Inspection on 16/03/06 for Priory Care Home, The

This inspection was carried out on 16th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Priory Care Home, The 16/02/07

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 16th March 2006 08:25 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.V286850.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. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Priory Care Home, The Address Crutch Lane Dodderhill Droitwich Spa Worcestershire WR9 8LW 01384 894093 01561 883358 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) Daniel Timothy Johnson Mrs Sara Naomi Bate, 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.V286850.R01.S.doc Version 5.1 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 19th September 2005 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. At the time of the inspection there were twenty-seven service users in residence and three vacancies. 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. 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. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine inspection that took place during the course of one day. During the inspection various records that the home is required to maintain and a number of policies and procedures were inspected. Parts of the premises were also inspected. Separate discussions were held with three service users and two members of staff. Time was also spent with the registered manager considering the progress made by the home in the implementation of the requirements and recommendation arising from previous inspections. The general manager was also present for most of the inspection. The comments made by the three service users with whom discussions were held were mainly positive. They confirmed that they were well cared for and treated with respect. They also confirmed that their privacy was respected and that the staff always knocked the door before entering their bedrooms. They felt confident about raising any concerns that may arise and they also felt that any concerns would be dealt with quickly and appropriately. It was confirmed that the daily routines did not impinge on their right of choice and that they were free to get up and go to bed when they wanted to. One service user said ‘We can have a drink when we want to and residents can make their own drinks if they’re capable of doing so’. One service user said that the service users were treated ‘fairly well’ and that some staff were ‘very caring’. The same service user said ‘I’m amazed at how much patience they do have’. However, the comment was also made that ‘Some staff are a bit slap dash’. Another service user said ‘The staff are mainly alright, one or two are a bit bossy and outspoken but on the whole they’re okay’. One service user stated ‘Some staff don’t stay very long but some have been here a long time’. The comments made by the service users in regard to social and recreational activities and food are included in this report under Standards 12 and 15 respectively in the section on ‘Daily Life and Social Activities’ below. Each of the service users was asked what changes, if any, they would like to see introduced. One service user said that she was ‘happy with things as they are’. Another service user said ‘For what it is, it’s fairly good. Taking it all round, they’re pretty good’. The third service user said, ‘More choice of food and more staff’. The two members of staff with whom discussions were held confirmed that they had been given a contract of employment and a job description. They also confirmed that they received individual supervision. They both said that staff meetings were held. One of the staff said that staff meetings were normally held once a year. They both stated that they enjoyed working at the home and their contact with the service users and their relatives. Both staff members confirmed that there was a good working atmosphere within the home and that the senior staff were approachable and supportive. They both Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 6 felt that their working conditions were good. In response to a question about what changes they would like to see, if any, one member of staff said, ‘The dining room needs to be redecorated and the colour coordination improved. The staffing is okay when no one is off sick but if staff are sick it becomes difficult because some staff are not always willing to cover the extra shifts’. Both staff felt that the service users ‘needed more individual care at times’. It was stated that some staff provided their own bacteria gel. One member of staff said that money should be available in the home to give to any member of staff that may have to escort service users to hospital. The money would enable the staff to pay for a taxi to return them to the home. The registered manager is asked to consider the comments made by the service users, particularly in regard to the staff, social and recreational activities and food and to take appropriate action to address the concerns expressed. The registered manager is also asked to take account of the comments/suggestions made by the staff and to make whatever improvements are considered necessary. It was pleasing to note that the home had continued to make good progress towards meeting all of the National Minimum Standards. During the inspection the home was inspected against eleven of the National Minimum Standards. Nine of the Standards were met and two of the Standards were nearly met. Since the previous inspection the number of requirements had fallen from seven to five. The number of recommendations had remained the same. What the service does well: What has improved since the last inspection? The home has continued to make steady progress towards meeting the National Minimum Standards. The registered manager stated that one of the bathrooms and several bedrooms had been refurbished. The hallway had also been redecorated and re-carpeted. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 7 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. