Inspection on 19/09/05 for Priory Care Home, The

This inspection was carried out on 19th September 2005.

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

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

Other inspections for this house

Priory Care Home, The 16/02/07

Priory Care Home, The 16/03/06

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 The Priory Care Home Crutch Lane, Dodderhill Droitwich Spa Worcestershire WR9 8LW Lead Inspector Nic Andrews Announced 19 September 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Priory Care Home Address Crutch Lane Dodderhill Droitwich Spa Worcestershire WR9 8LW 01905 771595 01561 883358 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr D T Johnson, Mr A D Johnson and Mrs S N Bate (trading as Wychbury Care Services) Mrs Jennifer Ann Watts Care Home 30 Category(ies) of DE(E) Dementia (over 65) - 6 registration, with number OP Old Age - 30 of places PD(E) Physical Disability (over 65) - 30 The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There were no conditions of registration other than those that are referred to on the previous page of this report. Date of last inspection 22 March 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. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine inspection that took place over one day. Service users’ records and staff records were inspected and a tour of the premises was also made. Separate discussions were held with six service users, one relative and one member of staff. Time was also spent with the registered manager discussing the progress that had been made in the implementation of the requirements and recommendations arising from the previous inspections of the home. Two of the registered providers and also the General Manager were present for most of the inspection. The member of staff that was interviewed spoke positively about the home. She stated that there was a homely, relaxed and ‘non-regimented’ atmosphere, good food and a good level of care. She said that the service users were always kept clean and smart in their appearance. She also said that the registered manager was ‘very fair and very approachable’. However, she wished that ‘there were more time for the staff to sit and chat with the residents’. The six service users with whom discussions were held also spoke positively about the home. Their comments about the staff included the following statements; ‘The staff are very good and very kind’. ‘The staff are always kind’. ‘The staff are first class’. ‘The staff are marvellous, they need a lot of patience’. One of the service users said, ‘The manager is very good to me’. Two of the service users stated that their rooms were always kept clean and tidy. Five of the six service users expressed their satisfaction with the food provided. Three of the service users were satisfied with the range of leisure activities that were provided. The service users felt confident about approaching the staff with any concerns or complaints that they might have. One service user said that she felt ‘well cared for and was always treated with respect’. However, one service user said that she would welcome the opportunity to exercise more often and to go on more outings. Three service users expressed concern over the staffing levels. They stated, ‘The home can’t get enough staff. There are not always enough staff on duty. There was a change-over of staff recently. The home has not got a full staff quota’. One service user stated that one member of staff did not handle her as carefully as she would like her to when getting her up in the mornings. Details of the service users’ comments were passed to the registered manager for investigation. The registered manager is also requested to ensure that the amount of physical exercise provided is sufficient and appropriate to meet all of the service users’ needs. As part of the inspection process ‘Comment Cards’ were issued to a number of service users and their relatives/visitors. A total of eleven Comment Cards The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 6 were returned completed. Most of the responses to the questions that were asked about the service provided by the home in the six Comment Cards received from the service users were positive. However, four of the service users liked living at the home only sometimes. Two of the service users felt well cared for only sometimes. One service user felt that the staff treated her well only sometimes. One service user felt that her privacy was respected only sometimes. Two service users wished sometimes to be more involved in decision making within the home. Three service users felt that the home provided suitable activities only sometimes. Five of the service users liked the food only sometimes. One of the Comment Cards contained an additional comment requesting ‘more regular exercises’ i.e. ‘twice a week’. The majority of the responses to the questions that were asked about the service provided by the home in the five Comment Cards received from the relatives/visitors were positive. However, three respondents felt that there were not always sufficient numbers of staff on duty. Two of the Comment Cards also contained additional comments. One of the Comment Cards described the care as ‘excellent’, the staff as ‘affectionate’, the service user’s bedroom as ‘spotlessly clean’ and the atmosphere as ‘homely’. The other Comment Card stated, ‘The staff are so caring and friendly and make my mother happy. She tells me she is very content and well looked after’. However, the same Comment Card also stated, ‘Everything is fine until sickness leave or