Inspection on 18/09/08 for Prince of Wales

This inspection was carried out on 18th September 2008.

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

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

Other inspections for this house

Prince of Wales 24/09/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Prince of Wales 246 Prince Of Wales Solihull Lodge Birmingham West Midlands B14 4LJ Lead Inspector Sarah Bennett Unannounced Inspection 18th September 2008 08:55 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 Prince of Wales DS0000069702.V372269.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. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prince of Wales Address 246 Prince Of Wales Solihull Lodge Birmingham West Midlands B14 4LJ 0121 436 6464 0121 430 7560 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) Edgbaston Investments Ltd Irene Simunyu (not yet registered) Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 20 The maximum number of service users to be accommodated is 20. 2. Date of last inspection 24th September 2007 Brief Description of the Service: The Prince of Wales Nursing Home is a detached two-storey purpose built home that provides accommodation on both floors for older people requiring varying levels of nursing care. The home is situated in a residential area on the outskirts of Solihull and borders of Birmingham. There is limited off road parking to the front of the property. An enclosed garden and patio is situated to the rear of the building and has seating that may be used when weather permits. The home is close to local amenities, such as a post office, a few small shops and a local park. There is a regular bus service to the town centres of Solihull and Shirley. Accommodation is divided into 16 single rooms and 2 shared rooms. Two of the single bedrooms have en-suite facilities consisting of a toilet, wash hand basin and bath; the bath is domestic in style and would not be suitable for people with mobility problems. There is level access to the entrance of the home, which is suitable for wheelchair users. A passenger lift gives access to the first floor enabling all areas of the home to be accessed. There is a range of equipment in the home such as grab rails, raised toilet seats, hoists and assisted bathing facilities for people with mobility problems. The home also has pressure-relieving equipment for those who may be at risk of developing pressure sores. Communal facilities consist of a dining room and a choice of three lounges over the two floors. A copy of the latest inspection report was available in the reception area. The service users guide stated that fees charged are dependent on the type of facility required and type of care package and needs of the individual. Specific advice on fees is available from the home manager. Fees do not include: dry cleaning, hairdressing, telephone calls, chiropodist, dentists and optician. This information was current at the time of the inspection and the reader may wish to contact the care service for updated information. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 5 Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment (AQAA) completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. Four of the people living in the home were case tracked. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Due to the needs of several of the people living there it was not possible to ask for their views on the home so time was spent observing practices and interaction from staff. Where people were able to comment on the care they receive their views have been included in this report. Some relatives visiting, the manager and staff on duty at the time were spoken with. Relatives, people living there, visiting professionals and staff completed our ‘Have your say’ survey about the home. Their views have been included in this report. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? The medication system is better. Medication can now be audited to ensure that people receive the medication they are prescribed so they can keep well. The assessment and care planning system has been developed further so that staff have more detailed information about how to meet people’s needs. There are more activities so that the people living there have more things to do and can be stimulated. Staff have got better at responding to people’s changing health care needs. Some furniture and carpets have been replaced so it is more homely and comfortable to live there. More ‘profiling beds’ have been bought so that people can be positioned better when in bed to aid their comfort. This also ensures staff safety when moving people. Staff have done more training so they have up to date knowledge to ensure they can meet people’s needs effectively. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 8 Hand towels and wash is available and staff use gloves and aprons so that the risk of cross infection is reduced. What they could do better: All bed rails must have bumpers in place. All staff must be aware of this so that people are not at risk of injury. Two written references must be obtained for all staff that work there. Evidence that nurses have current registration with the Nursing and Midwifery Council (NMC) should be available in their records. These will ensure that ‘suitable’ people are employed to work with the people living there. Footplates must be used with wheelchairs unless a risk assessment demonstrates alternatively. This is to ensure the safety of the people living there and reduce the risk of accidents. People must be moved safely and as stated in their moving and handling assessment so they are not at risk of being injured. The service users guide should be updated so that people have up to date information about the home. The recording of health professional’s visits should include more information about how the care can be monitored and people should be weighed as often as their care plan states. This will ensure that people’s health and well being is not at risk. There should be a photograph of the individual on their Medication Administration Record (MAR) so that unfamiliar staff would know who to give the medication to and ensure people get the medication they are prescribed. People should be supported to communicate in the way they are able to so they do not become frustrated and isolated. Care plans should contain more information about how to meet individual’s religious needs so that staff can respect the person’s beliefs. The people living there should be asked more often as to how they want the home to be run so they have more choice and control over their lives. Suitable numbers of well maintained bathing facilities should available so that people can access the bath at all times if they want to. Inventories of people’s belongings should be kept up to date to ensure that people still have their belongings and they have not been mislaid. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 9 All staff should have regular supervision so that they are supported in their role and know how to meet the needs of the people living there. 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. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 10 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 Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 11 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, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need and an opportunity to visit so they can make an informed choice as to whether or not they want to live there. Individual’s needs are assessed before they move in to ensure they can be met at the home. EVIDENCE: The homes service users guide and statement of purpose were available in the reception area so that the people living there and their relatives had the information they needed. They generally included the relevant and required information so that people had the information they needed to make a decision as to whether or not their needs could be met. They needed updating to state the current management arrangements as these had changed. The manager Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 12 stated in the AQAA that in the next 12 months they planned to re-write these documents so that they are kept up to date. The AQAA stated that prospective residents are encouraged to visit at any time to view the nursing home. Two relatives spoken to said they were able to visit the home before their relative was admitted to ensure it was suitable to meet their relative’s needs. The AQAA stated pre-admission assessments are conducted to ensure the individual needs can be met and these have been revised making it more detailed and specific to all activities of daily living. The manager said and records sampled showed that a pre-admission assessment is completed. An assessment is also completed when the person is admitted to the home so that staff are aware of how to meet the person’s needs. At the last inspection a requirement was made that staff have training in how to meet the needs of people who have dementia. Since then staff have received this training so they should have the appropriate skills and knowledge to meet individual’s needs. The home does not provide intermediate care. Therefore, standard 6 relating to this was not assessed. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that the health and personal care needs of the people living there are met so ensuring their health and well being. EVIDENCE: The manager said that the care planning system had changed to a system that provides more information for staff on how to meet individual’s needs. Records sampled included an assessment of the individual’s needs, which was then formulated into the care plan. The new system ensures that individual’s needs are regularly assessed to ensure that staff have the updated information they need to support people appropriately. Care plans sampled had been regularly reviewed and updated. Staff said that the new care plans are much better and provide more information. Where appropriate the person and their relatives had been involved in writing their care plan. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 14 We saw evidence that staff follow what is written in the care plans so that people get the care they need in a consistent way. For example: One person spends most of their time in bed. Their care plan stated that they needed staff to take their meals to them and stay with them while they ate them. A member of staff was observed doing this at breakfast and lunch - time so they could support the person appropriately. Where people had short-term infections or illnesses a care plan had been put in place so that staff knew how to support them to be well. Records showed that staff were monitoring people’s health. One person said that they were in pain. Care staff said that they would tell the nurse this and were heard doing so. This ensured that the person got medication so as to give them relief from the pain. The home has arrangements in place so that people’s health care needs are generally well met. For example: Records sampled showed that when people move into the home they are seen by the GP and any necessary referrals are made to other professionals so that their health needs can be met. Records sampled showed that people had regular check ups with the dentist, optician and chiropodist where necessary to ensure they keep well. Where people were able to they had consented to having any treatment done. One person’s daily records showed that they had recently been unwell. Care staff had reported to the nurses their observations and the nurse had taken appropriate steps and medical advice to ensure the person got the necessary treatment. They had been admitted to hospital but were now back at home. Their records showed that staff had followed the doctor’s advice and were ensuring that the person was comfortable and not in pain. We did see a few things that had not been followed up on. One person’s records indicated that they had blood tests in July this year but there were no further records as to the results of these and if any further health care was needed. Another person had blood tests in August but there were no records of the results of these. One person had a wound as a result of their medical condition. Their records stated that the wound was healthy and their dressing needed to be changed on 11th September. There was no record that this had been done. Staff said that they would check this as they thought this had been changed. It is difficult to weigh some people, as they are not able to get onto weighing scales. Therefore the circumference of their arm is measured to monitor if they are losing or gaining a significant amount of weight, which can be an indicator of an underlying health need. In June this year one person’s arm had