also required cleaning. Also call bells were not always accessible to residents to enable them to call for assistance when required. All residents are registered with local G.P’s. Feedback from health professionals indicated that there were times when staff were slow seeking advice and at other times they requested visits inappropriately. When advice was given it was always acted upon, but at times there is a lack of communication between staff. Also there were issues in respect of maintaining residents privacy as relatives of another resident are used as translators. A recent concern was raised in the respect of the end of life care for a resident that had not been managed appropriately by staff and they did not have the skills to manage effective pain relief, so needing to rely on the district nurses. If residents who require end of life care are admitted to the home action must be taken to ensure staff have the appropriate skills and knowledge to care for them. There are a number of residents with diabetes in the home and their blood sugar is monitored on a regular basis. However, there was no evidence that there was any monitoring of chronic diseases and this was confirmed on discussion with nurses. It was recommended that this be followed up with the relevant GP practices to ensure resident’s conditions are monitored effectively and any necessary action taken to prevent any complications. Also there is only one blood glucose monitoring machine for all residents and it was recommended that this be reviewed to reduce the risk of infection. The home has a range of pressure relieving equipment for residents who are at risk of developing pressure sores. At inspection it was noted that some of the pressure relieving cushions and mattresses had “bottomed out “ and were not fit for purpose, so putting residents at risk of developing pressure sores. This issue remains outstanding from the previous inspection and needs to be addressed with some urgency so resident’s needs are met. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 15 There are some residents in the home who suffer with dementia and staff have not received any training in this area. On discussion with some residents they stated some staff were good. However, some staff are bossy, abrupt and do not provide the assistance that they require. On discussion with one resident they stated “we suffer in silence; we have no moans or groans”. On discussion with some relatives and residents they stated that some of their property had gone missing and “Staff take your handbag off you for a few days”. The manager will need to follow up these issues and take appropriate action, so resident’s property is safe. The home uses a monitored dosage medication system and medication is stored correctly. They have a small range of homely remedies and consent for administration had been obtained from the GP’s. The information provided by the home indicated they had implemented new recording systems for medication entering the home and being destroyed. On inspection of the medication it was found to be of a good standard and all audits were correct, so ensuring residents receive the medication prescribed by health professionals. Staff have obviously worked hard to achieve compliance in this area. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of meals is variable and residents do not always receive their choice of food, to ensure they receive an adequate nutritious intake. There are no rigid routines and visitors can visit at time that suits them enabling residents to maintain contact with them. There is a lack of activities both inside and outside the home, so residents are not adequately stimulated. EVIDENCE: Visiting to the home is flexible enabling residents to maintain contact with family and friends at a time that suits them and this was confirmed on discussion with visitors. Residents are 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. Residents stated they may get up, go to bed and spend time as they wished. Feedback from some relatives was good. It was stated, “She has significant choice as to where she goes, where she has her meals.” Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 17 On touring the home many of the residents were sitting either watching the television or unoccupied. On discussion with them they stated they did get bored at times. On inspection of records it was noted that information had been sought about residents interests, but no action had been taken to use the information in order to implement any programmes of activities to provide stimulation for residents. Records of activities undertaken were based around watching the television and visitors to the home. The manager talked about exercise sessions to music, but there appears to be very limited opportunities for stimulation and this is an area that will need to be developed, so 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 their minister visited and gave communion on a regular basis. The home employs separate catering staff who cover all three meals. There are three main meals each day, which includes the option of a cooked breakfast, lunch and evening meal. On inspection of menus it was noted that there was a four-week rotating menu, there was a choice of meals but there was some repetition and there were no cultural options for residents from minority groups, who are currently resident in the home. Special diets were catered for and included puree meals and diabetic diets. However, there were no cultural