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 All prospective service users have their care needs assessed prior to admission. EVIDENCE: The home’s response to the requirement that was made in regard to Standard 1 as a result of the previous inspection was assessed. The requirement was that the home’s statement of purpose and service users’ guide must be amended in order to include all of the required information as outlined in this (i.e. the previous) report. A copy of the statement of purpose and the service users’ guide were made available for inspection. Both documents had been amended and contained all of the relevant information. Therefore, the requirement had been implemented. However, it was noted that there was a typographical error in paragraph 4 on page 7 of the statement of purpose regarding the number of service users with a physical disability for which the home was registered. This was a matter that needed to be addressed. The registered manager confirmed that usually either she or the deputy manager assessed prospective service users prior to admission. Sometimes the assessments took place during a pre-admission visit to the home by the prospective service user. A copy of the home’s ‘pre-admission assessment Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 10 form’ that was used for assessing prospective service users was made available for inspection. The form covered all of the aspects of care referred to in Standard 3.3. However, the registered manager was asked to consider increasing the amount of space on the form in respect of certain aspects of care in order to ensure that there was sufficient space for recording all of the necessary information. The registered manager confirmed that all of the service users had been assessed by the home and, in a number of cases, the home had also been provided with a community care assessment that had been carried out by the placing authority. The registered manager confirmed that all of the service users had a care plan that had been developed from the assessments. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 All of the service users had a care plan. There was evidence to show that the service users’ healthcare needs were being met. The home had a satisfactory policy and procedure for the administration of medication. The service users felt that they were treated with respect and that their right to privacy was upheld. EVIDENCE: It was confirmed that all of the service users had a care plan. A copy of the care plan form was made available for inspection. The care plan form covered all of the relevant aspects of care referred to in Standards 7.2 and 3.3 except ‘history of falls’. The care plans in respect of three service users were inspected. The contents were satisfactory and included risk assessments. The registered manager confirmed that the care plans of all the service users were reviewed at least once a month and were signed by the service users. The home’s response to the requirement that was made in regard to Standard 8 as a result of the previous inspection was assessed. The requirement was that the home must provide one care plan for each individual service user that covers all of the aspects of care referred to in Standard 3.3 with details of how all of the service user’s needs are being met. A copy of the care plan used by the home was made available for inspection. The requirement had been Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 12 implemented. The registered manager stated that the staff knew what signs to look for in respect of any service user at risk of developing pressure sores. Currently, none of the service users had any pressure sores. The district nurse provided pressure relieving mattresses and cushions, if necessary. The district nurse visited the home daily to administer insulin to one diabetic service user. It was stated that the home received support from the continence adviser. The continence adviser had visited the home the week prior to the inspection. Four service users were singly incontinent. The community psychiatric nurse visited three service users. Three service users received support from the consultant psychiatrist. Music and movement/exercise sessions were held every week. The registered manager said that approximately eight service users attended each session. The registered manager also confirmed that nutritional screening was carried out on all of the service users at the time of admission. The service users were weighed every month and a record of their weight was maintained. Fluid and diet charts were maintained, if necessary. Four service users who were diabetic were in receipt of special diets. One service user was encouraged to eat more because of her low weight. All of the service users were registered with one of three GP surgeries. The registered manager confirmed that all of the service users received regular dental checks. A chiropodist visited the home every 9 weeks. It was also confirmed that the service users’ eyesight was checked at least annually and more frequently, if necessary. Service users with hearing problems were referred to the audiology clinic for tests via the GP. The registered manager stated that she had no concerns about the level of medical and specialist healthcare support that the home received. The home had a satisfactory policy and procedure for the administration of medication. The home also had a copy of the guidance ‘The Administration and Control of Medicines in Care Homes and Children’s Services’. One service user self-administered her medication. A risk assessment had been carried out and the service user had a lockable facility in her bedroom for the safe storage of her medication. Appropriate medication records were maintained. The Medication Administration Record (MAR) Charts were inspected and these were satisfactory. It was confirmed that the home had an up to date list of the names and signatures of all the staff that were involved in the administration of medication. The home keeps photocopies of prescriptions. The medication was stored in a medicine trolley that was kept in a lockable store cupboard. An appropriate lockable cabinet was available for the safekeeping of Controlled Drugs. The ‘senior on duty’ held the keys to the medication cabinets. None of the service users were in receipt of Controlled Drugs at the present time. The home had a Controlled Drug register. Responsibility for the administration of medication was restricted to four members of staff i.e. the registered manager, deputy manager and two senior care assistants. All four senior staff members had undertaken accredited training in the administration of medication e.g. ‘Certificate in Safe Handling of Medication’. The home used the Nomad monitored dosage system. The registered manager stated that the home had a positive relationship with