holidays and then the staff are rushed off their feet but always appear to be patient with the residents’. What the service does well: What has improved since the last inspection? Since the previous inspection one of the bathrooms had been refurbished and a new bath hoist had been provided. A number of bedrooms had been redecorated and the appearance of the front of the premises had been improved. The number of hours per week worked by the general assistant and maintenance staff had been increased. The home had participated in and successfully completed the project ‘Having Your Say’ organised by the County Council’s Social Services Department. It was also stated that the level of communication between the members of the senior staff group had improved. Since the last inspection the home had made a successful application to the CSCI to increase the number of service users for which the home is registered from 29 to 30 people. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 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. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 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 standard(s) 1 and 4 Relevant information about the home and the services provided was available and there was evidence to show that the healthcare needs of the service users were being met. However, the statement of purpose and service users’ guide needed to be amended. EVIDENCE: The registered manager made available a copy of the home’s statement of purpose and service users’ guide. The statement of purpose was comprehensive and contained relevant information. However, the number of service users for which the home was registered was stated as 29. This was incorrect and should be stated as 30. The reference to the home’s emergency admission policy (paragraph 10) should clarify what the home’s policy on emergency admissions is. Similarly, the statement of purpose should state how often the residents meetings are held (paragraph 12) and details of the home’s emergency procedures should be included (paragraph 14). The service users’ guide was also comprehensive and contained relevant information on a range of issues. However, the number of service users for which the home was registered was stated as 29. This was incorrect and should be stated as 30. Details of the physical environment standards i.e. the number and size of all the rooms as specified in the statement of purpose, The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 10 should also be included in the service users’ guide. The service users’ guide should also include the service users’ views of the home as recommended in the previous inspection report. The registered manager confirmed that all of the service users had been given a copy of the service users’ guide. The home’s response to the requirement that was made in regard to the assessments of the service users’ needs as a result of the previous inspection was assessed. The registered manager provided a copy of two forms that were used for assessing the care needs of the service users i.e. a preadmission assessment form and an indicator of dependency form. The preadmission assessment form included a reference to all of the aspects of care listed in Standard 3.3. Therefore, the requirement had been implemented. The staff were well supported in their care of the service users by external agencies. The community psychiatric nurse visited three service users every month. The district nurse visited every day to administer insulin injections to one service user who is diabetic. The district nurse also visited twice a week to attend to two service users who had pressure sores. The district nurse also carried out a blood test once a month in respect of one service user. The registered manager confirmed that all of the service users were registered with a local GP. The services of three GP surgeries are used. An optician checked all of the service users’ sight at least annually and more frequently, if necessary. Service users were referred to an occupational therapist and physiotherapist via the GP as and when necessary. The home received visits from a private chiropody service every three months. An NHS chiropody service was provided every two months. A dental service was provided at least every six months. The home accommodated four service users that were diabetic. The registered manager confirmed that all four diabetic service users had had their eyes tested just prior to the inspection during the week commencing 12 September 2005. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 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 standard(s) 11 The home’s policy and procedures regarding dying and death were satisfactory. However, the service users’ wishes concerning terminal care and arrangements after death needed to be recorded. EVIDENCE: The home’s response to the requirement that was made in regard to Standard 7 as a result of the previous inspection was assessed. The requirement was that the format and content of the care plans must be improved so that they contain clear information about the needs of the service users and details of the action to be taken by the staff to ensure that all aspects of their care needs are met. The care plans of two service users were examined. It was noted that one of the care plans referred to ‘regular toileting’. The registered manager was advised to ensure that the written guidance on the action to be taken by the staff to meet the service users’ care needs must be specific. Therefore, the use of terms like ‘regular’ should be avoided and replaced with a specific instruction e.g. ‘every two hours’, or more or less frequent as appropriate according to the service users’ individual needs. Apart from this one exception, the contents of the two care plans that were inspected were satisfactory. The requirement was regarded as having been implemented. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 12 The home’s response to the requirement and recommendation that were made in regard to Standard 8 as a result of the previous inspection was assessed. The requirement was that the care plans must cover all aspects of the service users’ healthcare needs including specialist needs and how the needs are to be addressed. Copies of the care plans used by the home were made available for inspection. The home used three care plan forms, two of which contained the same information. The registered manager acknowledged that this was an unnecessary duplication. It was pleasing to note that the care plans included a reference to all of the aspects of care listed in Standard 3.3. Therefore, the previous requirement was regarded as having been implemented. However, for the purpose of clarity, safety and the avoidance of unnecessary duplication the home should have one care plan for each individual service user that contains all of the required information. The recommendation that was made as a result of the previous inspection that a separate list of the contact with members of the primary healthcare team should be maintained in respect of each service user had been implemented. The home’s response to the two requirements and one recommendation that were made in regard to Standard 9 as a result of the previous inspection was assessed. The first requirement was that a risk assessment must be carried out and recorded in respect of the service user who self-medicates. The requirement had been implemented. The second requirement was that action must be taken to ensure that the administration of medication is accurately recorded at all times and that the MAR Charts are checked on a regular and frequent basis. Any errors in the administration of medication must be reported to the CSCI. The MAR Charts were examined and no errors were identified. The requirement had been implemented. The recommendation was that the out of date reference to the NCSC in the home’s policy and procedure for the administration of medication should be replaced with a reference to the CSCI. Action was taken to implement the recommendation on the day of the inspection. The home had a policy and procedure on dying and death that was made available for inspection. The policy and procedure was satisfactory. The registered manager described the procedure that was followed in respect of the last service user that died in the home. The details that were given by the registered manager corresponded to the principles and practice outlined in Standard 11. The registered manager stated that the death of the service user was expected and the district nurse was involved. The registered manager also stated that the service users’ wishes concerning terminal care and arrangements after death had not been discussed with all the service users or recorded in their care plans. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 The service users were enabled to maintain contact with their family, friends and other visitors and the service users received a satisfactory diet. EVIDENCE: The service users were able to receive their visitors at any reasonable time and there were no unnecessary restrictions. The service users’ guide stated, ‘Visitors are encouraged and welcomed at all times but are asked to avoid mealtimes and unsocial hours’. An office was made available to the service users to enable them to see their visitors in private if it was not convenient or appropriate for them to use the dining room or their own bedrooms. The registered manager stated that if any service users chose not to see a visitor their wishes would be respected. The service users’ guide stated, ‘Residents’ wishes are recorded and honoured in respect of visiting rights’. The service users’ guide also contained information about the home’s policy on maintaining relatives and friends’ involvement with service users. The registered manager stated that the service users enjoyed the visits to the home by members of the local church particularly at Easter and Christmas. A member of the Anglican Church visited the home once a month to hold a Communion service. Members of the Salvation Army visited the home on a Sunday every six weeks. Two service users welcomed the visits they received from representatives of Age Concern. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 14 Normally, two cooks were employed for a total of 35 hours per week. However, the home had a vacancy for one part-time cook for 20 hours per week covering four days a week. Breakfast was served between 8:30 and 9:00 am. Lunch was served between 12:30 and 1:00 pm and tea was served between 5:00 and 5:30 pm. Drinks and biscuits or sandwiches were provided at 8:00 pm every evening. Drinks were also served mid-morning and mid afternoon and provided, if necessary, during the night. The registered manager stated that none of the current service users required liquefied meals. However, two service users had their food cut into small pieces. Sugar-free meals were offered to four service users who were diabetic. None of the service users had any food allergies. The service users’ food preferences were recorded. The home operated a four-week menu. The record of the food provided was inspected and was satisfactory. The registered manager stated that none of the service