Inspection on 24/09/07 for Prince of Wales

This inspection was carried out on 24th September 2007.

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

Prince of Wales 18/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Prince of Wales 246 Prince Of Wales Solihull Lodge Birmingham West Midlands B14 4LJ Lead Inspector Ann Farrell Key Unannounced Inspection 24th September 2007 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Prince of Wales DS0000069702.V350315.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.V350315.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 Mrs Anne Lynne Barry Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Prince of Wales DS0000069702.V350315.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 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 residents 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 centre of Solihull and Shirley. Accommodation for residents 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 garb rails, raised toilet seats, hoists and assisted bathing facilities for residents with mobility problems. The home also has pressure-relieving equipment for residents 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. Information was available to residents and their representatives on the notice board in the reception area. A service user guide, statement of purpose and copy of the latest report from the Commission was also available providing information about the services and facilities. The information indicated that fees ranged from £630 to £700 per week inclusive of the nursing element, which is paid by the Primary Care Trust. Fees are reviewed annually and there are additional costs for services such as hairdresser, chiropodist etc. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social care inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development The inspection was conducted over one day commencing at 8am and the home/provider did not know we were coming. This was the first statutory key inspection for 2007/2008 and the manager was present for the duration of the inspection. Information for the report was gathered from a number of sources: a questionnaire was completed before the inspection (AQAA); on the day of inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home also conversation with managerial and care staff plus visitors and some residents. A number of residents were unable to communicate their views verbally to the inspector so direct and indirect observation was used to inform the inspection process. Three residents who live in the home were’ case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. What the service does well: The home was clean, warm and odour free. Residents’ rooms were comfortable and homely so providing a pleasant environment for residents to live. The managers and nurses office is on the ground floor so providing easy access to visitors who wish to discuss progress or any concerns. Relatives stated they could visit at a time that suited them, so residents were able to maintain contact with them. One stated, “You could not find a better place than this; even I would move in”. “Who ever is in this home is very lucky, I would recommend it”. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 6 There were no rigid routines in the home and residents privacy and dignity was respected by staff, so residents were able to exercise choice in their daily life. Residents and relatives reported favourably on the standard of care and the friendly staff. “Staff are super”. Residents stated they enjoyed the meals; the food was of a good standard. The meals were culturally appropriate for the resident group and special diets were catered for. One visitor stated, “My mother was not eating anything when she came and they have got her eating now”. On discussion with visitors they stated the admission process was very good and they received adequate information before their relative moved into the home. What has improved since the last inspection? What they could do better: The medication system needs to be developed and action taken to ensure it is fully auditable and residents receive the medication prescribed by medical staff. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 7 The assessment and care planning system needs developing further to ensure they provide detailed information for staff about the action required to meet resident’s needs, so care is provided in a consistent manner. The arrangements for activities needs to be further developed to ensure residents are adequately stimulated. Some of the furnishings are starting to show signs of wear and action will need to be taken to replace or repair items in order to enhance the environment for residents. Also the paving slabs in the garden need to be made level to reduce the risk of accidents when used by residents. Consideration should be given to purchasing a further supply of profiling beds to enable positioning of residents when in bed and aid their comfort. Further staff training is required to ensure all staff have up to date knowledge in all core areas to ensure they can meet residents needs effectively. Some areas in respect of infection control need to be addressed further to reduce the risk of cross infection. 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.V350315.