the local pharmacist. The most recent visit to the Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 13 home by the pharmacist had taken place on 10 February 2006. The registered manager said that the service users’ medication was reviewed by the GPs ‘as a matter of course’. However, the staff ask the GPs to review the service users’ medication if they are concerned about the service users for any reason. The home had a dedicated fridge for storing medication that required cold storage. The registered manager stated that the staff endeavoured to ensure that the service users’ privacy and dignity were respected at all times. It was also stated that all of the good care practices outlined in Standard 10.1 were upheld. The registered manager said that the importance of these aspects of the service users’ care was reinforced through induction and NVQ training and individual supervision meetings. Three service users had their own telephone. A mobile handset was also available to enable service users to make and receive telephone calls in private. The registered manager confirmed that the service users wore their own clothes at all times. The service users’ clothes were individually marked or labelled. New items of underwear were kept by the home for use ‘in an emergency’ but the registered manager reaffirmed that the service users did not wear the clothes of other service users. It was stated that sometimes the staff donated items of clothing for use by service users who did not have many clothes of their own and no relatives to buy items of clothing for them. The registered manager confirmed that the staff adhered to all of the good care practices outlined in Standards 10.4 to 10.6. All of the service users were accommodated in single bedrooms. The home’s response to the recommendation that was made in regard to Standard 11 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, recorded in their individual files and carried out. The registered manager stated that a new form had been introduced that was used at the time of admission to record the service users’ wishes concerning terminal care and the arrangements after death. The same form would be used to record similar information in respect of all of the current service users. However, the recommendation had not yet been fully implemented and still stands. It was pleasing to note that bereavement training had been arranged for 11 and 17 May and 7 June 2006. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 There was evidence to show that the service users had opportunities to exercise choice and control over their lives and in relation to various aspects of their care. However, further work needed to be carried out to increase the opportunities for the service users to engage in a wider range of social and recreational activities. EVIDENCE: The registered manager stated that the routines of daily living were flexible. For example, the service users were able to get up any time between 6:45 and 8:45 am. Two different people visited the home to hold music and movement sessions. Musical entertainers came to the home to play the organ. Other activities included Bingo, card making, manicures, hairdressing, television, music and videos. Outings had been arranged during warmer weather periods to Evesham, Malvern, garden centres and to local pubs. A summer fete had been held and special occasions were celebrated. It was stated that the service users’ relatives were involved to a limited extent in the events organised by the home. The registered manager said that a choice of food was always available. An Anglican vicar visited the home once a month and held a Communion service. A member of the Roman Catholic Church visited one service user every Sunday for the same purpose. Members of the Salvation Army visited the home three times during the year. The registered manager stated that none of the service users wished to attend a place of worship. The registered manager also said that the home received a weekly visit from a Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 15 person with a dog. Three service users received a visit from a representative from Age Concern approximately every three weeks. Information regarding social and recreational activities was displayed on a notice board near to the lounge and service users were also informed individually. However, the home did not maintain a record of the activities provided. The service users with whom discussions were held were asked about the social and recreational activities provided by the home. One service user said that she liked ‘the vicar to come with the dog’. She also said, ’I like the exercise lady to come. I wish she could come more often’. Another service user said ‘There aren’t enough activities but a lot of the residents can’t join in’. She said ‘I would like to go shopping once a month’. The opportunities for service users to enjoy social and recreational activities that suited their needs, preferences and capacities needed to be reviewed and, where necessary, improved. The registered manager stated that the service users were encouraged to handle their own financial affairs. It was also stated that, in the majority of cases, the service users’ relatives were involved and had responsibility for this aspect of their care. It was confirmed that none of the service users had or required the services of an advocate at the present time. The service users’ guide stated ‘Residents and their relatives and friends can be informed of how to contact external agents (e.g. advocates) who will act in their interests’. It would be preferable if the name, address and telephone number of the local advocacy service were included in the service users’ guide in full. The registered manager confirmed that service users were entitled to bring personal possessions with them when they were admitted to the home. The service users’ guide also included a relevant statement about the service users’ right of access to their personal records in accordance with the Data Protection Act 1998. The home’s response to the recommendation that was made in regard to Standard 15 as a result of the previous inspection was assessed. The recommendation was that steps should be taken to identify the service users’ concerns about the food provided and to address any shortfalls in this aspect of the service. The registered manager stated that the service users had been consulted about the standard of food shortly after the