been measured and it was noted that it had decreased since the last month but the Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 15 person did not seem to have had a dramatic weight change. Staff had written to observe the next month but there was no record that it had been checked since. This could put the person’s well being at risk. Where people are at high risk of developing a pressure sore pressure relieving mattresses and cushions are used to lower this risk. Records indicated that people are moved regularly to reduce the risk of them getting sore skin. None of the people living there had a pressure sore indicating that staff ensure that care is given so that people’s health and well being is not at risk. The AQAA stated, “We have replaced some of our beds with new electric profiling beds in the last 12 months, enhancing comfort as well as promoting the integrity of pressure points to people who are at high risk of developing a pressure sore.” The AQAA stated, “ We have involved the dietician to offer training for nutritional screening.” Records sampled showed that each person had been assessed as to the nutrition they needed to keep healthy and what interventions such as food supplements they may need to do this. Generally records sampled showed that people were weighed as often as their nutrition plan stated they needed to be to ensure they were adequately nourished. Since the last inspection staff had recorded what each person eats and how much they eat so they can monitor if they are receiving the food they need. Some people have bedrails to stop them falling out of bed. Risk assessments are in place to ensure that they are safe to use bedrails and using them will not put them at further risk of injury. One risk of using them is to become trapped between the rails so that the person is at risk of being strangled. Bumpers designed for the bedrail are put on to reduce this risk. One person’s risk assessment stated that their bedrails are to be protected by bumpers at all times. When looking at the person’s bedroom we noticed that there were no bumpers on the bedrails. One care staff said they thought that the person did not need to use these. The nurse in charge said that the person needs to use them. The care staff got the bumpers from the storeroom and put them on the person’s bed to ensure their safety. It was a requirement at the last inspection that all bedrails must have bumpers in place. All staff must be aware of this so that people are not at risk of injury. The AQAA stated, “We regularly receive inspections on medication practice and storage to ensure people are receiving prescribed treatment for their wellbeing”. The medication is stored in a locked trolley in a locked room. The trained nurses give the medication to the people living there. Nurses were observed giving medication to people appropriately. Where people were refusing it nurses were heard explaining to the person what the medication was for and how it would help them so encouraging them to take it to ensure their well being. Boots supply the medication in pre-prepared blister packs. This helps staff to know what medication is to be given to each person and at what time so Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 16 reducing errors. There was not a photograph of the individual on their Medication Administration Record (MAR) so it was not easy for unfamiliar staff to know who to give the medication to. One nurse said she had recently suggested this to the manager so it is something that will probably be done. MAR sampled had been signed appropriately and cross-referenced with the person’s blister pack indicating that medication had been given as prescribed. Where people had needed or not needed medication that had been prescribed as required (PRN) staff had written on the back of the person’s MAR why this had been given or why it had been omitted. For example staff had not given a person a laxative as the person had a bowel movement so did not need this medication. Some tablets cannot be stored in blister packs as this affects how effective they are. MAR sampled showed that when medication was stored in boxes that the nurse had checked and counted as they gave the medication that it was being given as prescribed so ensuring the person’s well being. Audits showed that medication was being given as prescribed. Some medication prescribed to the people living there were Controlled Drugs (CD’s). These were stored separately as required. They were recorded when given and regularly checked in the CD register to ensure that they are not being misused. People’s personal care needs are well met and people are treated with dignity and respect, for example: Staff were observed throughout the day talking to people in a way that respected them as an individual. People were well dressed in individual styles that reflected their gender, age, the weather and the activities they were doing. Attention had been paid to individuals’ personal care so ensuring their self-esteem and well being. Staff said that the hairdresser visited every week and people could have their hair done when they wanted. Staff were observed sitting down to talk to people at the level they were sitting at so they were not standing over people. Staff were smiling at people when they were talking to them so making them feel safe and valued as an individual. Staff were observed checking that one person’s hearing aid was turned up enough and that they were hearing well. This is important as people can become socially isolated if they do not hear well. One person’s care plan stated that staff use a communication book/flipchart when communicating with them so they know what the person wants. Staff spoken with said that they think that the person does have this. The person Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 17 was observed sitting in the lounge but they did not have a communication book with them so staff would not be able to use this. As the person was not able to say what they wanted it is important that staff use this to avoid the person becoming frustrated. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living there have choice and control over most of the things they do, which could impact on their well being. People are supported to keep in contact with their family and friends so they can maintain the relationships that are important to them. EVIDENCE: Records sampled stated if the person practised a religion and if so what this was. They did not contain information about the religion, how the person was to be supported to practise this and how this may affect the things they do or their beliefs. This is needed so that staff can respect the person’s beliefs. Staff said that the priest often visits one person. The people living there said that regular activities such as a visiting singer, exercise to music class, massage therapist and hairdresser are provided. A member of staff also works two days a week organising activities with people. They were observed playing cards with people in the morning. People also said they play games if they want to. The AQAA stated that they plan to improve Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 19 activities by employing a permanent activities co-ordinator so that people are not bored. One person said in the survey that activities are usually arranged. Records sampled showed that people who spent most of their time in bed were encouraged to socialise and take part in activities so as to reduce their isolation. One person was observed knitting during the afternoon and staff were observed taking interest in what the person was making commenting that it was “pretty.” This obviously pleased the person helping to raise their selfesteem. Staff said that sometimes when the weather is good they take people out for a short walk locally to have a look around the shops. Records sampled showed and it was observed that visitors are welcome at the home to visit when they choose to so that the people living there can maintain relationships that are important to them. Relatives spoken with said that they are always made welcome and that the staff support them as well as their relative living there. The AQAA stated, “We are also planning to introduce a residents’ forum, which will be a three monthly meeting with the people capable of making contributions setting an agenda.” This will help to increase the choice and control that people have over their lives as these meetings are currently held annually with people’s relatives also involved. Staff were observed giving people the TV remote control so they could choose what they wanted to watch. Later in the afternoon when the people in the lounge were not able to use the remote control staff noted that children’s programmes were on so told people they would turn it to a different channel that they would probably enjoy more. This shows that staff are aware of individual’s needs and respect them as older adults. Throughout the day people were offered a choice of drinks. One person said that they did not always like the food and it was not always easy for them to eat it, as they have no teeth. They said, “When we have poultry we don’t have chicken gravy so all the meat tastes the same.” Records showed and the manager said that they are meeting with the chef to improve the food so that it is nutritious and what the people living there want. One person said there is always a choice of cereal for breakfast as well as a choice of fruit juice and they can have what they like. People said in the survey that they sometimes like the meals in the home. Food records showed that the people living there are offered a varied and nutritious diet that is appropriate to their cultural background. A record of what individual’s eat and drink is kept to show that people have a balanced diet. The AQAA stated, “We conduct regular quality surveys, asking each person and their relatives for their opinions and views. The overall satisfaction level was high though there were a few issues identified that required attention, such as Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 20 the introduction of an alternate option for a meal of choice. Although we have a four week set menu, people can now choose what they would like to eat at any given meal time. We provide a choice of meals with the carers visiting people in their rooms to ask of their dietary preferences.” Food records sampled did not indicate that an alternative to the menu is being offered each day. Throughout the day staff were observed regularly giving people drinks and supporting them to drink where needed to ensure they are well hydrated helping to keep them well. There were adequate food stocks available in the kitchen that included fresh fruit and vegetables. Some people are prescribed supplements and these were stored appropriately and given to the people that needed them. Staff were aware of why one person had thickener in their drinks as they had swallowing difficulties and another person had it to supplement their diet so they were adequately nourished. At the last inspection a requirement was made that all foods and sauces be dated when opened and discarded within appropriate timescales so to reduce the risk of food poisoning. This had been complied with. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. The arrangements for making complaints ensure that the views of the people living there are listened to and acted on. The people living there are protected from abuse to ensure their safety and well being. EVIDENCE: The complaints procedure was displayed in the reception area so that the people living there and their visitors would know how to make a complaint. The complaints procedure stated the details of the previous manager so should be updated with the current manager details. The AQAA stated and records showed that in the last year one complaint was received that was resolved within 28 days and was not upheld. We have not received any complaints about this service in the last year. One person said they knew how to make a complaint and were able to speak to the manager about the things they are not happy with. Records showed that this person had raised some concerns with the manager and action had been taken to resolve these. The manager said they would continue to monitor the Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 22 action taken to ensure that the person was satisfied with the improvements made. Staff records showed and staff spoken to said that they have received training in safeguarding vulnerable adults so they should have the knowledge as to how to protect the people living there from harm. The local multi – agency guidelines on protecting vulnerable adults were available. This ensures that staff have the information needed if an allegation of abuse was made so it can be reported to the appropriate people to ensure the people living there are protected from harm. Staff records showed that staff have received training about the Mental Capacity Act. This Act came into force in April 2007. This legislation requires an assessment of people’s capacity to be done if there is any doubt that the person does not have the capacity to make a decision about their health and welfare. If they are assessed as not having the capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. It is good that staff know about this legislation so they are aware of the implications of this for the people living there. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a comfortable, safe, clean and homely environment but this does not always meet their individual needs. EVIDENCE: The AQAA stated that since the last inspection they have fitted new sluice machines, fitted new carpets in every bedroom, all lounges, dining room and hallway and have redecorated the whole building. New blinds have been fitted in the lounge and dining room. New beds have been purchased with pressure relieving mattresses so to help to reduce the risk of people getting pressure Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 24 sores, which could impact on their health and well being. The AQAA stated that in the next 12 months they plan to continue replacing equipment where needed and renew curtains and bedding. The home was generally well maintained, homely and comfortable. There are two lounges on the ground floor one of which has patio doors so that people can look out over the garden. There is another lounge upstairs so that people have a choice of where to sit and spend their time. Four bedrooms were looked at. These were personalised and included people’s personal possessions and photographs of the people and places important to them. One person did not have a duvet on their bed but it was stored on their wardrobe. Staff said that the person prefers to have just a sheet as they get hot in the night indicating that staff know the needs of the people living there and what they prefer. One of the bathrooms on the first floor has a manual hoist over the bath. Staff would need to operate this by hand to get people in and out. Staff said that they do not use it very often because of this. The other bathroom upstairs is not adapted and staff said this is also not used, as people cannot step in and out of it. On the ground floor there is a shower room. Staff said this not often as most of the people living there do not like showers. Shower chairs are provided so that people can be wheeled in and out but it is not level access as there is a small raised part around the shower. One person’s bedroom seen had an en suite bathroom but they cannot use the bath, as it is not adapted for people with mobility problems. There is a bathroom on the ground floor that staff said most people used as it had an assisted bath with an electric hoist so that people could get in and out more easily with staff support. People on the first floor have to come downstairs to use this bathroom. There was a crack on one side of the bath panel. Tape had been put over it so that people were not at risk of being cut. Staff said that it had been like it for a while but was to be replaced. Consideration should be given to providing further adapted bathing facilities so that if the bath on the ground floor was not working people could still have a bath if they wanted to. A requirement was made at the last inspection for the paving slabs in part of the back garden to be made even so that people could use this area safely. The manager said that this has not been done, as there are plans to extend the property onto that area. To make the slabs even would mean that they had to be dug up and replaced, which would be a waste of money if the building plans go ahead. Staff said that they do not take people out that part of the garden, as they would be at risk of falling. One of the lounges looks out to that part of the garden so people can enjoy looking at it without being at risk of falling. There is another part of the garden that can be accessed independently and safely by people living at the home. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 25 Since the last inspection hand wash and hand towels had been provided in all toilets and bathrooms so helping to reduce the risk of cross infection. Staff cleaning were observed to be wearing protective gloves. Staff were observed wearing blue plastic aprons when they entered the dining room or kitchen so to reduce the risk of infection when they were serving or preparing food. The home was clean and free from offensive odours making it a pleasant place for people to live in. A member of staff is employed to work in the laundry. People had individual boxes for their clean clothes to be put in and these were all ironed and put in the individual’s room. Since the last inspection staff have received training in infection control. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development ensure that the needs of the people living there are met so ensuring their well being. The recruitment practices do not always ensure that the people living there are protected, which could impact on their safety. EVIDENCE: Rotas showed and it was observed that in the morning there are four care staff, a trained nurse, a domestic, chef and laundry assistant. Two days a week there is also an activity worker. In the afternoon there are three care staff, a trained nurse and a kitchen assistant. At night there are two care staff and a trained nurse. The manager and staff spoken with said the staffing levels are adequate to meet the needs of the people living there. One member of staff who completed the survey said there could be more staff on duty on the late shift. It was observed that there were enough staff on the late shift although if people had wanted to do activities outside the home this would be restricted with the staffing levels available. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 27 The manager said they were recruiting for one full-time staff and one part-time care staff. One member of staff was due to go on maternity leave and some care staff have been doing their nurse training and would soon be leaving to look for nursing posts. There were no nurse vacancies at the home. The manager and staff said that the use of agency staff working there had reduced. Rotas for one week showed that only one agency care staff had worked to cover a night shift. The AQAA stated that 35 of care staff have achieved and 23.5 are working towards achieving National Vocational Qualification (NVQ) level 2 or above in Care. The standard is that at least 50 of care staff have achieved this so when staff have completed it they will meet this standard to ensure they have the skills and knowledge to meet the needs of the people living there. Two care staff said they had completed NVQ level 2 in Care and were now doing level 3. This shows that staff are encouraged to develop their skills. Staff said that they liked working at the home. Staff said in the survey that they provide a good service to the people living there and are able to meet their needs One person living there said “The staff are as good as they can be.” Staff said that they have monthly staff meetings. They said that they add things to the agenda if they want to. Three records of the staff that work there were looked at. These included evidence that a Criminal Records Bureau (CRB) check had been completed to ensure that ‘suitable’ people are employed to work with the people living there. Two of the three records included two written references. One record only had one reference. At the front of each record there was a checklist that stated what documents had been received for the person. This stated that only one reference had been received indicating that it had not been mislaid but had never been received. This is required to ensure that staff are suitable and have the necessary experience and skills to work with the people living there. The manager said that new application forms and reference request forms are in place. These were seen and included more detail than the previous ones. One trained nurses evidence of registration with the Nursing and Midwifery Council (NMC) had expired in July 2006. The manager said that the nurse has up to date registration and this had been verified when the person was recruited by telephone to the NMC. The manager said that she would ensure that a copy of the person’s latest registration is obtained. Records sampled showed and staff said that they completed an induction when they started working there. The manager said that they plan to change the induction to the ‘Common Standards Induction’ so that staff have a thorough induction to ensure they have the skills and knowledge to work with the people living there. These induction booklets were seen so they are ready for new staff when they start. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 28 The manager said that a trainer had been employed to work there since May this year and all training is now done in-house. Records sampled showed that staff had received the training they need. Staff said that they have regular training and that this is relevant so they know how to meet the needs of the people living there. Some requirements were made at the last inspection for staff to receive training and these requirements have been met. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 29 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. The management arrangements ensure that the home is well run, which benefits the people living there. The health, safety and welfare of the people living there is not always promoted and protected, which could put them at risk of injury. EVIDENCE: Since the last inspection a new manager has been appointed as the previous manager retired from that post but is now employed as an administrator. The AQAA stated that employing an administrator had improved the running of the Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 30 home. The manager is going through our registration process. They have worked at the home as a Registered Nurse since 2005. They have completed NVQ levels 4 & 5 in Care and the Registered Managers Award. The AQAA stated that the management arrangements could improve further by employing a deputy matron who would be able to support the manager in their role. The manager and staff said that the owner is supportive and visits the home regularly to ensure it is being run in the interests of the people living there. Staff said that they think everything has improved recently. It is a friendly and nice place to work and the care that the people living there get is excellent. The AQAA stated, “ We could improve on quality assurance control.” The quality assurance system is now part of the new care management system that had been implemented in the home. The manager said this had made it easier to audit what is going on and if this improves people’s lives or not. For example the system calculates staff information i.e. absences on the computer so it is clear how this affects the day-to-day running of the home so that action can be taken to improve this. Weekly audits of the kitchen and laundry are being done as part of the quality assurance process. The outcome of this was that satisfactory standards of hygiene were being maintained so that the risk of cross infection is reduced. The manager said that since the last inspection a lockable storage space had been provided in each person’s bedroom so that they have secure space to store any valuables they have. Their relatives manage people’s money so the home does not store money on behalf of the people living there. Records sampled included an inventory of their belongings completed when they moved in to the home. These had not been updated since they had moved in so it was not clear whether or not they had any other belongings or whether they still had the belongings they had when they moved in. They should be reviewed regularly to ensure that people still have their belongings and they have not been mislaid. Supervision records sampled for care staff showed that the frequency of these had improved. The manager said that the nurses do the supervisions for the care staff and this had been scheduled throughout the year. The manager is to do the nurses supervision but said they have not yet had the chance to do these. The AQAA stated that in the next year they plan to improve staff supervisions and ensure each member of staff has an appraisal. Fire records showed that staff test the fire equipment regularly to make sure it is working. The manager said that a new fire recording book and systems are in place to improve fire safety. This was seen and had started to be used so that it was clearer what needed to be tested and when to ensure that the home was safe and the risks of there being a fire are reduced. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 31 The diary showed and staff said that the lift had been serviced in July this year to make sure it was safe to use. The AQAA stated that an engineer had completed the annual test of the gas appliances in January this year and stated that they were safe to use. The AQAA also stated that the hoists used to move people around had been regularly serviced so they are safe to use. Staff were observed pushing in their wheelchairs from the dining room to the lounge after their breakfast. Five out of the ten people that were observed did not have both their feet on the footplates of their wheelchair. Some people’s wheelchairs did not have any or only one footplate on. Others had footplates on but these were raised at the sides so that people’s feet were not supported which could put them at risk of injury. This was observed at the last inspection and a requirement was made that unless people had a risk assessment that stated the person was more at risk using footplates they must be used. The manager said that none of the people who use wheelchairs had risk assessments that stated this but they should all use footplates. The manager and the nurse in charge in the afternoon said that they would ensure that all staff complied with this. Following the inspection a letter was sent to the Provider and the manager requiring immediate action be taken to ensure people are not at risk of injury. The Provider responded to this within the timescale given and stated that action was being taken to ensure the safety of the people living there. Records sampled included an individual moving and handling assessment that stated what support each person needed to be moved and what equipment was to be used. Staff were observed moving people from their wheelchairs to chairs throughout the day as they needed to. One person was moved from their wheelchair to a chair in the lounge by two staff using a standing hoist. They were told what was happening and were moved safely. On three occasions staff were observed assisting people to move to a chair from their wheelchair by putting their hands under the person’s arms to move them, which could have put them at risk of injury. The nurse in charge said that all staff had received training in using the handling belts, which lessen the risk of injury when moving someone from one place to another. No handling belts were seen being used during this inspection. One care staff said that they help a person to get out of bed by putting their hands under the person’s arms to pull them up. This was not how it was described in their care plan or risk assessments that they needed to be moved and places both this person and the staff member at risk of injury. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 32 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 2 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 X 1 Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 33 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(4) Requirement Timescale for action 18/09/08 2. OP29 19 3. OP38 13 (4) 4. OP38 13 (4) All bed rails must have bumpers in place. All staff must be aware of this so that people are not at risk of injury. Outstanding from the last inspection. Two written references must be 31/10/08 obtained for all staff that work there to ensure that ‘suitable’ people are employed to work with the people living there. Footplates must be used with 29/09/08 wheelchairs unless a risk assessment demonstrates alternatively. This is to ensure the safety of the people living there and reduce the risk of accidents. Outstanding from the last inspection. People must be moved safely 18/09/08 and as stated in their moving and handling assessment so they are not at risk of being injured. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP8 Good Practice Recommendations The service users guide should be updated to include the current management arrangements so that people have up to date information about the home. The recording of health professional’s visits should include more information about how the care can be monitored and any follow up action easily retrievable to ensure people’s health needs are met. People should be weighed as often as their care plan states to ensure their health and well being is not at risk. There should be a photograph of the individual on their Medication Administration Record (MAR) so that unfamiliar staff would know who to give the medication to and ensure people get the medication they are prescribed. Where it has been recommended that people use a communication book to help them express their needs and wants this should be used. This will help to stop the person becoming frustrated, as they are not able to communicate. Care plans should contain more information about how to meet individual’s religious needs so that staff can respect the person’s beliefs. The people living there should be asked more often as to how they want the home to be run so they have more choice and control over their lives. An alternative to the menu should be offered so that the people living there can have more choice as to what they eat. The bath panel in the ground floor bathroom should be replaced so to further reduce the risk of people being cut by it. Consideration should be given to providing further adapted bathing facilities so that if the bath on the ground floor was not working people could still have a bath if they wanted to. Evidence that nurses have current registration with the Nursing and Midwifery Council (NMC) should be available in their records to ensure that suitably qualified staff are providing nursing care. Inventories of people’s belongings should be reviewed DS0000069702.V372269.R01.S.doc Version 5.2 Page 35 3. 4. OP8 OP9 5. OP10 6. 7. 8. 9. 10. OP12 OP14 OP15 OP21 OP22 11. OP29 12. OP35 Prince of Wales 13. OP36 regularly to ensure that people still have their belongings and they have not been mislaid. All staff should have regular supervision so that they are supported in their role and know how to meet the needs of the people living there. Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Prince of Wales DS0000069702.V372269.R01.S.doc Version 5.2 Page 37 - 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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