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information was available for prospective residents and their representative in a format that was accessible enabling them to make an informed decision about moving into the home. The information obtained prior to a resident’s admission enables staff to determine if residents needs can be met in the home, so providing confidence to prospective residents. EVIDENCE: The home provides long term nursing care for older people. Information was available to prospective residents and their representatives about the services and facilities enabling them to make an informed decision about moving into the home. A copy of the service user guide was also available in each resident’s bedroom. Feedback from a visitor whose relative had recently Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 10 moved into the home was positive and they received adequate information before moving into the home. It was stated they looked around the home before moving in; found it was clean and well run. They also stated the process of moving in was well organised and “The staff are super”. On inspection of records it was noted that a member of staff undertakes a preadmission assessment of prospective residents before they move in to the home to determine if staff are able to meet their needs. They were found to be of a satisfactory standard and this provides confidence to those moving in and their relatives that the home is able to meet their needs. The home has a number of residents who suffer with confusion/dementia. Staff have not had training in this aspect of care and this will need to be addressed to ensure they have the appropriate skills and knowledge to care with residents with dementia. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Suitable arrangements were in place to meet resident’s health care needs and ensure their well being. The care planning system and recording systems need further development to ensure that residents’ needs are being met in a consistent manner. Medication systems were not adequately robust to ensure residents received the medication prescribed to them. Residents were treated with respect and their privacy was respected. EVIDENCE: Following admission to the home a nursing assessment and risk assessments were completed by staff, so ensuring staff have information to draw up a care plan for individual residents. The home is in the process of introducing some new documents and some of the assessments were of an adequate standard, but others lacked detail and did not indicate resident’s strengths and weakness. Also there was no assessment in respect of continence or mental health where it was a concern/need. Staff had long term and short-term care Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 12 plans so addressing ongoing care and areas of concerns that were of a short duration such as an infection. Some of the care plans were pre printed and the instructions were vague and in some cases not relevant e.g. “maintain mobility within limits” and the resident was bed bound, “suggest join progressive mobility”. Where a resident needed a dressing to a wound it stated to apply the recommended dressing, but did not give details of the type of dressing to be used. Also there was no record of the size of wound etc. such as a photograph or graph. Some care plans were not comprehensive e.g. in respect of a resident with a feeding tube as there were no details about positioning of the resident, the medication given via the tube and care of equipment etc. Also there was no evidence that the correct care was given in respect of the feeding tube. The care plans were reviewed regularly and the information was of a good standard and staff had noted changes, but the care plans had not been updated to reflect the changes. Without up to date care plans it cannot be guaranteed that all staff are aware of residents needs and the action required and this may lead to inconsistencies in care. Staff complete daily records for each resident to indicate how they are progressing, the type of day enjoyed and any concerns. In some cases the daily records were of a good standard, but in others there was a comment such as “comfortable day” and no indication of any care given. The manager stated she was introducing some new documents that will record the care provided by staff on a daily basis. Since the last inspection bumpers had been provided to safety rails on beds. However, there were still some bed rails without bumpers for the safety rails in place. Also in some cases overlay pressure-relieving equipment was used on mattresses and this reduced the height of the bed rails from the mattress and could put residents at risk, as they should be at least 220mm from the mattress to the top of the bed rail. An audit will need to be undertaken and action taken where necessary to address the issue and ensure risks to residents are reduced. The majority of beds in the home are of the divan type, which are not the most suitable for moving and caring for residents in bed. The manager stated there are plans to purchase some profiling beds, which will aid the process and reduce risk to residents and staff. There is a range off equipment for moving and handling residents, which included hoists with slings and sliding sheets for moving residents when in bed. However, it was found that sliding sheets were not available in resident’s bedrooms. Where residents require moving in bed they should have an individual slide sheet, so as to reduce the risk of cross infection. Whilst touring the home it was noted that some staff were hoisting residents out of bed on their own. Good practice guidelines advocate two staff should be present when a resident is being hoisted and this practice should be reviewed to ensure residents safety. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 13 Other areas that were noted that need to be addressed to ensure residents safety and well being: • • • • • • • A small number of residents were sitting in their bedrooms and did not have access to a call bell to summon help when required. Some residents were moved in wheelchairs that did not have footplates in place and this could put them at risk of injury. A urinary catheter bag was found on a stand in a bedroom and the end was on the floor, so increasing the risk of infection. Electrical leads for equipment were trailing across the floor and could pose a trip hazard. One pressure-relieving mattress was set to 50, but it was only achieving a pressure of 29. This will need to be checked and replaced if necessary to ensure the risk of pressure sores is reduced. A number of residents did not have their dentures in place and one resident who was being fed by a feeding tube had very dry lips, suggesting her oral care had not been attended to. Some resident’s hair did not appear to have been arranged neatly, so impacting on their dignity. All residents are registered with a local G.P. and staff record visits by health professionals separately to enable easy retrieval of information. It was noted there were regular visits from the chiropodist, optician and more recently a dentist had visited. There was evidence of liaison with other health professionals such as the speech and language therapist, dietician etc, as required to ensure residents health care needs were met. However, on inspection of the records the outcome of the visit was not consistently recorded and therefore it was not easy to follow. Feedback from health professionals was good indicating that staff in the home refer appropriately when required. A local pharmacist delivers the homes medication on a monthly basis. The medication was stored in a medication trolley and storage cabinets in the ground floor office, which were observed to be clean and organized so that medication could easily be located. The homes medication system consisted of box system with handwritten Medication Administration Record (MAR) sheets. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. On inspection of the medication it was found that some audits were not accurate, so it could not be guaranteed that residents were receiving the medication as prescribed by health professionals. Also some medication had been recorded as administered when there was non in stock and there were times when stocks of medication were not available for some residents. Whilst touring the home it was also found that pots of cream had been opened and not dated to ensure they were used within timescales to reduce the risk of bacterial contamination. Also pots of cream were in Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 14 resident’s rooms that were not prescribed. Other areas that require attention to ensure a robust medication procedure include: • Oxygen was stored in the home that was not prescribed and there were no policies and procedures in place regarding the storage and use of it. • The medication fridge temperature was not maintained within safe limits. Staff were in the process of developing a homely remedy policy, so that medication bought over the counter could be given for short periods for common symptoms such as colds. The manager stated that they were changing the medication system to a monitored dosage system in the near future following advice from the pharmacist. It is recommended that staff audits be undertaken on a regular basis to ensure residents receive medication as prescribed. Residents were presented satisfactorily reflecting their gender, culture and preferences. Their privacy was respected and staff interacted well with residents. Feedback was positive and it was stated, “You could not find a better place than this, and even I would come in here”. Visitors stated they were happy with the care “Staff are super”. Residents stated they were happy and the staff were good. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a homely atmosphere with no rigid rules. Visitors can visit at a time that suits them and were made welcome, so residents are able to maintain contact with family and friends. There have been some developments in respect of activities, but further work is required to ensure residents are adequately stimulated. The menus indicated a variety of foods, so providing a range of nutritious meals. EVIDENCE: Visiting is flexible enabling people to visit at a time that suits them and residents to maintain contact with friends and relatives. Feedback from visitors was positive. One visitor stated, “You could not find a better place than this, even I would come in here”. “Who ever is in the home is very lucky; I would recommend it”. At the last inspection staff were registering residents with the ring and ride service so that they could go out. Activities in house included progressive mobility, which consists of gentle exercises to music, an entertainer visits every two weeks and some one visits to give massage therapies and records indicated that residents enjoyed this. There were individual one to one Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 16 