previous inspection. A meeting had been held with the service users on 10 March 2006 specifically to discuss the issue of food. The registered manager said that as a result of the meeting she had a better understanding of the service users’ needs. The cook was currently looking at the proposals that had been made. A meeting had been arranged between the cook and one of the registered persons to be held on 24 March 2006. The purpose of the meeting would be to agree any changes/improvements that needed to be made. The registered manager said that the cook ‘tried really hard’ to meet the wishes of the service users. The service users with whom discussions were held during the inspection were asked about the standard of food. One service user said, ‘I don’t think we’ve got anything to grumble about’. However, the two other service users felt that the standard of food could be improved. One service user described the Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 16 quality of the food as ‘up and down but improving’. She said that there had been a meeting recently about the food and she was ‘hoping that it would get better’. The other service user said that the food was ‘much improved’ and that the lunches were ‘quite good’. However, she felt that there were ‘too many sandwiches for tea’ and that the teatime meals ‘lacked variety’. She added, ‘They’ve had a meeting and they do try to find out what they can do for us’. It was clear that the home needed to continue to give attention to this aspect of the service users’ care. The Standard on food will be assessed more fully during the next inspection of the home. In the meantime, the recommendation was regarded as having been implemented. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home had policies and procedures in place to help ensure that the service users were protected from abuse. EVIDENCE: The home had a satisfactory policy and procedure in regard to the protection of vulnerable adults from abuse and whistle blowing. The registered manager confirmed that no incidents of suspected or alleged abuse had been reported to her or otherwise come to her attention since the previous inspection. The registered manager also confirmed that she had not had any reason to refer any member of staff who may be unsuitable to work with vulnerable adults for consideration for inclusion on the POVA register. The home had a policy on the ‘Management of Challenging Behaviour and Violence’. A reference in the home’s policy on ‘Physical Intervention’ to the former NCSC was changed to the CSCI during the inspection. The home’s response to the recommendation that was made in regard to Standard 18 as a result of the previous inspection was assessed. The recommendation was that the home should introduce a single policy regarding the service users’ money and financial affairs that includes all of the issues referred to in Standard 18.6. The home’s policies on ‘Gifts and Legacies’ and ‘Residents Property and Money’ contained details of all the relevant issues. The recommendation had been implemented. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 18 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): 26 The service users lived in clean and pleasant surroundings. EVIDENCE: The home’s response to the requirement that was made in regard to Standard 21 as a result of the previous inspection was assessed. The requirement was that a wash hand basin must be installed and the exposed pipe work boxed in the bathroom on the ground floor, the process of refurbishment of the bathroom on the first floor must be completed, a staff alarm call must be installed in the toilet on the first floor and a liquid soap dispenser provided and an opening restrictor fitted to the window in the bathroom on the first floor. It was pleasing to note that all aspects of the requirement had been implemented. It was also noted that the hoist in one of the bathrooms was not in proper working order. However, the registered manager confirmed that a new hoist had been ordered. The home’s response to the recommendation that was made in regard to Standard 22 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 Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 19 recommended disability equipment and environmental adaptations to meet the needs of the service users. The recommendation had not been implemented and still stands. The laundry was appropriately sited on the lower ground floor of the premises. Access to the laundry was obtained without soiled linen having to be taken through any areas where food was stored, prepared, cooked or eaten. The laundry had suitable hand washing facilities. The floor finishes were impermeable and the floor and walls were readily cleanable. The home’s policy and procedures on infection control were satisfactory. The laundry contained two washing machines and two tumble dryers. The registered manager confirmed that one of the washing machines had a sluicing facility and both machines had a specified programming ability to meet disinfection standards. However, it was noted that water was dripping from the exposed pipe work across the ceiling of the laundry as a result of condensation. The general manager stated that he would ensure that the exposed pipes were lagged. The home’s response to the requirement that was made in regard to Standard 26 as a result of the previous inspection was assessed. The requirement was that the premises, specifically bedroom 2, must be kept free from offensive odours. The requirement had been implemented. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 20 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): N/A It was not possible to form an overall judgement as none of the Standards in this section of the report were fully assessed. EVIDENCE: The home’s response to the requirement that was made in regard to Standard 27 as a result of the previous inspection was assessed. The requirement was that the home must continue to give consideration to the provision of a member of staff on sleeping-in duty at all times during the night, in addition to the two members of staff on waking duty, in order to ensure the care and safety of the service users in an emergency. The registered manager stated that she monitored the condition of the service users, the level of care that they required and the level of risk. The registered manager gave an assurance that the monitoring that she undertook was ‘an on-going process’ and that she would ensure that an extra member of staff was placed on duty at night if it was considered necessary. The requirement was regarded as having been implemented. The home’s response to the recommendation that was made in regard to Standard 28 as a result of the previous inspection was assessed. The recommendation was that arrangements should 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 by 31 December 2005. The registered manager confirmed that the home employed 19 members of care staff. Seven members of care staff had completed NVQ level 2 training. The recommendation, therefore, had not been fully implemented. As the date for the implementation of the recommendation had elapsed the recommendation Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 21 now becomes a requirement. It was pleasing to note that two further members of staff had commenced NVQ level 2 training. The home’s response to the recommendation that was made in regard to Standard 29 as a result of the previous inspection was assessed. The recommendation was that the two written references that are supplied on behalf of prospective staff should be obtained from people who are not directly related to the applicants. The registered manager confirmed that six new members of staff had been appointed to work at the home since the previous inspection. The files of the six newly appointed members of staff were made available for inspection. Three of the staff files contained two, relevant written references. However, one of the staff files contained a reference provided by the registered manager herself. Another staff file did not contain a reference from the employee’s previous employer. In respect of the third member of staff it was not clear whether one of the references was from the employee’s previous employer. The recommendation had not been implemented. The wording of the recommendation has been amended and is repeated in this report. In cases where a reference is not forthcoming or readily/easily obtainable the prospective member of staff should be asked to provide details of another appropriate referee who is able to comment on the person’s suitability to work with vulnerable adults. The registered manager stated that she normally conducted staff interviews on her own. The registered manager was advised to adopt a more thorough and robust approach towards the process of interviewing and appointing staff. The practice of providing a reference for and subsequently appointing a prospective member of staff by, the same person is unsatisfactory. The home’s staff selection and appointment procedures should be reviewed and revised in order to demonstrate a greater degree of impartiality and consistency. The home’s response to the recommendation that was made in regard to Standard 30 as a result of the previous inspection was assessed. The recommendation was that the individual staff training and development assessments and profiles should be amended in order to show clearly the details of the training that has been undertaken, the dates of the training, the training that will be provided and the proposed dates of completion. The recommendation had been implemented. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 22 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): 35 and 38 The home’s practices and procedures ensured that the service users’ finances were safeguarded. The health, safety and welfare of the service users and staff were promoted and protected. However, the systems for monitoring the quality of the service needed to be improved. EVIDENCE: The home’s response to the recommendation that was made in regard to Standard 31 as a result of the previous inspection was assessed. The recommendation was that the registered manager’s job description should be reviewed and updated where necessary. A copy of the registered manager’s job description had been forwarded to the CSCI following the previous inspection. The recommendation had been implemented. The home’s response to the three recommendations that were made in regard to Standard 33 as a result of the previous inspection was assessed. The first recommendation was that the results of service user surveys should be published and made available to current and prospective users, their Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 23 representatives and other interested parties, including the CSCI. The registered manager stated that some of the service users had short-term memory loss and that the response to the use of service user satisfaction questionnaires had been low. The recommendation had not been implemented and still stands. 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 recommendation had not been implemented and still stands. 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 registered manager stated that an attempt had been made to implement the recommendation. Questionnaires had been placed in the hallway near to the main entrance for the service users’ relatives and other visitors and stakeholders to use with little success. The home had received only two responses. The recommendation had not been fully implemented and still stands. Notwithstanding the disappointing response, the registered manager was advised to take a more pro-active approach to the implementation of the recommendation. The registered manager confirmed that the home was responsible for the personal allowances handed over for safekeeping in respect of the majority of service users. The service users’ money was kept in individual packets in a lockable facility. Individual records of the service users’ money were also maintained. The records that were checked were correct and up to date. The records were audited by one of the registered persons. The two most recent audits were carried out on 6 September 2005 and 10 February 2006. The registered manager stated that access to the lockable facility that contained the service users’ money and accounts was restricted to the registered manager. It was confirmed that no one connected with the running of the home acted as the agent or appointee on behalf of any of the service users. The registered manager stated that the home did not hold any possessions for safekeeping on behalf of any of the service users. The home’s response to the two requirements that were made in regard to Standard 38 as a result of the previous inspection was assessed. The first requirement was that a quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. The