Inspection on 16/02/07 for Priory Care Home, The

This inspection was carried out on 16th February 2007.

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.

Other inspections for this house

Priory Care Home, The 16/03/06

Priory Care Home, The 19/09/05

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 Priory Care Home, The Crutch Lane Dodderhill Droitwich Spa Worcestershire WR9 8LW Lead Inspector N Andrews Unannounced Inspection 16, 22 and 24 February 2007 09:40 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 Priory Care Home, The DS0000063578.V330360.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. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Care Home, The Address Crutch Lane Dodderhill Droitwich Spa Worcestershire WR9 8LW 01905 771595 01905 796038 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) Mr Daniel Timothy Johnson Mrs Sara Naomi Bate, Mr Adam David Johnson Ms Jennifer Ann Watts Care Home 30 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There were no conditions of registration other than those referred to on the previous page of this report. Date of last inspection 16th March 2006 Brief Description of the Service: The Priory is a large, detached property, formerly a Vicarage, which has been adapted for its present use as a care home. The home is situated in a quiet, rural area on the outskirts of Droitwich. There is a large car park at the front of the premises and a large garden at the rear. The home is registered to provide personal care for a maximum of 30 service users over the age of 65 years. All of the service users are accommodated in single bedrooms on the ground and first floor. Twenty-two of the bedrooms have an en suite facility. A number of the bedrooms enjoy attractive views of the surrounding countryside and the adjacent golf course. The home provides a passenger lift and a stair lift to enable the service users to access the accommodation on the first floor more easily. There are two lounges and a conservatory and a separate dining room. The homes stated purpose is to provide an environment in which older people may lead as normal a life as they are able. The homes underlying philosophy is to ensure that the service users care, well-being and comfort are of prime importance and to maintain their dignity, individuality and privacy. The fees ranged from £1372.00 to £1488.00 per month. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of three days. The home was inspected against the key National Minimum Standards. Time was spent with the registered manager assessing the home’s response to the requirements and recommendations that were made as a result of the previous inspection. Various records and a number of different policies and procedures that the home is required to maintain were inspected. A tour of part of the premises was also made. Individual discussions were held with three service users and three members of staff. As part of the inspection Comment Cards were also issued to the relatives of the service users and to visiting professionals. A total of fourteen Comment Cards, ten from relatives and four from visiting professionals, were completed and returned. The majority of the responses to the questions that were asked in the Comment Cards were positive. The additional comments that were made are reflected in this report. What the service does well: What has improved since the last inspection? The majority of the requirements and recommendations arising from previous inspections of the home had been implemented. The registered manager said that, since the previous inspection, a former office on the ground floor had been turned into a treatment room, the kitchen had been completely refurbished, other rooms had been refurbished and a hairdressing salon had been provided. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 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 Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. Prospective service users were provided with sufficient information to enable them to make a choice about the home. They were given opportunities to visit the home and their needs were assessed prior to admission. However, some aspects of the information provided needed to be more detailed. EVIDENCE: A copy of the statement of purpose was made available for inspection. The contents were acceptable. The statement of purpose contained a reference to all of the relevant issues. However, the statement of purpose could be enhanced in places by the provision of more detailed information. For example, by including a reference to, • The use of questionnaires for consulting with and obtaining the views of service users. (Paragraph 12). • The arrangements made for the care and accommodation of service users in the event of a temporary closure of the home as a result of a fire. (Paragraph 14). • The provision made by the home to enable service users to receive visitors in private. (Paragraph 17). Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 9 A copy of the service users’ guide was also made available for inspection. The contents were satisfactory. The service users’ guide included a reference to all of the relevant issues. However, the service users’ guide should state clearly that it is the service users’ guide The registered manager stated that all of the service users apart from one recent admission had been issued with a statement of their terms and conditions of residence (contract). It was also stated that all of the service users or their relatives had signed the contracts. The service users’ files that were inspected contained a copy of the contract. The home provided two forms of contract, one for permanent or long-term care and one for short stay admissions. However, it was noted that the copies of the contracts that were made available for inspection referred to Wychbury Care Home and not to The Priory. The contracts did not refer to the occupancy of a specific room. The registered manager stated that all prospective service users were assessed prior to admission. The registered manager usually carried out the assessments accompanied by the training officer. A copy of the form that was used to assess the