sessions with residents. Resident’s birthdays were celebrated and on arrival there was evidence that they had just celebrated a residents 100th birthday. However, further work is required in this area to ensure residents are adequately stimulated as some stated they did get bored at times. On discussion with residents they stated they could get up and go to bed when they wanted. They could spend time where they wanted and staff respected their wishes. It was stated a priest visits the home regularly, so meeting residents spiritual needs. Also a hairdresser visits on a regular basis, so residents have opportunity to have their hair done professionally. There was one dining room, which was pleasantly decorated, so providing a pleasant environment for residents to take their meals. Residents are encouraged to take their meals in the dining room, but may take them in other areas if they wish. There were separate catering staff who provide cover for all meals. Breakfast consisted of a light meal, but a cooked breakfast was available on request. There was a four-week rotating menu that provided a variety and choice of meals, based on European meals, which was suitable for the current resident group. Special diets such as diabetic and puree meals were also provided. Copies of the menus were available on each dining table so residents were aware of the menu for the day. The cook stated that there was a new shopping policy with the change of proprietor and there had been occasions when he had run out of items and so had to substitute with alternatives. At the time of inspection the cook had a joint of meat out for the next day and it was felt by the inspector that it did not provide sufficient protein for the number of residents in the home. On discussion with the manager she stated that they had recently had a number of vacancies, were wasting food and the size of joints had been reduced to accommodate for this. The manager stated she would review this area with the increase in the number of residents. During inspection there was no fresh fruit and vegetables available, but it was stated that these were obtained on a regular basis. Guidelines state that five portions of fruit and vegetables should be eaten each day for a healthy diet and fresh produce may be preferred by some residents as they have a different taste, texture and appearance to frozen or canned. The chef retains a record of food taken by residents each day, but it had not been completed consistently. This record will need to be comprehensive in order to meet the regulations, demonstrate alternatives offered and in case of any problems. Residents were observed to take breakfast and lunch on the day of inspection. They were given assistance as required and they stated they enjoyed the food. One visitor stated, “She was not eating anything when she came in and the staff had got them eating now”. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had not received any complaints and the manager has an open approach taking action as soon as any issues/concerns are raised. Staff knowledge in respect of safeguarding residents was varied and some further training is required in this area to ensure residents are fully protected. EVIDENCE: The home has a complaint procedure and means of recording any complaints. On inspection no complaints had been recorded and the Commission had not received any complaints in respect of the home. The manager stated that if there were any issues raised she would deal with it and address anything before it became a complaint. This is positive as it shows an open approach to any issues and a commitment to ensuring residents needs were met. On discussion with residents and relatives they stated they were happy with the service, the staff were very caring and they had no complaints. One visitor stated that if he had any concerns he would go straight to the manager. A notice is available on the notice board referring to the complaints procedures, but it does not outline the procedure and refers people to the manager. A copy of the procedure should be made available to all residents and their representatives so that they are clear about the procedure to follow in the event of any complaint. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 18 There were procedures and guidance from the Local Authority in respect of safeguarding residents and the prevention of abuse. On discussion with some staff their knowledge was adequate, but there was some hesitation and gaps in knowledge. Staff would benefit from some further training in this area to ensure all staff are fully aware of the procedures to follow in the event of any allegation of abuse, so residents are fully protected. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and homely environment. Re-decoration and refurbishment is in progress, so enhancing the environment for residents. EVIDENCE: Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 20 The home is a modern two storey purpose built detached property set in it’s own grounds. The accommodation was homely, clean and odour free. Communal areas consist of a dining room adjacent to the kitchen plus two lounges on the ground floor and one lounge on the first floor giving residents a choice of areas to sit. Since the last inspection the corridors, dining room, lounge, offices and staff room have been re-decorated. New carpets have been fitted in corridors and on the day of inspection the dining room carpet was being replaced. New chairs had been provided in the lounge and it was stated more chairs and carpets were on order, so enhancing the environment for residents. There was a pleasant garden to the rear of the home with level access and seating for residents when the weather permits. However, it was noted that the paving slabs were rather uneven and may pose a risk to residents who use the area. Also there was access to the rear of the home by the side of the building. This aspect should be risk assessed and action taken if necessary to ensure adequate security. Corridors were fitted with handrails and doorframes were wide, so suitable for residents with mobility problems or wheelchair users. Also there was a passenger lift that provides access to all areas of the home All bedrooms are well appointed and adequately furnished. They had a telephone point and television point that could be used where required to enhance resident’s quality of life. Although there were two double electrical sockets in bedrooms it was noted that in some cases electrical wires were trailing across the floor and could pose a trip hazard. This area will need to be reviewed and appropriate action taken to reduce the risk. On discussion with one resident she stated she liked her bedroom and it was noted that bedrooms had been personalised by residents with pictures, ornaments etc, so providing a more homely environment. A number of the beds had suitable mattresses to aid with pressure relief and reduce the risk of pressure sores developing. It was noted that most of the beds were of the divan type and may not be suitable for moving and positioning residents. The manager stated that two profiling beds were on order, which will overcome this issue and so enhance resident’s comfort and staff safety. A programme of renewal of divan beds will need to be taken into consideration in the future. There were sixteen single bedrooms with wash hand basin and two had ensuite facilities consisting of toilet and bath. However, the bath was rather low and may not be suitable for residents living in the home with mobility problems. There were also two shared rooms and curtains were provided between beds to ensure residents privacy. All areas had a call bell system to enable assistance to be summoned when required. There were assisted bathing facilities on each floor to enable assistance to be given to residents who require a bath. One of the bathrooms on the first floor Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 21 had a domestic style bath, which was used for storage and was not suitable for residents. Also the shower room on the ground floor was being used as a storage area. A review of storage facilities in the home should be undertaken with a view to ensuring all bathrooms are available for use. Whilst touring the home it was noticed that toiletries, cleaning materials, razor, scissors etc. were stored in bathrooms. These should be returned to resident’s rooms after use. Areas that needed attention include: • • • The hot water was hot to touch in some areas. Hot water should be maintained at 43 degrees plus or minus 1 degree in areas accessed by residents for washing and bathing to reduce the risk of scalding. Some laminated shelves and cupboards were damaged and will need attention, as they cannot be cleaned properly. The mirror in one wardrobe was broken and this needs to be replaced as it poses a risk to residents. All areas were individually and naturally ventilated and restrainers were fitted on windows for security and safety. There was a sluice on each floor and they have been fitted with sluicing disinfectors since the last inspection, so improving aspects of infection control. However, it was noted there was no liquid soap or paper towels in some areas where infected materials/incontinence materials were handled and this needs to be addressed to reduce the risk of cross infection. The kitchen was clean, orderly and well stocked. Temperatures of fridges, freezers and hot foods were being recorded and a cleaning schedule was in place, so ensuring adequate hygiene. Some foods and sauces in the fridge had not been dated and this will need to be addressed to ensure they are used within appropriate timescales. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels were adequate to meet resident’s needs and there had been an improvement in the recruitment procedures, so ensuring residents were safeguarded by the employment of new staff. Staff training needs further development to ensure all staff have adequate skills and knowledge to care for residents and ensure their needs are met consistently. EVIDENCE: The registered manager is on duty five days a week, which are flexible according to the needs of the home. The duty rota indicated there was adequate staff on duty to meet the current residents needs with one nurse at all times and four to five carers in the morning, three carers in the evening and two carers overnight. Domestic, catering, laundry and maintenance staff support care staff and the manager is supernumerary. A small sample of staff files was inspected to determine the recruitment process. On inspection they were found to be satisfactory with all checks completed prior to commencing employment, so ensuring residents are protected by the employment of new staff. The home had details of the induction training that meets the standards of the Social Skills Council, so that new care staff are provided with