Inspection on 04/01/06 for Prince of Wales House

This inspection was carried out on 4th January 2006.

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 House 11/04/08

Prince of Wales House 23/04/07

Prince of Wales House 03/05/06

Prince of Wales House 03/08/05

Prince of Wales House 07/10/04

Prince of Wales House 28/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Prince of Wales House 18 Prince of Wales Drive Ipswich Suffolk IP2 8PY Lead Inspector Jane Offord Unannounced Inspection 4th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000029240.V276100.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. DS0000029240.V276100.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 Post Vacant Care Home 43 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (33) of places DS0000029240.V276100.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2005 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. DS0000029240.V276100.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 on a weekday between 9.30 and 16.00. The administrator and new manager were available throughout the day to assist with finding files and giving information. During the day a number of other staff were spoken with and they were all open and co-operative. Three staff files and three residents’ files and care plans were seen. The duty rotas, some maintenance certificates, the complaints log, the medication policy and some medication administration record (MAR) sheets and the activities programme were all seen as part of the evidence gathering process. The administrator explained the system used to manage residents’ personal allowances. A tour of the premises was undertaken and a number of residents’ rooms were seen as well as some bathrooms and toilets, two lounges, one dining room and the clinic room. The home was clean and tidy on the day of inspection with no unpleasant odours. Some of the rooms seemed over warm but the dining room in the special needs unit felt very cool. 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 activities programme has been increased and the activities co-ordinator is to receive additional training for the post. There is a dedicated craft room that looks well used by the residents. The patio doors in the special needs unit have had the opaque double glazed glass replaced so the view to the garden is no longer restricted. DS0000029240.V276100.R01.S.doc Version 5.1 Page 6 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. DS0000029240.V276100.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 DS0000029240.V276100.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): None of these standards were inspected on this occasion. EVIDENCE: DS0000029240.V276100.R01.S.doc Version 5.1 Page 9 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 the plan of care will cover all their needs. EVIDENCE: Three residents’ personal files and care plans were inspected. One consisted of information from a previous placement and was still on that service’s paperwork although the resident had been in Prince of Wales House for at least two months. There was no indication that there had been any review or updating of the resident’s needs since they were admitted to the home. The assessment of care needs used on admission looked at areas such as communication, sight, hearing, mobility including the aids used, personal care, diet, continence, sleeping and oral care. Two assessments seen also included social interests, risks and spirituality. The care plans generated from these assessed headings were very sparse. The daily records frequently mentioned a problem that there was no care plan for. One resident had problems of constipation, falls and was ‘low in mood’ but the only intervention on the care plan was related to a problem with alcohol DS0000029240.V276100.R01.S.doc Version 5.1 Page 10 consumption. Another resident’s daily records said that the resident had ‘expressed suicidal tendencies’ but again there was no care plan to cover this need. Another had severely impaired hearing and needed two hearing aids but the care plan did not cover that. A number of risk assessments were not completed or partially completed. One resident had a diagnosis of diabetes but the nutrition risk assessment was not filled in. Another resident with a history of falls did not have a moving and handling assessment completed and a further assessment for tissue viability was filled out but not totalled. The total would have made that resident a high risk and should have recorded the interventions needed to protect them. The files contained records of visits by or to health professionals including the GP, community nurse and stoma care nurse. The medication policy was seen and contained guidelines on administration of medication, storage and ordering. There were also procedures for managing homely remedies and for residents who wished to self medicate. There was a section relating to covert administration of medication and the right of the resident to refuse medication or treatment. The MAR sheets were inspected and there were no gaps seen in the signature boxes. When a medication was prescribed as ‘as required’ (PRN) and there was a choice of dose i.e. one tablet or two, the number of tablets given was not always recorded. 