care needs of prospective service users was made available for inspection. The contents were satisfactory. The form was headed ‘PreAdmission Assessment’ and included a reference to all of the aspects of care listed in Standard 3.3. The amount of space provided on the form for recording all of the relevant information was limited in places. The registered manager was advised to amend the layout of the form in order to increase the amount of space for recording all of the necessary details. The service users’ files that were inspected contained copies of their assessment forms. The registered manager said that prospective service users were invited to visit the home prior to admission. However, they did not always do so, sometimes because they were in hospital. One of the service users with whom discussions were held confirmed that she had visited the home prior to admission. Two other service users said that their relatives had visited on their behalf. During the visits that were made prospective service users were given the opportunity to meet other service users and staff, have a meal and view the vacant room. The registered manager said that prospective service users were always given a copy of the service users’ guide. The registered manager was advised to maintain a record of the date when a copy of the service users’ guide was issued to any prospective service user and/or their relatives. The first four weeks following admission were regarded as a trial period. The service users’ guide stated, ‘Prospective residents are invited to make pre-admission visits and to move in on a month’s trial basis before they and/or their representatives make a decision to stay’. The registered manager stated that the home did not normally accept emergency admissions. The service users’ guide stated that, in the event of an emergency admission occurring, an assessment would be ‘put into place within 5 working days’. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users’ health and personal care was based on their individual needs. The principles of privacy and respect were put into practice. However, more attention needed to be given to aspects of care relating to care plans and medication. EVIDENCE: All of the service users had a care plan and there was written evidence available to show that the care plans were reviewed every month. The home also had a care plan that could be used for service users that were terminally ill. The care plans that were inspected were clear and contained instructions for the staff. However, the instructions were not always as specific as they should be. Phrases such as ‘please observe’ and ‘check regularly’ were used and these instructions needed to be more specific. For example, what to observe and check and the frequency should be clearly stated. Risk assessments had been carried out and recorded in respect of falls, nutrition, pressure sores and diabetes. Nutritional screening was carried out on all service users at the point of admission. Weight charts were maintained. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 11 There was evidence to show that the service users’ healthcare needs were being met. It was confirmed that all of the service users were registered with local GP’s. The staff were supported in their care of the service users by the district nurses, the continence adviser, the community psychiatric nurse and the consultant psychiatrist. Two service users that had pressure sores and one service user that required insulin injections were receiving appropriate care and attention from the district nurse. The district nurse had provided several service users with pressure relieving mattresses and cushions. The service users were weighed monthly and their food and fluid intake was monitored when necessary. The service users’ were receiving appropriate dental, hearing and ophthalmic checks and attention. The Comment Card from the relative of one service user said ‘I feel that the carers really do care. They want Mum to be happy and “go that extra mile for her”. They get concerned for her health and act appropriately. I am very happy with Mum’s care’. Another respondent said that she ‘would like to be more informed when minor accidents occur or the doctor or nurse has attended’. Another respondent said that their relative was ‘cared for very well’ and that, ‘All staff are very caring. Little skin tears are always carefully dressed’. Appropriate arrangements were in place to ensure that the medication was stored securely. Medication was kept in a lockable trolley in a lockable store. Access to the medication storage was restricted to the registered manager and three senior assistants. The senior assistant on duty was responsible for the keys to the medication storage. The home had a controlled drug cupboard that complied with the Misuse of Drugs (Safe Custody) Regulations 1973. The home had a controlled drug register in which the administration of controlled drugs were recorded. Two members of staff signed the register for the administration of controlled drugs. The home had a dedicated refrigerator for medication that required cold storage. However, the refrigerator was not locked. A record of the fridge temperatures was being maintained. Medication for external and internal use was stored separately. The home maintained a record of the signatures of the staff that were involved in the administration of medication. The home also had a record of the signatures of the staff confirming that they had read and understood the medication policy and procedure. The date of opening of medication was written on the outside of the containers/packets. The policy and procedure on the administration of medication had not been reviewed since 26 January 2004. The home had a copy of ‘The Administration and Control of Medicines in Care Homes and Children’s Services’ dated June 2003 and published by the Royal Pharmaceutical Society of Great Britain. It was confirmed that the home had a positive relationship with the local pharmacist. The last audit that was undertaken by the pharmacist was 26 January 2006. Where the medication was written on the MAR charts by hand two members of staff were checking