users required constant, individual supervision. However, it was also confirmed that staff were always present at meal times. It was confirmed that none of the service users needed to undergo a risk assessment because of the risk of choking. One service user required occasional staff help with feeding. The service users were consulted about the food provided at service user meetings. The service users were also asked each day about their choice of food for the following day’s meals. Special aids were provided to enable two service users to maintain their independence at meal times. Five of the six service users with whom discussions were held during the inspection commented positively about the standard of food. However, five of the six Comment Cards that were used to obtain feedback from the service users contained less favourable responses about the standard of food. Steps should be taken to identify the service users’ concerns about the food and appropriate remedial action taken to address any shortfalls in this aspect of the service. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home had a satisfactory complaints procedure and the service users felt confident that their concerns would be responded to quickly and appropriately. EVIDENCE: The home had a satisfactory policy and procedure on complaints. The home also had a register in which the details of any complaints made against the home could be recorded. One complaint against the home was made direct to the CSCI during the past year that was investigated under the local Protection of Vulnerable Adults Procedures. There were four elements to the complaint. Three elements of the complaint were upheld and one element of the complaint was not upheld. In a subsequent discussion with the general manager, it was confirmed that all of the requirements that had been made as a result of the complaint had been implemented. 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. It was stated that a number of issues relating to the service users’ financial affairs were referred to in several different documents i.e. service users’ guide, terms and conditions of residence and staff handbook. The main benefit in bringing all of the relevant issues together in one document would be in ensuring, through supervision meetings, that the staff had read and understood the home’s policy on these issues. The recommendation had not been implemented and still stands. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22 and 25 The home was safe, comfortable and well maintained. However, a small number of improvements were needed to some of the bathroom and toilet facilities. EVIDENCE: The location of the home was not ideal for the recruitment of staff and there were no shops or other amenities in close proximity. However, the home was accessible, safe and well maintained. A number of rooms enjoyed attractive views of the surrounding countryside and adjacent golf course. The home provided a vertical lift and a stair lift to enable the service users to access the accommodation on the first floor more easily. The sitting areas were comfortable and homely. The home had a programme of routine maintenance and renewal of the fabric and decoration of the premises. The front of the premises was attractive in appearance and had undergone a noticeable improvement since the previous inspection. The rear garden was tidy and accessible to people in wheelchairs. The registered manager confirmed that the most recent visit to the home by the Fire Safety Officer had taken place in March 2004. It was also confirmed that the Environmental Health Officer had The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 17 visited on 10 January 2005. Since then the floor in the kitchen had been upgraded and a new fridge and dishwasher had been provided. The registered manager confirmed that there were no outstanding issues to be addressed from either of the two visits. The home’s response to the recommendation that was made in regard to Standard 20 as a result of the previous inspection was assessed. The recommendation was that efforts should be made to improve the appearance of the rear garden e.g. raised flowerbeds, shrubs and plants etc. Some improvements had been made. However, the registered provider stated that the service users had been consulted about further improvements to the rear garden but had expressed their satisfaction with the present large, grassed area. The recommendation is, therefore, regarded as having been implemented. The home provided twenty-two bedrooms with an en suite facility. There were four separate toilets together with a wash hand basin, and paper towel and liquid soap dispensers on the ground floor. The toilets were fitted with grab rails and the toilet doors were clearly marked. There was also a bathroom containing a bath with a hoist and a toilet but no wash hand basin. A wash hand basin must be provided. The registered provider said that he would ensure that an anti-bacterial liquid dispenser was installed in the bathroom. In the meantime, the service users should only use the toilet in the bathroom prior to bathing. The exposed pipe work in the bathroom must be boxed. There was a toilet on the ground floor for use by staff and visitors. On the first floor there was a bathroom that was being refurbished. The process of refurbishment had almost been completed. However, the mirror had to be wall mounted, the radiator fitted and a liquid soap dispenser provided. The registered provider gave an assurance that the outstanding work would be completed in the near future. A recommendation was made as a result of the previous inspection that as part of the planned refurbishment of one of the bathrooms on the first floor a suitable hoist should be installed or, alternatively, a medi-bath should be provided for the benefit and safety of both service users and staff. The recommendation had been implemented. There were also two separate toilets. They contained a wash hand basin, paper towel and liquid soap dispensers and grab rails. Both toilet doors were clearly marked. However, one of the toilets did not have a staff alarm call. There was another bathroom on the first floor without a toilet. This bathroom had a hoist, a wash hand basin and a paper towel dispenser. However, it did not have a liquid soap dispenser or an opening restrictor on the window. 