registered manager confirmed that a commercially produced quality assurance system had been purchased for the home. The deputy manager had been given responsibility for ensuring that the quality assurance system became fully operational. The registered manager stated that the home was approximately a ‘quarter of the way through’ the process of implementing the system. Therefore, the requirement still stands. The second requirement was that all staff must be provided with updated training on food hygiene, fire safety and infection control. The registered manager confirmed that all the staff had undertaken fire safety training arranged by Complete Training on 25 Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 24 January 2006. The staff had not yet undertaken training on food hygiene and infection control. Therefore, the aspects of the requirement that had not been implemented still stand. However, it was pleasing to note that arrangements had been made for the staff to undertake training on infection control and food hygiene on 5 April and 18 April 2006, respectively. The registered manager confirmed that the home had three first aid boxes that contained all of the appropriate items. It was also confirmed that the registered manager had undertaken training in the protection of vulnerable adults from abuse in 2005. The deputy manager and one of the senior care staff had undertaken similar training on 23 February 2006. The other senior care assistant had not yet undertaken the training. It was stated that all the staff had undertaken inhouse training on the protection of vulnerable adults. It was confirmed that all hazardous substances were securely stored on the second floor of the premises. The ‘yellow bag’ system was used for the disposal of clinical waste. The home’s electrical wiring system was checked on 23 March 2005. PAT testing was carried out on 12 January 2006. The home’s maintenance person checked the water temperatures in October 2005. The registered manager said that the Legionella check that was done every year was due to be carried out shortly in March 2006. Thermostatically controlled mixer valves were fitted to all of the hot water outlets used by the service users. Opening restrictors had been fitted to the windows. The home employed a maintenance person for 24 hours per week to ensure that the home was properly maintained. The registered manager needed to introduce a recording system for ensuring that the checks on the security of the premises were being maintained. The general manager was aware of the problem of water leakage at the rear of the premises and gave an assurance that repairs would be carried out as soon as possible i.e. when the winds were less severe, to address the matter. It was stated that a copy of the home’s policy on health and safety had been issued to all members of staff and was also included in the ‘starter packs’. The home had copies of the documentation relating to RIDDOR and COSHH. Risk assessments had been carried out on all of the relevant safe working practice topics. Safety procedures had been posted in appropriate locations including those relating to infection control, cold weather and oxygen used by one service user. The home used probes for checking the temperature of the food and the fridge and freezer temperatures were recorded daily. Newly appointed staff undertook the induction training provided by Mulberry House. It was stated that the induction training met the Skills for Care standard. Two members of staff were currently undertaking the induction training. One of the staff members had been in post for several months. However, the record of the induction training that had been undertaken had not been kept up to date. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 26 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 OP12 Regulation 16 Requirement 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. 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. A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. (Previous timescale 31/12/05 not met). All the staff must be provided with updated training on food hygiene and infection control. (Previous timescale 31/12/05 not met). Arrangements must be made to ensure that the senior member of staff that has not undertaken formal training in the protection of vulnerable adults from abuse does so as a priority. DS0000063578.V286850.R01.S.doc Timescale for action 30/04/06 2 OP28 18 31/12/06 3 OP38 24 30/06/06 4 OP38 13,18 30/04/06 5 OP38 13,18 31/05/06 Priory Care Home, The Version 5.1 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP11 OP12 OP22 Good Practice Recommendations The service users wishes concerning terminal care and arrangements after death should be discussed and recorded in their individual files and carried out. 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 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. Appropriate action should be taken to ensure that water is prevented from dripping from the exposed pipes in the laundry. Two relevant, written references one of which should be from the applicant’s previous or most recent employer, should be obtained in respect of all prospective staff prior to their appointments and any gaps in employment records explored. The home’s staff selection and appointment procedures should be reviewed and, where necessary revised, in order to demonstrate greater impartiality and consistency. The results of service user surveys should be published and made available to current and prospective users, their representatives and other interested parties, including the CSCI. 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 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 registered manager should introduce a system that assures her that the security of the premises is being DS0000063578.V286850.R01.S.doc Version 5.1 Page 28 4 5 OP26 OP29 6 7 OP29 OP33 8 OP33 9 OP33 10 OP38 Priory Care Home, The 11 OP38 maintained to a satisfactory standard. The induction records in respect of all the staff should be completed at the time when the training has been undertaken. Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 29 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: 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 Priory Care Home, The DS0000063578.V286850.R01.S.doc Version 5.1 Page 30 - 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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