and signing the MAR charts as being correct. However, it was noted that where the medication dose was for one or two tablets the actual amount administered was not always being recorded. Photographs of the service users were attached to the MAR charts to help ensure correct identification. The Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 12 receipt of medication coming into the home was recorded. The prescriptions were seen before they were sent to the pharmacy and copies were retained by the home. At night the keys to the medication trolley and cupboard were locked in the same store in which the medication was kept. The registered manager and three senior staff each had a key to the store. A key to the store was not left on the premises. Consequently, the night staff did not have access to the store and were, therefore, unable to gain access to the medication during the night. If a service user required medication during the night the senior member of staff that was ‘on-call’ would have to be contacted and return to the home in order to administer the medication. The registered manager stated that, alternatively, medication would be prepared by the day staff and placed in the office in readiness for administration by the night staff. Both of these practices are unsafe. Staff on duty at night must have immediate access to the medication and secondary dispensing is unacceptable. It is also unsafe practice for the keys to the medication store to be taken off the premises. Night staff must receive accredited training in order to administer medication. The procedure for the administration of medication during the night must be reviewed in order to ensure that safe medication practices are adhered to closely. The home’s policy and procedure for the administration of medication must be amended in order to reflect the changes made. A member of staff with whom a discussion was held understood the importance of upholding the service users’ privacy and dignity. The responses that were given to the questions asked reflected good practice. A mobile handset was provided to enable the service users to make and receive telephone calls in private. It was stated that five service users had their own telephone. Mail was given to the service users unopened unless the letter related to a hospital appointment in which case it was opened in their presence. It was confirmed that the service users always wore their own clothes and that they were offered a choice of what to wear. It was stated that the home did not have a clothes store but on occasions members of staff brought in clothing for individual service users. One service user was referred to by her ‘pet’ name. The registered manager subsequently confirmed that the service user preferred the term. It was also confirmed that staff were instructed during induction on how to treat service users with respect. The privacy of the service users was enhanced by the provision of all single room accommodation. The service users with whom discussions were held confirmed that they were treated with respect by the staff and that their privacy was maintained. Standard 11 was not inspected on this occasion. However, the home’s response to the recommendation that was made as a result of the previous inspection was assessed. The recommendation was that the service users’ wishes concerning terminal care and arrangements after death should be discussed and recorded in their individual files and carried out. The recommendation had been implemented. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 13 Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 14 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 and 15. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users were able to retain contact with their relatives and friends and they were consulted and offered choice on a number of issues affecting their care. The service users were satisfied with the standard of food provided. However, there was scope for improving some aspects of the catering arrangements. EVIDENCE: One requirement and one recommendation were made in regard to Standard 12 as a result of the previous inspection. The requirement was that the service users must continue to be consulted about the programme of activities arranged by or on behalf of the home and appropriate facilities and activities for recreation provided according to the service users’ needs and preferences. The registered manager stated that the requirement had been implemented through meetings with the service users. Service users’ meetings had been held on 5 June and 6 October 2006. The registered manager said that another meeting was due to be held shortly. The social and recreational activities provided included Bingo, hairdressing and manicures each week. Every two weeks music and movement sessions were held and an organist also visited the home to play to the service users. Singers visited the home once a month. The home also provided jigsaws, television and, occasionally, craft sessions. The home had the shared use of a mini-bus that was available to take service users on outings during the warmer weather. The home held a summer fete Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 15 during 2006. The recommendation was that a record of the social and recreational activities provided by the home including the dates and the names of the service users that participate should be maintained. The recommendation had been implemented. A record of the activities that took place was maintained in a book kept for this purpose. The home had visits from the Anglican minister every month. A member of the Roman Catholic church visited every week. The service users were informed individually about the activities that took place and information was also displayed on the notice board e.g. a Christmas buffet. There were no unnecessary or unreasonable restrictions in regard to visiting. The service users with whom discussions were held confirmed that they were able to see their visitors in private and that their visitors were made welcome and offered a drink. The service users’ guide contained positive information about the home’s policy on maintaining