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 recommended disability equipment and environmental adaptations to meet the needs of the service users. The recommendation had not been implemented The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 18 and still stands. The home provided a passenger lift and a stair lift. The registered manager confirmed that all parts of the communal facilities were accessible to the service users, including those who used wheelchairs. Handrails were provided in the corridors. The bathrooms and toilets were fitted with hoists and grab rails. The registered manager confirmed that none of the service users were waiting to be assessed for the use of any individual specialist equipment. It was also confirmed that the home had adequate storage facilities. The home’s response to the requirement that was made in regard to Standard 24 as a result of the previous inspection was assessed. The requirement was that all of the items of furniture specified in Standard 24.2 must be provided in rooms occupied by service users e.g. comfortable seating for two people etc. The service users’ bedrooms that did not contain all of the required items at the time of the previous inspection were inspected. It was pleasing to note that all of the bedrooms had been provided with all of the items except where the provision of any item posed an unacceptable risk to the service user. In these cases the service users files contained an appropriate record of the discussion and decision made. The requirement had been implemented. It was pleasing to note that all aspects of Standard 25 were met. It was noted that there was a strong smell of urine in bedroom 2. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The staffing arrangements were sufficient to meet the needs of the service users and the home was endeavouring to ensure that its workforce reached a satisfactory standard in NVQ level 2 training. EVIDENCE: The registered manager provided details of the staffing arrangements within the home. In addition to the registered manager the home employed a deputy manager for 35 hours per week, two duty supervisors for a total of 70 hours per week, six care assistants for a total of 165 hours per week, four night care assistants for a total of 110 hours per week, three general assistants for a total of 60 hours per week, a cook for 15 hours a week, a maintenance worker for 24 hours per week and a housekeeper/trainer for 30 hours per week. There were vacancies for a part-time cook (25 hours per week), a night time care assistant (30 hours per week), care assistants (96 hours per week) and one care assistant was on maternity leave (30 hours per week). The registered manager confirmed that there were always two members of staff on waking duty at night. The registered manager also stated that another member of staff on sleeping-in duty was provided when it was considered necessary e.g. when a service user was ill. It was also stated that the home had an efficient ‘on-call’ system. Nevertheless, 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 two waking staff, in order to ensure that sufficient staff are immediately available in the event of an emergency. A copy of the staff duty rota was made available for inspection. The staff rota indicated that that the home was adequately staffed. None of the staff were below the age of 21 The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 20 years. The home did experience difficulties in the recruitment and retention of staff. The registered manager felt that this was because of the location of the home and its relatively isolated position. The service users who were spoken to during the inspection expressed their concern over the difficulties that the home had in trying to recruit and retain a stable workforce. The registered provider stated that he intended to recruit a full-time member of staff who would be employed on a flexible basis to help cover holidays and sickness absences in both of the homes owned by the registered persons. The home’s response to the recommendation that was made in regard to Standard 27 as a result of the previous inspection was assessed. The recommendation was that the registered providers should continue to monitor the staffing arrangements in the home carefully in order to ensure that the registered manager has sufficient time to devote to her management responsibilities without detriment to the care needs of the service users. The registered manager stated that, although she still spent some time every week in the provision of direct care to the service users, she felt that she had sufficient time to fulfil her management duties. It was stated that the appointment of the general assistants and the housekeeper/trainer had helped to relieve some of the pressure of work. The recommendation 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 timescale