the appropriate Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 23 training to enable them to care for residents initially. However, this had not been used to date as no new care staff had been recruited recently. It was stated that over 50 of care staff had completed NVQ level 2 in care and some staff were going on to undertake NVQ level 3. This provides staff with the appropriate skills and knowledge to care for residents and ensure their needs are met. Some staff had received updated training in areas such as emergency aid, infection control, health and safety and basic food hygiene via a video recording. Although this provides basic information it needs to be combined with a training plan that is delivered by a member of staff who is competent in the area. There was no evidence of any updated training in respect of manual handling and the manager stated they had arranged for an external company to undertake the training with staff. On discussion with some staff about the fire procedure they were not fully aware of it and some staff had not undertaken two fire drills per year as required to ensure they were aware of the procedure in the event of a fire. Although there have been some developments in this area over the past year further work is required to ensure all staff receive up to date training and have the necessary updated skills and knowledge to meet residents needs and ensure they are safe. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has considerable experience and has developed systems within the home, which is run in the interests of residents. The health and safety of residents was protected by regular servicing/maintenance of equipment. EVIDENCE: The manger is a registered nurse and has worked in the home for a number of years. She is registered with the Commission and new proprietors have recently taken over the home. The information prior to the inspection indicated that servicing and testing of equipment was in place. On inspection it was found to be satisfactory with the exception of the passenger lift certificate, the emergency lighting had not been Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 25 tested since February 2007. These areas will need to be addressed to ensure the health and safety of residents, staff and visitors at all times. The manager stated she did not hold any money on behalf of residents and any extras would be paid for by the home and reimbursed by relatives. They did hold some valuables on behalf of residents, but there was no record of this and no receipt had been given to residents. This needs to be addressed to demonstrate the home has suitable systems in place for safeguarding resident’s valuables. The home does not have a formal quality assurance system at present. They have recently joined the Nursing Homes Association and secured the services of a Care Home Consultant to assist with changes etc. and it was stated they were going to review the policies and procedures. Also the new proprietor has met with staff, residents and relatives at a recent meeting and it was stated he visits the home on a regular basis. There was no evidence of formal staff supervision so that staff performance, training and support are monitored and discussed. The manager stated that they were reviewing policies and procedures at present to ensure they are up to date and in line with current guidance. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 2 X 3 2 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 1 1 2 2 Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 18(1) Requirement All staff should undertaken training in respect of caring for people with dementia so that they acquire the knowledge and skills to meet their needs effectively. Robust systems must be in place for care planning, which are comprehensive, holistic and provide detail about the action required by staff to meet resident’s needs. Care plans must be updated to reflect residents’ changing needs. Care plans must include an assessment and plan in respect of continence management and confusion where appropriate. Care plans are required to ensure resident’s needs are identified and met appropriately. Timescale of 7/4/06 and 30/3/07 not met. The system of daily recording should be reviewed to ensure it reflects the care given and the condition of the resident. DS0000069702.V350315.R01.S.doc Timescale for action 30/03/08 2 OP7 15(1)(2) 30/11/07 3 OP7 17(2) 20/10/07 Prince of Wales Version 5.2 Page 28 4 OP8 13(4) Timescale of 30/1/07 not met. All bed rails must have bumpers in place. All bed rails must be sufficiently high enough when pressurerelieving equipment is used. Footplates should be used with wheelchairs unless a risk assessment demonstrates alternatively. These are required to ensure the safety of residents and reduce the risk of accidents. Timescale of 30/12/06 not met. Suitable systems must be in pace to ensure residents safety when they are being moved with the use of a hoist. Call bells should be accessible to residents when in bedrooms so that they can summon assistance if required. All residents who require slide sheets for moving in bed must have an individual one to reduce the risk of cross infection. Systems must be in place to ensure a robust procedure for the administration and recording of medication to include: • The accurate administration and recording of all medication given to residents. • Ensure there are adequate stocks of medication at all