relatives and friends involvement with service users. The registered manager said that members of the local chapel visited the home once a month to sing and to talk to the service users. Member of the Salvation Army also visited the home approximately three times per year. The registered manager confirmed that the involvement in the home by these local groups was in accordance with the service users’ preferences. The service users with whom discussions were held confirmed that they were able to make decisions about matters that affected their care. For example, they were able to choose when they got up and went to bed, where they ate their meals and what clothes they wore. The registered manager said that the service users were also able to exercise choice regarding their personal friendships, how frequently they bathed and which lounge they sat in. The registered manager stated that none of the service users were in receipt of support from an advocate at the present time. Information was included in the service users’ guide about how to contact the local advocacy service and Age Concern. One service user received regular visits from a representative of Age Concern. The service users were able to bring personal possessions with them when they were admitted. The service users’ bedrooms contained evidence to show that this practice was upheld. The service users’ guide contained an appropriate reference to the service users’ right of access to the records held about them by the home under the Data Protection Act 1998. The service users were offered three full meals each day. The meals were served at appropriate intervals. Drinks were provided mid-morning and midafternoon and drinks and snacks were available throughout the day. Supper was served at different times depending on the service users’ needs and preferences. The home operated a four-week menu. The record of the food provided was varied and the food observed being served during the inspection was wholesome and nutritious. Details of the daily menu were displayed in the main corridor near to the dining room. The service users were offered water or orange squash with their lunch. A warm drink was provided after the meal. It was agreed that it was possible to offer a third alternative cold drink with the Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 16 lunchtime meal e.g. black current juice. The cook confirmed that she catered for three service users that required liquidised/soft food diets and six service users that were diabetic. The cook agreed that it was preferable to prepare and present the food provided in liquidised form in separate portions in order to make it more attractive and appealing. The service users were consulted daily about their choice of food and diets. There was a choice of two meals for lunch and the teatime meal. If the service users did not like the food offered an alternative meal was provided. There was always a choice of dessert at lunchtime including fresh fruit and cheese and biscuits. A list of the service users’ food preferences was kept in the kitchen. Special plates and cutlery were provided where necessary. Three service users required staff assistance when eating. Since the previous inspection the kitchen had been extended and refurbished. Some of the equipment, including the cooker, blender, microwave and extractor fan, was new. The cook confirmed that all of the kitchen equipment was in good working order. The kitchen contained a cleaning schedule, first aid box, fire blanket and a fire extinguisher. A record of the fridge and freezer temperatures was maintained. Food samples were not kept. It is good practice to retain a sample of the food provided for a period of 72 hours in case there is an outbreak of food poisoning. The daily record of the food provided was not up to date. The dining room was not a very congenial setting and was in need of refurbishment. (See Standard 19). The service users with whom discussions were held were satisfied with the standard of food provided. One service user stated, ‘The food is very good. I can’t complain about the food’. Another service user said, ‘The food is alright. I’m eating more here than anywhere else’. The Comment Card from the relative of one service user described the food as ‘excellent’. Another respondent described it as ‘nutritious’. Another respondent said that his mother was ‘well fed’. Another respondent said, ‘For a residential home the cooking cannot be faulted and certainly is a large part of the contentment of being there’. Priory Care Home, The DS0000063578.V330360.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 and 18. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The home had a satisfactory complaints procedure and other relevant policies and procedures to ensure that service users were protected from abuse. EVIDENCE: The home had a satisfactory complaints procedure that was referred to in the service users’ guide. A copy of the complaints procedure was also displayed on the notice board in the main corridor. A record of complaints received by the home was maintained. The home had not received any complaints since the previous inspection. The service users with whom discussions were held felt confident about making a complaint. They also felt that any complaint that was made would be dealt with quickly and appropriately. One service user said, ‘If anything was wrong I’d go to a member of staff straight away’. Another service user said that the registered manager was ‘very approachable’. The home had policies on ‘abuse’, ‘whistle blowing’ and ‘management of challenging behaviour and violence’. However, the policies had not been reviewed since 26 August 2005. The policies and procedures should be reviewed at least every year. It was confirmed that the staff received training on basic awareness of abuse during 2006 and that further training would take place on 8 and 14 March 2007. The registered manager stated that she had received abuse awareness training in 2005 provided by a colleague that was employed by the same company. The training was based on Age Concern training. However, the registered manager had not undertaken any training on the protection of vulnerable adults from abuse at a management level. The home’s policy regarding the service users’ money and financial affairs called Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 18 ‘Residents Property and Money’ was satisfactory. The registered manager stated that copies of the home’s policies and procedures were kept in the staff room for the staff to read and that they were discussed during supervision. The registered manager confirmed that no incidents of alleged or suspected abuse had occurred within the home, been reported to her or otherwise come to her attention since the previous inspection. The registered manager also confirmed that she ha had no reason to refer any member or former member of staff for consideration for inclusion on the POVA register. Priory Care Home, The DS0000063578.V330360.