set for the implementation of this recommendation had not expired. However, it was noted that five members of staff had already completed the NVQ level 2 training. In addition, one member of staff held a qualification in social care. The home employed thirteen care staff. Therefore, the recommendation had not been fully implemented and still stands. However, it was also noted that three members of staff intended to commence NVQ level 2 training in the near future. Three members of staff, two of whom had already completed the NVQ level 2 training, were intending to commence NVQ level 3. The home employed agency staff. It was stated that one agency staff member had been employed for one shift every two weeks over the past few months to help cover the holiday period. The home had an equal opportunities policy and there was evidence to show that the policy was upheld. The files of three members of staff were examined. The files contained the relevant information as required by Regulation apart from a photograph. The registered manger confirmed subsequently that this deficiency had been addressed. However, it was also noted that a close relative had supplied one of the two written references for one of the staff. The home must ensure that the two written references supplied on behalf of prospective staff are obtained from people who are not directly related to the applicants. It was confirmed that a Disclosure application had been obtained or requested from the CRB in respect of all the The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 21 staff. A POVA first check had been made in respect of the staff whose CRB Disclosure results were still awaited. It was also confirmed that all the staff had been given a copy of the code of conduct and practice set by the GSCC. All the staff except those who were still completing their probationary period had been issued with a statement of their terms and conditions of employment (contract). It was also stated that all the staff had been given a copy of the home’s Employees Handbook. It was confirmed that, where applicable, each member of staff had been provided with a commercially produced ‘Induction, Foundation and Training Record’ that covered all of the relevant issues. However, it was also stated that, usually, Foundation training was not provided. If possible, all of the newly appointed staff were expected to commence NVQ level 2 training following the successful completion of their induction training. If this is not possible, Foundation training was provided ‘in-house’ by the home’s housekeeper/trainer. It was confirmed that all the staff received three paid days training per year. Individual training profiles were in place for all the staff. However, it was not clear from the records that were examined what training had been provided or when and what training was still outstanding. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36 and 37 The home was being managed satisfactorily, arrangements were in place to ensure that the staff received appropriate supervision and support and relevant records required by Regulation were being maintained. However, the systems for monitoring the quality of the service needed to be improved. EVIDENCE: The registered manager had relevant experience and qualifications to undertake her role. The registered manager had completed the NVQ level 4 training in October 2003. She had also undertaken training in Basic Awareness on Adult Abuse on 14 July 2005, Fire Safety on 28 January 2005, Medicine Administration in December 2004, Infection Control in July 2004 and First Aid at Work in October 2003. The registered manager had a satisfactory job description. However, the job description that had been most recently supplied to the Commission for Social Care Inspection (CSCI) contained an out of date reference to the National Care Standards Commission. The reference The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 23 should be changed to the CSCI. There were clear lines of accountability within the home and the external management. The home’s response to the two recommendations that were made in regard to Standard 32 as a result of the previous inspection was assessed. The first recommendation was that further work should be undertaken to promote communication and a clear sense of direction for the staff regarding the aims and purpose of the home. The registered manager stated that the recommendation had been addressed through staff supervision meetings and staff training. The recommendation was regarded as having been implemented. The second recommendation was that evidence should be provided to show that management planning and practice encourage innovation, creativity and development. The registered manager cited the involvement by the home in ‘Having Your Say’ as evidence to show that the recommendation had been implemented. As a consequence, six weekly meetings had been held with the service users. The service users had been helped to understand the role of the key workers and were being encouraged to make choices and to have a greater participation in the decisions affecting their care. The registered manager also said that there was a ‘more open’ atmosphere within the home. It was pleasing to note that the home’s involvement in ‘Having Your Say’ had had a positive impact. The registered manager and staff should continue to promote the work that has been done and to build on and record the changes and achievements made by the home. The home’s response to the one requirement and four recommendations that were made in regard to Standard 33 as a result of the previous inspection