Inspection on 07/06/05 for Priorsmead

This inspection was carried out on 7th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Priorsmead 29/11/07

Priorsmead 02/11/06

Priorsmead 01/11/05

Priorsmead 15/03/05

Priorsmead 28/06/04

Priorsmead 18/03/04

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 Priorsmead Canterbury Way Thetford Norfolk IP24 1EB Lead Inspector Jerry Crehan Announced 07 June 2005 09:30 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 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. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Priorsmead Address Canterbury Way, Thetford, IP24 1EB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01842 752039 01842 750357 Norfolk County Council - Community Care Katrina Dixon Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: It is recommended that the home be registered to 16 Older People only People who need wheelchairs to assist with independent mobility at point of admission can only be accomodated in rooms numbered 7, 7, 17 and 20 All of the bedrooms are to be used for single occupancy only.. Date of last inspection 15th March 2005 Brief Description of the Service: Priorsmead is a care home situated on the outskirts of the town of Thetford and offers ground floor accommodation for up to 16 elderly people. It is owned and operated by Norfolk County Council. Nursing care is not provided. There is one day-care placement, and some respite placements are made. All of the bedrooms are designed for single occupancy with a restriction for service users who require wheelchairs for mobility to four of the homes larger bedrooms. The home has a call bell system installed so that service users are able to summon assistance from their rooms, communal areas or bathing and toilet facilities. Service users’ meetings are held to discuss issues residents wish to raise, and there is a programme of activities, including craft, games and quizzes and music. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 7.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with seven of the fourteen service users in addition to a relative, staff and the registered manager. Nine comment cards were received from relatives of service users indicating satisfaction with the care provided at the home. Two comment cards questioned whether there had been staff shortages at the home, however all comment cards expressed satisfaction with the care provided at the home. Fourteen comment cards were received from service users prior to the inspection. These also expressed satisfaction as to the care received at the home. What the service does well: What has improved since the last inspection? The improvement in the assessment of risk is noticeable from the last inspection and the home has worked hard to meet the previous inspections requirements. The patio area to the rear of the home is greatly improved, and now provides easy access to an area of interest for many service users. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 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. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 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 standard(s) 1, 2, 3, 5 The home provides clear and accurate information that would assist service users in making an informed choice as to the home’s ability to meet their needs. The needs of prospective service users are adequately assessed. EVIDENCE: The home has produced documentation including a Statement of Purpose and Service User Guide that is provided to every service user and was available within the home. A number of service users spoken to indicated that they had received information regarding the home and its facilities, and had been provided with the opportunity to visit before to moving in. One service user recalled that their ‘social worker took me to several homes – I chose Priorsmead’. Terms and conditions of residence are provided to service users where possible. Some service users indicated that they were held either by their relatives or by the home. Evidence was seen of assessments by referring agencies, and that these had been added to by the completion of pre-admission assessments by either the manager or senior staff (care coordinators) at the home. Assessments seen adequately addressed issues required by the Standard. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 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 standard(s) 7, 8, 9, 11 The care planning system is clear and adequately provides staff with the information they need to meet the health and care needs of service users. Service users health and personal care needs are well attended to. EVIDENCE: Comprehensive individual care plans were available and there was evidence that these are regularly reviewed. An improvement since the last inspection in the assessment of risks and clarity of information for staff in risk assessments was noted. The quality of individual care plans was reflected in feedback from service users, who indicated that they felt extremely well cared for and that they wanted for nothing at the home, one service user indicating that ‘if you ask for something, you’re soon supplied it’. Care plans refer to the involvement of a variety of community health professionals. Service users confirmed access to, among others, the GP, district nurse, chiropodist and optician. Medication records and storage were reviewed and found to be satisfactory. There are no service users currently accommodated at Priorsmead who take responsibility for administering their own medication. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 10 The home had recently offered palliative care to a service user at their request, following discharge from hospital. This was clearly carried out with care, sensitivity and respect. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 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 standard(s) 13 & 15 Visitors are encouraged and made welcome. Meals in the home are good offering both choice and variety. EVIDENCE: Service users indicated that their visitors were made welcome at the home at any time of their choosing and usually made tea or coffee. Visitors are usually seen in the privacy of service users own rooms. However, it was also apparent that communal areas were set aside at times too, as visitors were present at the time of the inspection. A comment card completed by a relative of a service user indicates that the ‘atmosphere at Priorsmead is always positive and welcoming’. Service users spoken to were complementary about the quality of the menu on offer, which appeared to offer varied and appealing options. At the time of the inspection it was apparent that service users had been provided choice as to their main meal, and choice as to where they preferred to take it. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 12 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 standard(s) 16 & 18 Arrangements for dealing with complaints and protecting service users are satisfactory. EVIDENCE: Service users spoken to indicated that they would speak with the manager if they had a complaint or concern, and that they felt they would be listened to. There have been two complaints in the last twelve months that have been satisfactorily dealt with within the required timescale. There was accessible information available in the home as to how to make a complaint. The home has a procedure for responding to allegations of abuse, including ‘whistle blowing’. Staff spoken to are aware of these procedures and their function, and have had access to appropriate training. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 13 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 standard(s) 20,21,22,23,24,26 A comfortable, well-maintained and equipped accommodation is provided by the home. The interior has a noticeably homely feel, and accessible garden and patio areas enhance the communal space available. EVIDENCE: The home is well maintained and provides a variety of internal communal areas in addition to accessible garden areas (including a patio) at the front and rear of the home. These were in use at the time of the inspection. There are sufficient toilet, bathing and washing facilities that are adequately equipped to meet service users needs. A bathroom that had previously been used for storage has been cleared since the last inspection and is in use. There is sufficient equipment to meet the assessed needs of service users, including a specialised hoist. All of the bedrooms are single. Twelve bedrooms are below 10 square metres, though all are similar in size. Many service users bedrooms were clearly personalised with their own furniture and possessions. Service users had Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 14 clearly been able to create a homely feel within their individual rooms. Some beds seen look rather old and institutionalised in appearance. It was noted that used dressings had been left on the floor of the laundry, though not apparently by home staff. The provision of a clothesbasket in the home’s treatment room should be considered, and that disposable gloves should be available in the laundry in order to prevent the spread of infection. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 Staff have a very good understanding of service users support needs, and maintain positive relationships with service users and their relatives. There are concerns about staff deployment that potentially put service users at risk. EVIDENCE: Despite some recent staff turnover the home provides a relatively stable, and experienced staff group. Staffing levels are comfortably above the minimum standard required. Service users indicated that there was sufficient staff available to meet their needs (and this was apparent at the time of the inspection) and felt that they were in safe hands. It was noted during the staff ‘hand-over’ to the afternoon staff that for a time of approximately fifteen minutes service users throughout the home were unsupervised, thereby presenting concerns as to the welfare of service users and the security of the home. The manager advised that there are six staff who have achieved NVQ 2 training (or above), that three staff were nearing the completion of this training, with a further two staff just embarking on the training. The successful completion of this training by these staff will bring the NVQ 2 trained staff compliment to 58 . Staff files looked at showed that service users are protected by good recruitment practices. However, it was noted that in one instance that a CRB disclosure was not evident, and that this may be being held by the proprietor. Therefore it was not possible to determine whether the check had been made and whether it had been made properly. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,38 The home is well managed by a competent manager who has the confidence of service users, relatives and staff alike. The home is run in the best interests of service users. EVIDENCE: It is apparent that service users and staff have respect for, and confidence in the manager. A comment card completed by the relative of a service user relatively recently accommodated at the home indicates that ‘in the short time my mother has been residing at Priorsmead, the care and attention given to her has been exceptional’, and goes on to say that the manager and staff are a credit to the Social Services Department. The manager has recently undertaken professional training successfully completing the ‘Registered Managers Award’. The home has a number of strategies to ensure that it runs in the best interests of service users. These include quarterly residents meetings, regular questionnaires for service users as to their satisfaction with their care plans Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 17 and any changes made to them; and an annual survey to measure the performance of the home, which is also sent to relatives and outside agencies. Service users financial interests are safeguarded by the home; the vast majority of service users financial affairs are managed by their relatives, though other arrangements are in place. The home seeks to promote the health, safety and welfare of service users, though issues identified concerning staffing compromise this. Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x 3 3 3 3 3 x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 3 x x 2 Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 26 27 Regulation 13(3) 18(1)(a) Timescale for action The registered person must Immediate ensure that systems are in place and to control the spread of infection. Ongoing The registered person must Immediate ensure that arrangements be and made for monitoring the safety Ongoing of service users during staff hand-over periods. The registered person must Immediate ensure that evidence of CRB and checks is available at the home. Ongoing Requirement 3. 29 19(1)(b)(i ) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 28 Good Practice Recommendations It is recommended that the registered provider ensure continued progress toward meeting the 50 NVQ training requirement by 2005 Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 20 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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 Priorsmead I55s24997priorsmeadv223580070605(4).doc Version 1.30 Page 21 - 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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