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 and 26. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users lived in clean, comfortable and homely surroundings. However, some improvements to the environment were needed for the benefit of the service users. EVIDENCE: The home was located in a fairly isolated rural position. The advantage of the location was that many of the rooms enjoyed attractive views over the surrounding countryside. The disadvantage was that staff recruitment was made more difficult. The registered providers had overcome this problem by recruiting staff from outside the area and transporting them to the home daily. The premises were accessible, comfortable and generally well maintained. A programme of routine maintenance and renewal of the fabric and decoration of the premises was available. A book in which items that needed repair and/or replacement were recorded was also maintained. It was stated that the maintenance book was checked weekly. An audit sheet was kept and an audit of different rooms/areas in the premises was carried out each month. Items due for repair or replacement were recorded on a works schedule and dealt Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 20 with by the housekeeper or maintenance manager. The dining room including the lighting was in need of refurbishment and this matter was in the monthly audit as an item of work to be addressed. The rear garden had not been developed to its full potential. It could be made more attractive and used to promote the service users’ interests and involvement with the provision of raised flowerbeds etc. It was pleasing to note, therefore, that further landscaping was planned for the summer. The registered manager said that there had been no recent visit by the Fire Safety Officer. However, the registered manager confirmed that there were no outstanding fire safety issues. A senior care assistant had delegated responsibility for matters relating to fire safety. The Environmental Health Officer had visited on 16 June 2006. The subsequent letter dated 22 June 2006 highlighted a number of issues that required attention. The registered manager stated that all of the issues relating to the kitchen had been addressed and that the home’s health and safety policy had been reviewed and amended. However, the Environmental Health Officer had not yet returned to check compliance. The registered manager stated that a written assessment of all the hazardous substances used by the home had not been completed. Standard 22 was not fully inspected on this occasion. However, the home’s response to the recommendation that was made as a result of the previous inspection was assessed. The recommendation was that the advice of a qualified occupational therapist should be sought in order to ensure that the home provides all of the recommended disability equipment and environmental adaptations to meet the needs of the service users. The recommendation had not been implemented and still stands. The premises were clean and tidy. The registered manager said that the home had recently purchased a new cleaner that helped to maintain odour control. The laundry was sited in an appropriate place and was equipped with suitable facilities. The equipment included an industrial washing machine with a sluicing facility, a top loader and two tumble dryers. A recommendation was made as a result of the previous inspection that appropriate action should be taken to ensure that water is prevented from dripping from the exposed pipes in the laundry. The recommendation had been implemented. The home provided protective aprons and gloves and these were seen being used by the staff. The staff cleaned manually the commode pots that were used. The home did not have appropriate facilities to carry out this task and manual cleaning is not the recommended method of decontamination. Disposable commode pots should be used. The service users with whom discussions were held said that their clothes and their rooms were always kept very clean. The Comment Card from the relative of one service user described the home as ‘clean and comfortable’. Another respondent said, ‘A family atmosphere. Visiting is like visiting in her own home. The room is always spotlessly clean with fresh bed linen’. Another respondent said, ‘Laundry returned promptly. Room kept very clean’. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 21 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 and 30. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The staff recruitment procedures and induction programme were satisfactory. However, the deployment and training of staff were in need of further development. EVIDENCE: A copy of the staff duty rota was made available for inspection. The duty rota included the names of the staff, their position and the hours they worked. The names of the staff were not referred to consistently on the duty rota. The duty rota referred to the members of staff by their initials, their first name and the first initial of their first name and surname. The hours worked at the home by the training officer were not included on the duty rota. However, it was stated that it was intended to change the duty rota and that, when this was done, the training officer’s hours would be included. In addition to the registered manager the home employed a total of twelve staff that were employed to carry out caring duties (days) for a total of 394.5 hours per week. During the mornings and afternoons the registered manager was on duty, a senior care assistant and three or sometimes two care assistants in addition to the ancillary staff. In the evenings a senior care assistant and two care assistants were on duty. Additional staff must be on duty at peak times of activity during the day. In a home of this size, in addition to the registered manager and ancillary staff, one senior care assistant and three care assistants should be regarded as the normal level of staffing for most periods of the working day. The home encountered difficulties in the recruitment of staff locally. In order to overcome this problem two permanent members of staff and one laundry assistant were transported from Hagley each day. Two members of staff were Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 22 on waking duty at all times during the night. The home employed two cooks. Two members of staff were employed to carry out domestic duties for a total of 40 hours per week. The service users with whom discussions were held spoke positively about the staff. One service user said, ‘Most of the staff are very good. They are really good to me’. Another service user said, ‘I can’t say anything about them, they’re very kind to me’. The Comment Card from the relative of one service user stated that their relative ‘requires a safe, clean environment with nutritious food and lots of tender loving care. She receives all of this’. Another respondent said, ‘Staff are very caring and sensitive’. Another respondent said, ‘General environment and overall care is excellent. Care is very focussed on individuals and attentive when something appears out of the normal with immediate feedback’. However, the same respondent said that the home could improve by ‘preventing understaffing at times which would help avoid entering the premises through an unlocked front door and being unable to find a member of staff. This is rare but has happened on more than one occasion. One or two members of staff not always ensuring comfort of residents, leaving them without a cardigan or not being able to hear because of hearing aid problems. Belongings sometime go astray with no explanation’. The relative of another service user said that the home provided ‘a happy and friendly atmosphere’. The same respondent said that the home could be improved by providing ‘more staff allowing them to give more time to the residents’. Another respondent said ‘Staff seem to work long hours and this could affect their care, more carers if possible’. Another respondent said that their relative ‘requires a safe, clean environment with nutritious food and lots of tender loving care. She receives all of this’. The home employed a total of sixteen care staff (days and nights). Four members of staff had completed the NVQ level 2 training, one other member of staff had completed the NVQ level 3 training and was awaiting verification and another member of staff had completed the NVQ level 4 training. Therefore, a total of six members of staff had NVQ level 2 or above. This fell below the 50 trained members of staff required by the National Minimum Standards. Therefore, the requirement that was made in regard to NVQ level 2 training as a result of the previous inspection had not been implemented and still stands. It was pleasing to note that two members of staff intended to commence NVQ level 3 training and a further four members of staff were at various stages in undertaking the NVQ level 2 training. The files of three members of staff were inspected. All three files contained evidence of an application form, an enhanced CRB disclosure check, proof of identity and two written references. The registered manager stated that all the staff had been issued with a copy of the code of conduct and practice set by the General Social Care Council. However, it was noted that two of the files did not contain a copy of the staff contracts. Copies of staff contracts should be kept on the staff files. The files in respect of the staff that were transported each day from Hagley were not available for inspection. The registered manager said that the files were held at the company’s home at Wychbury. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 23 The records that are required to be kept in respect of all the staff employed by the home must be maintained at the home and made available for inspection. Two recommendations were made in regard to staff recruitment procedures as a result of the previous inspection. Both recommendations had been implemented. The home provided its own three-day staff induction programme. This was followed by a further ‘Skills for Care’ induction. Each new member of staff was issued with an employees’ handbook. The employees’ handbook included a reference to several principles of care i.e. respect, privacy, dignity, choice and individuality. Priory Care Home, The DS0000063578.V330360.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 and 38. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect for the service users’ interests and safety. However, there was scope for developing the systems that monitor practice and compliance with the home’s policies and procedures. EVIDENCE: The registered manager was competent and had the necessary experience to run the home. She confirmed that she had completed the NVQ level 4 training in October 2003. She had also completed the Registered Managers’ Award training. The registered manager had also undertaken food hygiene training and fire safety training within the previous twelve months. The registered manager confirmed that she had completed accredited training in the administration of medication at Worcester College in November 2004. The registered manager had a satisfactory job description. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 25 A requirement was made as a result of the previous inspection that a quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. In response, the home had purchased a commercially produced quality assurance system. The registered manager stated that she was working her way through the manual and had ‘got about three quarters of the way through’. The effectiveness of the system had not yet been fully developed or assessed. Therefore, the requirement had not been fully implemented. The wording of the requirement has been amended and is repeated in this report. The home had a business and development plan dated May 2007. Three recommendations were made in regard to Standard 33 as a result of the previous inspection. The first recommendation was that the results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties including the CSCI. Since the previous inspection twenty questionnaires had been issued to the service users relatives/friends. There had been eleven responses. Six questionnaires had been issued to visiting professionals and four responses had been received. Ten questionnaires had been issued to service users and eight responses had been returned. The findings from the responses of each of the three groups had been analysed. Copies of the results had been placed on display on the notice board in the main corridor. Therefore, the recommendation had been implemented. Questionnaires should continue to be used as part of the home’s quality assurance monitoring. The registered manager was advised to continue to record the action taken as a result of the surveys in order to demonstrate the home’s responsiveness to the views expressed. Details of the information gained from the surveys and the action taken should be issued to each of the groups involved. The second recommendation was that the registered manager and staff should be able to demonstrate a commitment to lifelong learning and development for each service user, linked to implementation of his/her individual care plan. The registered manager stated that this recommendation had not yet been implemented. However, two members of staff had been given responsibility for implementing this recommendation with each service user individually. The third recommendation was that the views of family and friends and of stakeholders in the community (e.g. GPs, chiropodist, voluntary organisation staff) should be sought on how the home is achieving goals for service users. The recommendation had been implemented as outlined above. The registered manager was advised to repeat the exercise at least every twelve months. The registered manager confirmed that no one employed by or connected with the running of the home acted as an agent or appointee on behalf of any of the service users. The registered manager also confirmed that money was held in safekeeping by the home for twenty-three service users. The service users’ money and accounts were kept separately in individual wallets in a lockable cabinet with restricted access. The money and records in respect of two service users was checked at random and was correct. The registered manager said that the accounts were usually audited every twelve months. It Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 26 was recommended that the independent checks should be more frequent e.g. every three months. The registered manager confirmed that no valuables were held in safekeeping for any of the service users apart from some ‘official’ papers in respect of one service user. The registered manager was advised to maintain an accurate record of any items that were handed over for safekeeping. Standard 36 was not inspected on this occasion. However, the registered manager said that she and the training officer had shared responsibility for staff supervision. It was also confirmed that all the staff had attended a supervision meeting recently. The registered manager stated that they were ‘just about keeping up with the frequency of supervision’. Risk assessments had been carried out and recorded for all safe working practice topics referred to in Standards 38.2 and 38.3. The stair lift and passenger lift had been serviced on 11 July and 15 November 2006, respectively. The bath hoists had been serviced on 1 November 2006. PAT testing had been carried out on 16 February 2007. The water had been checked for Legionella on 13 February 2007. The boilers and central heating system had been serviced in January 2007. A new manual hoist had been provided on 26 October 2006. The home maintained a record of accidents. The home had relevant information relating to RIDDOR and COSHH. The home held copies of the monthly reports following visits made by the registered provider in accordance with Regulation 26. The last recorded monthly check on the emergency lighting was 29 December 2006. The registered manager said that a check had been carried out in January 2007 but had not been recorded. The fire risk assessment stated, ‘To be reviewed in January 2006’. However, there was no indication that the fire risk assessment had been reviewed. Nine members of staff had undertaken moving and handling training during 2006 and seven members of staff were due to undertake the training on 28 March 2007. Ten members of staff had completed first aid training and five staff were due to undertake it on 23 February 2007. Dementia care training had been arranged for nine members of staff on 8 March 2007. A certificated training course in dementia care was being arranged for six members of staff commencing in the near future. All the staff had undertaken in-house fire safety training. Ten staff had undertaken training in fire safety provided by an external trainer and five staff were due to receive the training on 22 February 2007. Two senior care assistants had undertaken human resource development training in the management of staff on 28 & 29 June 2006. However, none of the staff had undertaken any training in person centred planning. Two requirements and two recommendations were made in regard to Standard 38 as a result of the previous inspection. The first requirement was that all the Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 27 staff must be provided with updated training on food hygiene and infection control. The registered manager confirmed that the majority of staff including both cooks had undertaken food hygiene training in October 2006 and February 2007. Four members of staff were due to undertake the