options to meet the needs of residents from minority groups. The system of ordering has changed so that residents are able to order their meals the day prior to serving them. On discussion with residents they stated the meals were variable and it depended who was in the kitchen cooking, they did not always receive what they had ordered and in some cases the meal had not been cooked properly. On discussion with one of the cooks they stated they had just reviewed the menus and had asked residents about their preferences and any choices they would like to see on the menu. The home does receive a supply of fresh vegetables and fruit, so enabling staff to provide healthy options. There is a dining room on the ground floor adjacent to the kitchen where meals can be taken and residents also have the choice where to have their meals. 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. Lunch was served to a number of residents in the dining room, so providing a pleasant and social occasion. Tables were pleasantly arranged to accommodate four residents, but no condiments were available. Staff were available to give assistance as required. It was noted that there was interaction between some staff and residents, but this was not consistent and some staff placed bibs on residents and fed them without any explanation or discussion. Appropriate cutlery was not always made available to enable residents to maintain their independence. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 18 Residents at the same table were not served their meal at the same time and some residents were asking where their meals were. The meal was hot and well presented, but the pudding did not match what was on the menu and residents were offered yogurt, ice cream or tinned fruit and cream. The arrangements for meals and standard of cooking will need to be reviewed to ensure residents receive a satisfactory diet that is well cooked and meets their needs and preferences. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 19 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 home does not have available policies and procedures and does not have robust systems in place to ensure residents are safeguarded, or provide confidence that their views are listened to or acted upon. EVIDENCE: The information provided by the home indicated that they had received ten complaints. On inspection of the records it was found that the investigation and action taken were not consistently available. One of the complaints was in respect of a member of staffs approach and attitude to a resident and in the inspector’s opinion it should have been referred to Social Care and Health under the adult protection procedures. The Commission had concerns raised about the care of one resident who had been admitted to hospital before visiting. On inspection of the records it was noted that there were aspects of care provided in the home that had not been managed effectively and the residents condition had not been monitored appropriately. The residents also required treatment in the home that nurses were unable to provide. This was discussed and issues outlined in full with the manager and a nurse, so that action could be taken to prevent re-occurrences. The manager will also need to ensure that all nurses are trained in the management of this aspect of care or alternatively residents with this condition should not be admitted to the home. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 20 A copy of the complaints procedure is available in the reception area informing anyone visiting of the procedure to follow in the event of a complaint. Also a copy of the procedure is made available in the service user guide, which is available in each resident’s bedroom and feedback from visitors indicated they were aware of the procedure As identified earlier in the report and at the last inspection issues were raised about staff attitude at the time of the inspection and from feedback following the inspection. The management have been consulting relatives via a survey, so receiving feedback about areas that need improvement and it was noted that issues had been raised about some staff’s attitude. Further work is required in this area and action must be taken to ensure residents are treated with respect and staff approach residents in the correct manner. As identified earlier in the report some residents personal belongings had gone missing and a resident stated their handbag was taken off them for days. The manager will need to take appropriate action to address the issues raised and put systems in place to ensure they do not re-occur, so protecting resident’s property On discussion with staff responses were variable as to the safeguarding procedures. Some were not aware of what constitutes abuse and the action to take in the event of any allegation. This means that residents are not adequately protected. This will need to be addressed through staff training, to ensure staff are fully aware of the procedures to safeguard all residents. The manager acknowledged in the information provided before inspection that training was to be provided in this area and it is recommended that this is undertaken with some haste. The home will need to develop a policy in relation to safeguarding residents that is in line with the multi agency guidelines. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and generally well-maintained environment, so providing a safe place to live. The arrangements for bathing and toilet facilities need developing to meet the needs of residents with mobility problems. The sluicing facilities need upgrading to ensure effective infection control measures. EVIDENCE: The home is registered to provide care for forty-five residents. Since the last inspection the ward area has been changed to provide three single rooms with en-suite facilities, which are of a good standard. One of the en-suite facilities has a shower with toilet and the other two have a toilet and wash hand basin. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 22 Some new furniture for bedrooms had been purchased, staff hand washing facilities had been provided in bedrooms, so enhancing arrangements for infection control. Locks had been fitted to bedroom doors enabling residents to lock them if they wish, so enhancing privacy. There are 30 single rooms and six double bedrooms with wash hand basin and call bell, which can be used to summon assistance if required. A sample of rooms were inspected and it was noted that the lighting requires 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 some furnishings were damaged and will need to be replaced, to enhance the facilities in the home. Some radiators were not covered and may pose a risk due to scalding. All bedrooms have two double sockets and a television aerial so providing adequate sockets for electrical equipment. There are five communal bathing facilities, some 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 some of the bathrooms did not have a wash hand basin or toilet in the bathroom and the call bell was not accessible to the bathing facility to summon assistance. There are a number of toilets situated around the home and partitioning has been provided to enhance privacy, but some are not suitable for residents with mobility problems to access, due to restricted space and this area will need to be reviewed to ensure suitable bathing and toilet facilities are available for all residents. 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 via the boiler thermostat in order to protect residents from scalding. The manager must ensure the water that is stored and circulating is at the correct temperature to reduce the risk of legionella. On touring the home it was noted that some of the doors were propped open or were not closing properly into the rebates and this may pose a fire hazard. An audit should be undertaken and appropriate action taken. The stairs leading form the ground to first floor has a handrail along it, which provides partial enclosure, but it may pose a risk to some residents and action will need to be taken to reduce the risk. 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. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 23 Other areas that needed attention to ensure adequate infection control procedures include: • • • • Washbowls were found on floor in resident’s rooms. On occasions staff were seen walking around the home with gloves and white aprons on. These should be removed after use and hands washed. Although the home was generally cleaned to a satisfactory standard, areas such as commodes, raised toilet seats had not been adequately cleaned. There were also some isolated areas of odour that need to be addressed. Since the last inspection the manager has contacted the Health Protection Unit and they have undertaken an audit of the home in respect of infection control to assist staff with identifying areas that need to be addressed, so reducing the risk of infection. 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 not adequately cleaned in all areas. It was found that he freezer temperatures were not appropriate for the safe storage of food. Other areas that required attention to ensure good hygiene practices include: • • • • • Decanted foods must be dated with the use by date. Vegetables had been stored on the floor Sauces had been opened, not dated and not stored properly. Some windows did not have appropriate mesh screens in place. The first aid box had no appropriate plasters. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for the level of staffing in the home was adequate to ensure resident’s basic needs were met. Further staff training is required to ensure staff have the skills and knowledge to care for residents and ensure their needs are met. EVIDENCE: Currently there are thirty-four residents in the home plus two residents in hospital. The manager works on a full time basis and is supernummary. Since the last inspection a deputy manager has been employed, so strengthening the management team, enabling monitoring, audits etc. to be undertaken. Staff rotas indicated there are two nurses on duty during the day and generally seven carers during the morning and five carers in the evening. There is one nurse overnight and four carers on duty. In addition, to nursing and care staff there is separate domestic, laundry, catering, maintenance and administration staff. This appeared adequate at the time of inspection. However, there continues to be a fairly high turnover of staff and a number of bank staff and agency staff are utilised to cover absences where required, which could impact on the consistency of care provided. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 25 A small number of staff files were inspected to determine the quality of the recruitment process and it was found to be of a satisfactory standard, so protecting residents. It was noted that one member of staff, who had a student visa was working in excess of twenty hours per week, which is in contravention of the legislation. Where staff have a student visa they can only work twenty hours per week in term time. It is recommended that the home obtain information from the college where training is being undertaken as to the term/holiday times so that this can be monitored. Also some nurses PIN registration number had expired and there was no evidence that they had been renewed. The manager stated he had only been made aware of this and was to undertake the appropriate checks to ensure the nurses were still registered with the Nursing and Midwifery Council and able to work as qualified nurses. Less than 50 of care staff are trained to NVQ level 2 in care, so staff do not have the appropriate skills and knowledge to meet residents specific needs. Some staff had undertaken training in the core areas e.g. health and safety, manual handling, infection control and basic food hygiene. However, this training needs to be extended to all staff to ensure they have the basic skills and knowledge to care for residents. On discussion with staff about the fire procedure their knowledge was poor and this puts residents at risk in the event of a fire. To date the home has used an induction programme that is based on the homes policies, procedures and routines, but it does not meet the standards of the Social Skills Council. The manager is in the process of developing this and he stated nurses and the senior carer would be responsible for delivering the training. However, systems need to be put in place to ensure the training is delivered in a consistent manner to ensure staff have the appropriate knowledge and skills initially to care for residents. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements in the management of the home and many systems have been developed, which need to be fully implemented now, to ensure residents are safe in the home at all times. EVIDENCE: A new manager took up the post towards the end of last year and has applied to the Commission for registration. He is a registered nurse with several years experience and hopes to undertake the Registered Managers Award in the near future. Since the last inspection a deputy manager has also been employed, so providing a stronger management presence in the home, enabling auditing systems etc to be implemented. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 27 A quality assurance system is in the process of being developed with the use of audits. A meeting has already taken place with relatives and written feedback has also been received from them earlier this year. It was stated that residents meetings are to be implemented and consideration should be given to obtaining feedback from other stakeholders to inform the process. Once this has been completed an annual development plan should be drawn up indicating outcomes for residents. The proprietor or their representative does not write reports regarding the conduct of the home on a monthly basis, which is required under the regulations and this will need to be addressed. The manager stated he has commenced formal staff supervision and has seen two of the nurses to date. This is to be cascaded down to all staff to provide support, identify strengths and weaknesses and any training needs, so developing the skills of the team. The manager stated 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, so safeguarding resident’s health and safety in the home. Areas that require further attention include in house testing of fire points and emergency lighting system, as they were not completed regularly although servicing of equipment has taken place. Also systems must be in place to ensure hot water is stored and circulated at the correct temperatures and is not above 43 degrees ( or – 1 degree) at outlets accessible to residents, so reducing the risk of any scalds to residents. Also systems need to be implemented to run of water from little used outlets regularly to reduce the risk of legionella. Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 28 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 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 1 2 3 1 X 3 2 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1)(2) 18(1) Requirement Robust systems must be in place for care planning, which is comprehensive, holistic and provides detail as to how resident’s needs are met. Care plans must be regularly reviewed in a meaningful manner and updated to reflect residents’ changing needs. Care plans must include an assessment and plan in respect of continence management where appropriate. . Timescale of 30/8/06 and 30/3/07 not met. Systems must be put in place to ensure staff are aware of the contents of care plans and they are implemented, so that residents needs are met in a consistent and timely manner. Daily records should indicate the care given, type of day residents have experienced etc. to demonstrate care interventions that have taken place. Where it is identified that a referral to a health professional is required staff must make the appropriate referral to ensure specialist advice is sought and DS0000067126.V343698.R01.S.doc Timescale for action 30/08/07 2 OP7 17(2) 30/06/07 3 OP8 12(1) 13(2) 30/06/07 Priestley Rose Version 5.2 Page 31 medical needs are met. Systems must be in place for staff to implement advice given by health professionals to ensure resident’s specialist needs are met. Timescale of 30/1/07 not met. Where it is required to monitor 30/06/07 residents fluid balance, food intake, bowel movements etc. staff must make