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. DS0000029240.V276100.R01.S.doc Version 5.1 Page 11 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, 15 People who use this service can expect to be offered a 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 five days a week. The programme for December included a Christmas draw, a pantomime, a Christmas party, a carol service, Christmas shopping in Felixstowe, visits from two entertainers and an outing to Shotley for a Christmas meal. There were photographs of some of the residents enjoying these activities displayed in the hall of the home. The co-ordinator keeps individual records of residents’ participation in the planned activities and whether or not they enjoy them. One resident had taken part in a ‘word search’ and the records stated that they wanted more of that activity. Another had done some work in the dedicated craft room and the record was that they ‘really enjoyed this afternoon’. The records showed evidence of a wide range of activities and outings. In the summer there had been visits to Needham Lake and Alton Water. There were also games such as dominos, bingo and beetle drives offered regularly. DS0000029240.V276100.R01.S.doc Version 5.1 Page 12 One resident who prefers to remain in their room said that they were kept supplied with knitting wool by the co-ordinator and had been ‘commissioned’ to knit some cushion covers for some of the other residents’ rooms. During the day a number of visitors came and went. The staff welcomed people by name and answered questions. One resident said they had been to a relative’s home for Christmas day. They had three children living nearby and they popped in whenever they could. Although the kitchens were not visited on this inspection the lunchtime meal that was served to some residents in their room was seen. It looked well presented and hot. One resident said ‘the food is always lovely’. A resident who did not like milky products asked for their pudding, that had custard on it, to be changed for fruit and a carer willingly did that, returning with a bowl of tinned peach slices. DS0000029240.V276100.R01.S.doc Version 5.1 Page 13 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: A complaint from a resident had been received the day before the inspection. The manager discussed the complaint and the way forward with the inspector and then took the decision to make a POVA referral and continue the process of suspending a member of staff. A further complaint that was made by another resident some months ago, about their care during the night, was investigated thoroughly and records of the methods used and the findings were seen. Staff spoken with were clear about being able to recognise potentially abusive situations and what they would do about them. Care staff said they had recently had POVA training. Ancillary staff were also able to identify the correct way to manage any situation that caused them concern but had not received POVA training. DS0000029240.V276100.R01.S.doc Version 5.1 Page 14 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, 20, 22, 24, 25, 26 People who use this service can expect to live in a well-maintained and comfortable environment with their own possessions around them, however they cannot be assured that the hot water and heating systems meet regulation standards. EVIDENCE: Since the last inspection the service has employed a fulltime maintenance person. There is a book kept in the entrance hall for staff to report any maintenance jobs that are required. The maintenance person checks the book three times a day and indicates when jobs are completed. 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. Individual residents’ rooms were arranged to suit them with many personal items in use and on display. One resident said they had ‘a lovely view of the Orwell Bridge’ and they were very happy in the home. DS0000029240.V276100.R01.S.doc Version 5.1 Page 15 The use of specialised pressure relieving mattresses and cushions was observed and wheelchairs and walking aids were seen. 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. Corridors and doorways were wide enough for wheelchair users and there was level access to the gardens. The residents in the special needs unit had access to an enclosed garden. Work on the hot water system was being carried out during the last inspection however further work has been identified as needed before the system will function properly. Several of the residents’ rooms did not have hot water in the washbasin and staff were transporting hot water in jugs up and down the main stairway. The heating in some rooms was too much and in others the room felt cool. Staff said they were unable to control individual radiators to regulate the temperature. Two showers were seen and had notices on them that they were not to be used. When staff were asked they did not know why but said they had been out of order for a long time. The following day the inspector spoke to the Responsible Individual about these issues. They said they were getting tenders for the work needed to remove asbestos and replace water tanks. They would ask the maintenance person to verify that all the radiator thermostats were functioning. The showers were not in use, as they had no thermostatically controlled mixer valves in them. That would be included in the work to be done. DS0000029240.V276100.R01.S.doc Version 5.1 Page 16 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, 29, 30 People who use this service can expect to have their needs met by staff who are correctly recruited, but they cannot be assured that there will always be enough staff on duty for the level of resident dependency or that all staff have received all the appropriate training to do their job. EVIDENCE: Three staff files were seen. They all contained evidence of an enhanced Criminal Records Bureau (CRB) disclosure being sought and obtained prior to the employee commencing in the post. There were two references, a photograph of the employee and evidence that identification documents had been seen and photocopies taken, in all the files seen. Care staff spoken with said they had had induction training when they commenced in post. Since then they had had updates in moving and handling, fire awareness, caring for people with