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Inspection on 03/05/06 for Prince of Wales House

Also see our care home review for Prince of Wales House for more information

This inspection was carried out on 3rd May 2006.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home completes the checks for new staff correctly and maintains good staff files that are easily accessible. The meals looked appetising and residents reported that there was a good level of choice and the quality of the meals was good. The homes offers residents a range of interesting and stimulating activities. There are good management systems in place to audit and monitor the quality of the provision.

What has improved since the last inspection?

The medication systems appeared to work well and staff now record the numbers of tablets given on a PRN basis. The showers, which were out of order at the time of the last inspection, have been repaired. Staff are now receiving regular supervision.

What the care home could do better:

Care plans and daily records must be accessible and need to be completed much more fully to offer holistic care to residents and identify interventions required if a need has been highlighted. Ancillary staff should be included in most mandatory training but particularly the Protection of Vulnerable Adults (POVA) training. The ongoing problems with the hot water and heating system must be addressed urgently to allow provision of hot water in all the residents` rooms and stop the practice of transporting jugs of hot water up and down stairs. The non smoking policy should be reviewed with the residents who were admitted when the home permitted smoking , and efforts made to reach a compromise.

CARE HOMES FOR OLDER PEOPLE Prince of Wales House 18 Prince of Wales Drive Ipswich Suffolk IP2 8PY Lead Inspector Cecilia McKillop Unannounced Inspection 3rd May 2006 10:00 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 House DS0000029240.V292045.R01.S.doc Version 5.1 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 House DS0000029240.V292045.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Prince of Wales House Address 18 Prince of Wales Drive Ipswich Suffolk IP2 8PY 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) 01473 687129 01473 604869 The Partnership in Care Limited Mrs Moya Elizabeth Blake Care Home 43 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (33) of places Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: The home is situated in a residential area of Ipswich about three miles from the town centre. There is a parade of local shops nearby and regular buses into the town. The accommodation is on two floors with passenger lift access for people unable to manage stairs. On the ground floor is a special needs unit for ten residents with a diagnosis of dementia. There is a large enclosed garden that is accessible by separate doors from the special needs unit and the main house. The bedrooms are single occupancy with bathrooms and toilets placed throughout the home within easy reach. There is a large lounge and dining room on the ground floor and smaller quiet lounges available if preferred. The special needs unit has a lounge, dining area and kitchen, with access to an enclosed part of the garden. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place midweek and the purpose was to inspect against the key standards, follow up matters, which were identified at the last inspection and investigate a complaint. The manager was available to assist with accessing records and answering queries. During the day a number of staff, residents and visiting relatives were spoken with. A sample of staff files, resident’s records and care plans were seen. The duty rotas, the complaints log, and the medication administration record (MAR) sheets were all seen as part of the evidence gathering process. A tour of the premises was undertaken and a number of residents’ rooms were seen as well as some bathrooms and communal areas. The home was clean and tidy on the day of inspection with no unpleasant odours. All the residents seen looked comfortable and well presented. Interactions between staff and residents were appropriate and respectful. What the service does well: What has improved since the last inspection? The medication systems appeared to work well and staff now record the numbers of tablets given on a PRN basis. The showers, which were out of order at the time of the last inspection, have been repaired. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 6 Staff are now receiving regular supervision. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 7 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 House DS0000029240.V292045.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Service users needs are assessed prior to their admission to the home EVIDENCE: Standard 3 and 6 were last inspected in August 2005 and found to comply with the requirements, so they were not examined in detail at this inspection. The records on a newly admitted service users was chosen at random and the records evidenced that an assessment process was followed prior to their admission. The newly admitted resident had been visited in hospital by the manager but had not visited the home before moving in. The inspector was informed that residents and their families are always invited to look around the home. The home offers ‘transitional care’ rather than ‘intermediate care’. The key difference being that the home does not offer a rehabilitation package but accommodation while a care package is prepared to allow a resident to return to their own home. The admission process for a permanent resident and a resident moving in on a transitional basis is the same. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 9 The statement of purpose and service users guide has recently been amended following a change to the organisations smoking policy. One resident and their family expressed concern about the homes change to a non-smoking environment. The resident had been admitted when the home allowed smoking and expressed concern that this change had taken place without alternative arrangements being made to meet her needs. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use this service can expect to be treated with respect and have their health care needs met, however they cannot be assured that staff can access their plan of care or that it will cover all their needs. EVIDENCE: The home has introduced a new computer recording system and all residents care and monitoring records are held in this way. While considerable efforts had been made to transfer over all the relevant information there were problems on the day of the inspection and staff were unable to access the records on a resident who had recently gone to hospital and subsequently been discharged. Daily records and care plans of four residents were examined as part of the inspection process. However the care plans were not always sufficiently detailed and they had not been updated to reflect residents changing needs. One resident was described as independent but in discussion with staff it was clear that they were using a hoist to move this resident. Another resident was identified as having poor nutrition but this was not addressed as part of a care plan. There did not appear to be system in place for the monitoring of resident Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 11 weight were there was a concern about their nutrition. It was reassuring in talking to staff about one of the cases examined that a referral had been made to a specialist but this had not been documented. Daily records were also being completed on the computer system and while there were examples of good practice the records just prior to the inspection mainly consisted of comments such as had a good day and were not very informative. Risk assessments were in place although were not examined in detail at this inspection. The MAR sheets were inspected and there were no gaps seen in the signature boxes. Staff were recording the numbers of tablets given on a PRN basis. The member of staff on duty who was responsible for administering the medication confirmed that she was undergoing training in the administration of medication. Staff were observed knocking on residents’ doors prior to entering the room. They spoke respectfully to residents and offered them choices about what they wanted to do or where they would like to be. Residents spoke highly of the staff. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use this service can expect to be offered meaningful activities programme, be encouraged to maintain contact with family and friends and receive a balanced diet. EVIDENCE: The service employs an activities co-ordinator and the inspector was informed that there was an ongoing programme of activities. The home has a dedicated craft area for resident use. One resident said that in the better weather, trips out to local places of interest are organised. On the afternoon of the inspection residents were observed resting in their rooms, listening to music and walking in the garden. Visitors came and went during the day and residents spoken with said that their relatives were always welcomed. One resident spoken with said that he had a key to his room and could come and go as he liked. Although another resident expressed concerns about the lack of control she felt she had over her life. This resident was unhappy about the homes decision not to allow smoking in the home or grounds. The lunch meal was served to residents in the dining room or in resident’s bedrooms. Residents had a choice of sausage casserole or an omelette with a Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 13 range of vegetables. The meal looked freshly prepared and nutritious. Residents told the inspector that the food was good. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use this service can expect that any complaint will be taken seriously and investigated and that they will be protected from abuse. EVIDENCE: An anonymous complaint was received by the CSCI in the week preceding the inspection. The complainant expressed concern about the care received by a resident and said that the home continued not to have hot water in all the bedrooms. The complainant said that this resulted in staff having to carry hot jugs of water around the home. The inspector was unable to investigate the aspect of the complaint, which related to the resident because the residents records had been computerised and were unavailable. The Proprietor was subsequently written to and asked to investigate this aspect of the complaint and report back to the commission. The inspector found that there continued to be a small number of bedrooms without hot water and has written to the proprietor requiring him to address this. The homes records of complaints were examined as part of the inspection and no further complaints had been received since the last inspection. There was evidence from previous investigations that the home takes complaints seriously and undertakes a thorough investigation. There was evidence both from discussion with staff and an examination of the records that staff receive training to help them recognise potentially abusive situations and what actions to take. In the sample examined however one member of ancillary staff had not undertaken POVA training. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 People who use this service can expect to live in a well-maintained and comfortable environment, however they cannot be assured that the hot water systems meet regulation standards. EVIDENCE: The building was clean and tidy on the day of inspection with no unpleasant odours present. The furnishings and décor throughout were in good order and homely. The entrance and hallway was in the process of being decorated. . Individual residents’ rooms were arranged to suit them with many personal items in use and on display. One resident said that they had a lovely large room and a number of others expressed satisfaction with their rooms. The corridors and stairs had grab rails and banisters and there was a passenger lift to allow people with poor mobility access the first floor. Since the last inspection some work has been undertaken to address the issues with the hot water however there remains a number of resident’s rooms, which did not have hot water in the wash hand basin. Staff currently carry water in jugs to these rooms for washing. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 16 The manager confirmed that the showers, which were broken at the time of the last inspection, had been repaired. The water temperatures in a sample of bathrooms were tested and were found to be within the recommended levels. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use this service can expect to have their needs met by staff who are correctly recruited. Training is offered but would benefit from further expansion. The numbers of staff were in the process of being reviewed. EVIDENCE: Two staff recruitment files were seen. They all contained evidence of an enhanced Criminal Records Bureau (CRB) disclosure/ POVA being sought and obtained prior to the employee commencing in the post. There was evidence of two references being received. Two new staff had started work at the home the day before the inspection and they were in the process of being inducted and were shadowing more experienced members of staff. They reported that they were being supported and had been shown the basics such as what to do in the event of a fire. A sample of training records were examined and there was evidence of staff having access to a range of training including moving and handling, POVA training, medication, food hygiene and fire awareness. The manager said that it was planned that the records would be individualised which would allow senior staff to better identify gaps in training. This will be followed up at a future inspection. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 18 The manager informed the inspector that the home currently employs 31 care staff and out of this number, 12 staff have successfully completed National Vocational Qualifications. Two staff are in the process of doing NVQ. The home does not therefore currently meet the standard of 50 of care staff having achieved NVQ level2. Staffing levels on the day of the inspection were generally satisfactory. Staff were observed to be busy but responded to calls for assistance promptly although bells did ring for some time before being answered during the staff handover. Staff interviewed did not identify concerns about the overall staffing levels but said that problems arose when staff went off sick or when staff had annual leave, because there were no arrangements for cover. This was discussed with the manager who said that efforts were generally made to find cover for shifts from within the staff team but there was agreement for agency staff to be used if needed. The manager said that the staffing rota was in the process of being reviewed along with dependency levels and additional staffing will be provided in the early evening. This area will be re examined at the next inspection. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 People who use this service can expect it to be managed by a person of good character and to have their health and safety protected. The record management system is in need of review. EVIDENCE: The manager has been in post under a year but came from a similar post in an adjacent county. Since taking up the post they have appropriately managed a number of issues related to care practice and staff. The compliments log was seen and there were a large number of cards and letters from visitors and relatives. They were very pleased with the level of care and consideration being given the residents. The records and discussions with staff evidenced that staff receive regular supervision. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 20 As outlined earlier in the report the home has recently moved its resident’s individual records from paper to computer records. However staff were unable to access all of these records on the day of the inspection. Maintenance certificates were not seen at this inspection but were examined at the inspection in January 2006 and found to be satisfactory. Records of accidents are maintained and matters reported under the RIDDOR regulations. Windows restrictors were in place on the first floor windows and there was records maintained on the testing of water temperatures. There was also evidence of regular testing of portable electrical items. The company has a Quality assurance manager and the last audit of the home was undertaken in March 2006. Regulatory visits by the operational manager are also undertaken as required. The manager said that there are plans in place to undertake a survey of residents looking at overall satisfaction. A residents meeting was due to take place later in the week Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 21 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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 1 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 1 3 Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 22 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 OP7 Regulation 15 (1) Requirement Care plans must be developed to address residents’ identified needs for any area of their care. Assessments identifying levels of risk in areas such as nutrition must be completed and actions taken to monitor any changes. Residents records must be accessible to staff. The work required on the hot water system must be urgently undertaken so that residents can all access hot water their rooms. An action plan with a timescale of the work must be sent to CSCI within 28 days of receipt of the draft report. The non smoking policy must be reviewed with those residents who were admitted under the previous policy. Residents must be enabled to make decisions with regard to their care, health and welfare. An action plan should be provided to the commission DS0000029240.V292045.R01.S.doc Timescale for action 01/06/06 2. OP8 13 (1)(c) 01/06/06 3 4. OP37 OP25 17(1) 23 (2) (j)(p) 01/06/06 01/06/06 5 OP4 12(2) 12(3) 01/06/06 6 OP28 18 01/06/06 Prince of Wales House Version 5.1 Page 23 outlining the plan in place to achieve 50 of staff with NVQ level 2. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP18 Good Practice Recommendations 2. All ancillary staff should receive POVA training. Prince of Wales House DS0000029240.V292045.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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 House DS0000029240.V292045.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!