accurate records and take appropriate action if there are any abnormalities to ensure residents needs are met. Staff must ensure there is a proactive approach to care with early identification and action in respect of concerns Timescale of 30/1/07 not met. All mattresses and pressure 30/07/07 relieving cushions that have “bottomed out” must be replaced to reduce the risk of pressure sores developing. Timescale of 30/6/06and 28/2/07 not met. 30/06/07 Systems must be in place to ensure staff are aware of how to approach and interact with residents to ensure residents are treated with dignity and respect and their needs are met. Timescale of 30/6/06 and 30/1/07 not met. Action must be taken in respect of issues in relation to staff attitude as identified in the report. Timescale of 30/1/07 not met. All staff should receive training in respect of caring for residents with dementia so they have the skills and knowledge to meet resident’s needs. DS0000067126.V343698.R01.S.doc 4 OP8 12(1) 5. OP8 12(1) 23(2)(c) 6 OP8 12(1) 12(4) 18(1) 12(5)(b) 7 OP8 12(1) 18(1) 30/11/07 Priestley Rose Version 5.2 Page 32 8 OP8 13(4) 17(2) Systems must be in place to ensure all bed rails are of a suitable height when pressurerelieving 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 not met. Systems must be in place to ensure residents receive assistance with personal hygiene to meet their preferences and needs, so they are clean and comfortable to include • Oral care. • Accessible drinks. • Hair combed and neatly arranged etc. • Nails cleaned. Timescale of 30/1/07 not met. All staff must ensure the brakes on wheelchairs are secured before residents are transferred to ensure residents safety and prevent accidents from occurring. 30/06/07 9. OP8 12(1) 12(2) 30/06/07 10 OP8 13(4) 30/06/07 11 OP8 12(1) 18(1) Call bells must be accessible to residents, so that they can summon assistance when required. The management of continence 30/08/07 should be reviewed, assessments undertaken and continence programmes implemented where appropriate to ensure residents continence needs are met. Staff should be provided with training where required to ensure assessments and plans can be implemented and resident’s needs met. DS0000067126.V343698.R01.S.doc Version 5.2 Page 33 Priestley Rose 12. OP15 16(2)(i) 17(2) 13 OP16 22 14. OP18 13(6) The arrangements for meals 30/07/07 should be reviewed to ensure residents receive a nutritious diet that meets their needs and they enjoy, to include: • Residents receive the choice of food they have ordered. • The meals are cooked to a satisfactory standard. • Provide appropriate cutlery to enable residents to maintain independence. • Provide condiments. • Provide cultural options to meet resident’s cultural needs. • Serve residents who sit at one table at the same time. • Maintain an accurate record of food taken by residents. Action must be taken in respect 30/07/07 of all complaints and records must include the nature of the complaint, the investigation, the findings, outcome and resolution. This is to ensure they are dealt with appropriately and learning can be achieved so that there are no re-occurrences. Timescale of 20/6/06 not met All staff must receive training in 30/07/07 respect of the safeguarding procedures and staff must be able to demonstrate knowledge to ensure residents are protected. Timescale of 30/3/07 not met. All incidents of abuse must be reported to Social Care and Health as they are the lead agency and will decide on the appropriate action to be taken. Action must be taken in respect Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 34 of resident’s personal property that is missing and records maintained in the home to give reassurance to residents that their property is safe. A policy must be drawn up in respect of safeguarding residents and all staff made aware of it, so protecting residents. 15 OP19 16(2)(j) 20/07/07 Action must be taken to ensure adequate standards of hygiene in the kitchen to include: • The use by date is recorded on decanted foods. Timescale of 30/1/07 not met. • Food items must not be stored on the floor • Sauces must be dated when opened, stored appropriately and used within specified timescales. • All areas must be cleaned properly. • Mesh screens must be provided to windows. Freezers must be maintained at appropriate temperatures to ensure food items are safe for use. Complete the re-decoration 28/09/07 programme to ensure residents live a pleasant environment Timescale of 30/6/06 not met Systems must be in place to ensure all doors close properly into the rebates and they are not propped open, so reducing the risk in the event of a fire. Timescale of 30/6/06 and 28/2/07 not met Action should be taken to ensure the stairs are safe for use by residents. DS0000067126.V343698.R01.S.doc 16. OP19 23(2)(b) 17. OP19 23(4) 30/06/07 18 OP19 13(4) 30/06/07 Priestley Rose Version 5.2 Page 35 Timescale of 30/6/06 and 28/2/07 not met 19. OP21 23(2)(b) (j)(n) 12(4) Suitable bathing and toilet facilities must be made available for residents to use including: A call bell is accessible to all toilet and bathing facilities. • A toilet and wash hand basin is fitted in all bathing facilities. • The arrangement of toilets are reviewed and action taken where necessary to ensure they can be accessed by residents with mobility problems. Timescale of 30/03/07 not met. 20. OP24 16(2)(c)1 2(1)23(2) (c) An audit of all furnishings must be undertaken and any damaged items replaced to ensure it is fit for use. Timescale of 30/6/06 and 