times. • Ensure all creams are dated when opened and discarded after appropriate timescales to reduce the risk of bacterial infection. • Ensure the drug fridge is maintained between 2-8 DS0000069702.V350315.R01.S.doc 20/10/07 5 OP8 13(5) 13(4) 12(1) 20/10/07 6 OP8 20/10/07 7 OP8 13(3) 20/10/07 8. OP9 13(2) 30/10/07 Prince of Wales Version 5.2 Page 29 9 OP15 17(2) Sch4 10 OP15 16(2)(i) 11 OP16 22 12. OP18 13(6) 18(1) 13 OP19 23(2)(b) 14 OP19 13(4) 15 OP19 16(2)(j) degrees to ensure medication is stored correctly. • Ensure all creams etc are prescribed for residents use unless it is a homely remedy. A comprehensive record of food provided to residents must be retained in the home in sufficient detail to determine whether the residents receive a nutritious and well balanced diet. Timescale of 25/03/06 and 30/12/06 not met. Review the protein content of meals and provide a range of fresh fruit and vegetables to ensure residents receive a nutritious diet. A copy of the complaints procedure must be made available to residents and their representatives so they are aware of the full procedure. Timescale of 30/1/07 not met. Training should be provided to all staff to ensure they are fully conversant with the procedure to follow in the event of an allegation of abuse and the whistle blowing policies, so residents are protected. Timescale of 30/1/07 not met. A review of all furnishings should be undertaken and a programme of replacement/repair undertaken to ensure a pleasant environment for residents to live. Timescale of 30/1/07 not met. The paving slabs to the rear of the property should be made even to reduce the risk of accidents to residents. All foods and sauces must be dated when opened and discarded within appropriate timescales. DS0000069702.V350315.R01.S.doc 20/10/07 20/10/07 30/10/07 30/11/07 30/03/08 30/03/08 20/10/07 Prince of Wales Version 5.2 Page 30 16 OP26 13(3) 17. OP30 16(2)(j) 17(2) 18 OP30 13(5) 17(2) 19 OP30 13(3) 17(2) 20 OP30 23(4)(d) (e) 17(2) Timescale of 30/12/06 not met. There must be suitable arrangements in respect of infection control to include: • The provision of liquid soap and paper towels in all areas where continence or infected materials are handled. • Toiletries and personal equipment must be returned to resident’s bedrooms after use in bathrooms. Timescale of 30/1/07 not met. All staff must undertake training 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 and records retained in the home to ensure residents safety. Timescale of 30/3/07 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. Records must be kept in the home Timescale of 30/3/07 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 31/01/06and 30/3/07 DS0000069702.V350315.R01.S.doc 20/10/07 28/02/08 30/11/07 30/12/07 30/10/07 Prince of Wales Version 5.2 Page 31 21 OP35 17(2) 22 OP38 23(4)(c) 17(2) 23 OP38 13(4) 17(2) not met. 30/10/07 A record must be kept of all valuables that are held on behalf of residents to ensure their property is adequately protected. The emergency lighting systems 30/10/07 must be checked monthly in house to ensure it is working properly. A certificate for the passenger lift 30/10/07 must be available to demonstrate it is fit for use. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP8 OP8 OP8 OP8 OP8 OP9 Good Practice Recommendations Review the system of recording health professional’s visits to provide more information about the outcome of visits that is easily retrievable, so that care can be monitored. Systems should be in place to ensure pressure-relieving mattresses are working effectively at all times. Review the arrangements in respect of catheter care to reduce the risk of infection. Introduce a system for monitoring of wounds e.g. photographs so that they can be evaluated effectively to determine if there are improvements. Review the arrangements for oral care to ensure resident’s oral care needs are met. Policies and procedures should be drawn up for the storage and administration of oxygen to ensure its safe use. Audits of medication should be undertaken to ensure medication is administered as prescribed. The arrangements in respect of activities needs further development to ensure residents are adequately stimulated. DS0000069702.V350315.R01.S.doc Version 5.2 Page 32 7 OP12 Prince of Wales 8 9 10 11 12 OP19 OP22 OP25 OP31 OP33 13 OP36 A risk assessment should be undertaken in respect of security of the home, to ensure residents are safe at all times. Suitable arrangements must be made for the storage of the homes equipment etc. so that it does not impinge on the facilities for residents. Review the arrangements for electrical sockets and cables in resident’s bedrooms to reduce the risk of accidents. The registered manager should undertake the Registered Managers Award Course, to ensure she has up to date knowledge regarding management of a care home. An effective quality assurance and quality monitoring systems should be implemented and include feedback from all stakeholders in order to monitor the services and facilities and put systems in place for continuous improvement. A system of formal staff supervision should be set up to monitor staff progress and provide support. Prince of Wales DS0000069702.V350315.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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.V350315.R01.S.doc Version 5.2 Page 34 - 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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