dementia and recently, POVA training. The senior carers who administer medication have had one training course about medication but no updates. One carer said that the pharmacist is always helpful if they ask. The manager was following up an offer of training from Boots so staff could be updated. Some ancillary staff, including the maintenance person, should have training in moving and handling loads and POVA. DS0000029240.V276100.R01.S.doc Version 5.1 Page 17 A number of care staff raised concerns that the staffing levels were not sufficient to meet the needs of the residents. They said there were times they could not bath residents because of lack of time and that if the kitchen staff were short then carers had to do the washing up. The duty rotas were seen and staffing on the day of inspection consisted of 2 seniors and 4 carers on an early shift, 1 senior and 5 carers on a late shift with 3 carers to cover the night shift. In addition there were 4 domestic staff on duty during the day, an administrator, an activities co-ordinator and a maintenance person. The manager was also present for the day. In discussion with the manager they explained that staffing has recently been reduced at times, as the present residents are less dependent than previously. This is not always the case as the number of contracted hours means that there are times when staff numbers are at the old levels. The manager intends to keep dependency levels under review to ensure that staffing is at the appropriate level. DS0000029240.V276100.R01.S.doc Version 5.1 Page 18 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, 38 People who use this service can expect it to be managed by a person of good character and to have their financial interests and health and safety protected, however they cannot be assured that the staff are appropriately supervised. EVIDENCE: The manager has been recently appointed and had been in post only six weeks at the time of this inspection. They 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. Previous requirements and recommendations, with the exception of those relating to the hot water system, have all been actioned within the time scales. 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 DS0000029240.V276100.R01.S.doc Version 5.1 Page 19 care and consideration being given the residents. One comment said, ‘I want to thank personally all the staff who made my Mum and Dad’s stay so special. You made them feel so welcome’. The administrator demonstrated the system used to manage the residents’ personal allowances. All monies are kept in individual wallets in a safe in the office. The administrator and the manager hold the only two keys. A clear audit trail was demonstrated and receipts are kept safely. One wallet was randomly checked and tallied with the recorded total. Some residents manage their own money. When their allowance is delivered to them two staff sign as witness to the transaction. All residents’ rooms have a lockable drawer for valuables and all the rooms have locks on the doors. Staff spoken with said they had not received supervision regularly. One senior had only had two sessions in eighteen months. The service has been without dedicated leadership for a period of time. The new manager said they have a plan to introduce a programme of supervision for all staff. Evidence of maintenance certificates was seen. There had been a satisfactory inspection of the fire alarm system done in October 2005 and a check on gas safety dated September 2005. A food hygiene inspection took place in January 2005 and the home’s insurance policy was valid until March 2006. The certificates for the hoists appeared out of date but the administrator was able to locate the most recent evidence showing that the hoists had been serviced in September 2005. DS0000029240.V276100.R01.S.doc Version 5.1 Page 20 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 1 3 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 3 DS0000029240.V276100.R01.S.doc Version 5.1 Page 21 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 2 Standard OP7 OP8 Regulation 15 (1) 13 (1)(c) 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 and tissue viability must be completed and scored so the appropriate interventions are identified and actioned. When PRN medication is prescribed with a choice of dose i.e. one or two tablets, the number of tablets given must be recorded on the MAR sheet. The work required on the hot water and heating system must be urgently undertaken so that residents can all access hot water their rooms, use showers if they wish and adjust heating from individual radiators. An action plan with a timescale of the work must be sent to CSCI within 28 days of receipt of the draft report. All staff who are responsible for medication administration must receive regular updates in training from a recognised DS0000029240.V276100.R01.S.doc Timescale for action 20/03/06 04/01/06 3 OP9 13 (2) 04/01/06 4 OP25 23 (2) (j)(p) 31/03/06 5 OP30 18 (1)(c)(i) 31/03/06 Version 5.1 Page 22 6 7 OP36 OP38 18 (2) 13 (4) (a) trainer. A programme of formal supervision of staff must be implemented. The practice of carrying jugs of hot water to the rooms at present without a supply must be risk assessed and a copy sent to CSCI within 28 days of receipt of the draft report. 31/03/06 31/03/06 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 OP27 OP18 Good Practice Recommendations Regular review of the staffing levels in relation to the dependency needs of the residents should be undertaken. All ancillary staff should receive POVA training. DS0000029240.V276100.R01.S.doc Version 5.1 Page 23 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 DS0000029240.V276100.R01.S.doc Version 5.1 Page 24 - 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!