28/02 not met. All lighting must be satisfactory and accessible from beds to meet resident’s needs and enable them to switch a light on when in bed. Covers should be provided to radiators to reduce the risk of scalding. Timescale of 30/6/06 and 28/2/07 not met 22. OP26 13(3) A sluicing disinfector and suitable 28/10/07 racking should be provided in sluices to ensure adequate infection control procedures. Timescale of 30/6/06and 28/2/07 not met All staff must undertake training DS0000067126.V343698.R01.S.doc 30/12/07 • 28/07/07 21. OP25 23(2)(p) 28/09/07 23. OP30 16(2)(j) 30/09/07 Page 36 Priestley Rose Version 5.2 17(2) in respect of basic food hygiene and records must be retained in the home to ensure staff have the appropriate knowledge and practice to maintain adequate hygiene standards in the kitchen and when handling food. Timescale of 30/3/07 not met. All staff must undertake updated training in respect of moving and handling residents, systems must be in place to ensure good practice at all times to ensure residents safety and records must be kept in the home. Timescale of 30/1/07 not met. All staff must undertake training in respect of infection control and systems must be in place to reduce the risk of cross infection and. Records must be kept in the home Timescale of 28/2/07 not met. All staff must undertake updated training in respect of fire prevention and fire drills at least twice a year and be able to demonstrate the action to take in the event of a fire to ensure residents safety in the event of a fire. Timescale of 30/1/07 not met. Staff must undertake training in respect of first aid and there must be one first aider on each shift to ensure residents receive appropriate treatment in the event of an accident. Timescale of 30/4/07 not met. The proprietor must ensure systems are in place for a report to be written regarding the conduct of the home following DS0000067126.V343698.R01.S.doc 24 OP30 13(5) 17(2) 30/07/07 25 OP30 13(3) 17(2) 28/08/07 26 OP30 23(4)(d) (e) 17(2) 30/07/07 27 OP30 13(4) 17(2) 30/09/07 28. OP33 26 30/07/07 Priestley Rose Version 5.2 Page 37 visits each month. Timescale of 30/1/07 not met. 29. OP38 13 (4)(a) Action must be taken to ensure 30/06/07 all fire points are checked weekly and emergency lighting is checked monthly to ensure they are in good working order in the event of a fire. Timescale of 30/6/06 not met Action must be taken to ensure water is stored and circulated around the home at the correct temperatures. 30/07/07 30 OP38 13(4) 23(4) 17(2) 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 Refer to Standard OP1 Good Practice Recommendations A statement of purpose should be reviewed and enhanced to include all the information outlined in the Care Homes Regulations. A copy of the contract of residence should be made available to all residents so they are aware of the terms and conditions. Staff should liaise with the G.P. regarding monitoring of chronic diseases to ensure health care needs are met and managed effectively. A review of blood glucose monitoring machines should be undertaken and additional resources provided to reduce the risk of cross infection. Residents should be consulted as to their wishes in respect of the gender of staff who provides personal care and a DS0000067126.V343698.R01.S.doc Version 5.2 Page 38 2. OP2 3. OP8 4. OP8 5. OP8 Priestley Rose cross gender policy drawn up to ensure residents preferences and dignity is maintained. 6. OP8 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. A suitable activity programme should be drawn up based on resident’s interests and preferences to ensure they receive adequate stimulation. Windows that have been identified as needing painting are painted in order to enhance the environment and life of them. Ensure all areas are odour free at all times, so providing a pleasant place to live. All areas must cleaned effectively and kept clean at all times, so ensuring good infection control and a pleasant environment. At least 50 of all care staff should be trained to NVQ level to in care to ensure they have the skills and knowledge to care for residents and ensure their needs are met. Where staff are employed on a student visa they must not work in excess of 20 hours per week during term times to ensure the home acts within the law. All nurses PIN registration numbers must be checked regularly to ensure they are still registered with the Nurses 13 OP30 All new care staff must 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 DS0000067126.V343698.R01.S.doc Version 5.2 Page 39 7. OP12 8. OP19 9. 10 OP26 OP26 11 OP28 12 OP29 14 OP33 15 OP36 Priestley Rose and arrange suitable training. 16 17 OP38 OP8 Also water is run from all hot water outlets that are not used regularly in order to reduce the risk of legionella. All nursing staff should undertake training in respect of end of life care to ensure resident’s needs are identified and met at this time. A review of the communication systems should be undertaken to ensure information is passed on to all staff so they are aware of resident’s needs and how they are to be met. Action must be taken to ensure residents privacy is maintained at all times. 18 OP8 19 OP10 Priestley Rose DS0000067126.V343698.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House Stephenson Street Birmingham West Midlands 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.V343698.R01.S.doc Version 5.2 Page 41 - 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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