training within the next three months. It was also confirmed that the majority of staff had undertaken training in infection control in September 2006 and on 25 January 2007. Three members of staff were due to undertake the training within the next three months. Therefore, the requirement was regarded as having been implemented. The second requirement that a senior member of staff must undertake formal training in the protection of vulnerable adults from abuse had been implemented. The first recommendation was that a system should be introduced that provides assurance that the security of the premises is being maintained to a satisfactory standard. The registered manager stated that a checklist relating to the security of the building had been introduced. However, the senior staff had not completed any of the forms. Therefore, the recommendation had not been fully implemented and still stands. The second recommendation that the induction records of all the staff should be completed at the time when the training has been undertaken had been implemented. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 28 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 5 Requirement The statement of terms and conditions of residence (contract) must be amended so that it includes the name of the home and the specific room to be occupied. The care plans must set out in detail the action that needs to be taken by the care staff to ensure that all aspects of the service users’ needs are met. The refrigerator used for storing medication that requires cold storage must be kept locked at all times when not in use. Where the medication is prescribed for one or two tablets the actual number of tablets administered must be recorded on the MAR chart. The policy and procedure for the administration of medication must be amended to reflect good practice particularly in regard to the administration of medication during the night. The daily record of the food provided must be kept up to date. DS0000063578.V330360.R01.S.doc Timescale for action 30/04/07 2 OP7 15 30/04/07 3 OP9 13 31/03/07 4 OP9 13 31/03/07 5 OP9 13 30/04/07 6 OP15 17 31/03/07 Priory Care Home, The Version 5.2 Page 30 7 OP18 13,18 8 9 OP19 OP19 23 13 10 OP27 18 11 OP28 18 12 OP29 19 13 OP33 24 14 OP38 13,23 The registered manager must undertake training in the protection of vulnerable adults from abuse at a management level. The dining room including the lighting must be refurbished. A written assessment of all the hazardous substances used by the home must be carried out in accordance with the recommendation of the Environmental Health Officer. Additional staff must be on duty at peak times of activity during the day e.g. one senior care assistant and three care assistants. Arrangements must be made for staff to receive training that will enable a minimum of 50 of the care staff to attain a qualification at NVQ level 2 or equivalent. (Previous timescale 31/12/06 not met). All of the required information relating to the employment of staff must be kept at the home and available for inspection. The home’s quality assurance system must be fully developed in accordance with the requirements of Regulation 24 and Standard 33. The fire risk assessment must be reviewed at least annually and a record of the monthly emergency lighting checks must be maintained in accordance with the recommendations of the Fire Safety Officer. 30/06/07 30/06/07 30/04/07 30/04/07 30/09/07 31/03/07 30/06/07 31/03/07 Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 31 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 OP1 Good Practice Recommendations The statement of purpose should be amended in accordance with the guidance given in this report and the service users’ guide should state clearly that it is the service users’ guide. A record should be kept of the dates when copies of the service users’ guide are issued to prospective service users. The home’s policy and procedure for the administration of medication should be reviewed at least once a year by the registered manager, signed and dated. Three alternative cold drinks should be offered at lunch times. Food provided in liquidised form should be prepared and presented in separate portions to make it more attractive and appealing in order to maintain appetite and nutrition. A daily sample of the food provided should be retained in the home for a period of 72 hours. The home’s policies and procedures on the protection of vulnerable adults from abuse should be reviewed at least annually. Raised flowerbeds and other attractive features should be provided in the garden for the benefit and interest of the service users. The advice of a qualified occupational therapist should be sought in order to ensure that the home provides all of the recommended disability equipment and environmental adaptations to meet the needs of the service users. Disposable commode pots should be used. The staff duty rota should include the hours worked by all the staff including the training officer and all the staff should be referred to in a consistent way e.g. by reference to the first initial of their first name and surname, to enable easy recognition by a person inspecting the rota for the first time. Copies of staff contracts should be maintained at the home. The registered manager and staff should be able to demonstrate a commitment to lifelong learning and development for each service user, linked to DS0000063578.V330360.R01.S.doc Version 5.2 Page 32 2 3 4 5 6 7 8 9 OP5 OP9 OP15 OP15 OP15 OP18 OP19 OP22 10 11 OP26 OP27 12 13 OP29 OP33 Priory Care Home, The 14 OP35 15 16 OP38 OP38 implementation of his/her individual care plan. The service users’ money and accounts should be independently audited every three months and an accurate record should be maintained of any items handed over for safekeeping. All the care staff should undertake training in person centred planning. The registered manager should introduce a system that assures her that the security of the premises is being maintained to a satisfactory standard. Priory Care Home, The DS0000063578.V330360.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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