was assessed. The requirement was that a quality assurance system must be introduced in accordance with the Requirements of Regulation 24 and Standard 33. It was confirmed that a commercially produced, quality assurance system had been purchased for the home. However, the system was not yet fully operational and its effectiveness could not be fully assessed. Therefore, the requirement still stands. The first recommendation was that there should be an annual development plan for the home, based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users. A copy of the home’s ‘Business and Development Plan’ dated May 2005 was made available for inspection. The Plan contained relevant information to show that the recommendation had been implemented. The second recommendation was that 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 recommendation had not been implemented and still stands. The third 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 the service users had been consulted but very little interest had been shown. It was stated that the service users lacked motivation. However, books and magazines had been provided. Every two The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 24 weeks there was a reminiscence session and a music and movement group. It was suggested that further work, perhaps through the key workers, could be done to ascertain the views of all the service users on a range of issues and activities. Where interest was expressed plans could be made to address the needs of the service users either individually and/or collectively. The recommendation still stands. The fourth 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 forms had been issued but there had been no response. It was suggested that if no response was forthcoming the home should try alternative ways to obtain the views of relatives and other stakeholders e.g. meetings at the home. The recommendation had not been fully implemented and still stands. The registered manager was responsible for the supervision of the deputy manager and two, senior care staff and they, in turn, were responsible for the supervision of the care staff. The registered manager confirmed that all the staff had attended three formal supervision meetings since the 1 April 2005. The requirement that was made as a result of the previous inspection that care staff must receive formal supervision that includes all aspects of practice, philosophy of care in the home and career development needs, at least six times a year was regarded as having been implemented. The registered manager gave an assurance that the staff supervision process would continue. All of the records that the home was required to keep were being maintained. The requirement that was made as a result of the previous inspection that evidence must be provided to show that all the staff have been made aware of the contents of the home’s policies and procedures had been implemented. The registered manager provided documentary evidence to show that this process was being carried out and monitored through supervision. The home’s response to the three requirements that were made in regard to Standard 38 as a result of the previous inspection was assessed. The first requirement was that all the staff must be provided with updated training on food hygiene, fire safety and infection control. It was stated that it was intended to provide all the staff with a module-based course using Mulberry House as an external verifier within two months. All the staff had undertaken internal fire safety training. However, training by an external fire safety expert will be provided for five new members of staff on 9 November 2005. An internal module-based course will be provided for all new staff within three months. The arrangements that had been made to implement the requirement were noted. However, the requirement had not been fully implemented and still stands. The second requirement was that evidence must be provided to show that the whole of the premises have undergone an electrical safety check by an appropriately qualified person. A Period Inspection Report dated 23 March 2005 was made available for inspection to show that the requirement had been implemented. The third requirement was that a system must be The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 25 introduced to ensure that falls and other accidents are monitored and investigated on a regular basis. The registered manager confirmed that she maintained a procedure that enabled her to monitor accidents and to incorporate this aspect of care in the monthly reviews of the service users’ care plans. The requirement was regarded as having been implemented. It was noted that 48 accidents had been recorded in one month. The majority of the accidents were of a minor nature. The registered manager was advised to continue to ensure that all accidents, however minor, were recorded and responded to appropriately. The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x 2 2 x x 3 x STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 1 x x 3 3 x The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 and 5 Requirement The homes statement of purpose and service users guide must be amended in order to include all of the required information as outlined in this report. 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 users needs are being met. A wash hand basin must be installed and the exposed pipework 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. The premises, specifically bedroom 2, must be kept free from offensive odours. The home must continue to give consideration to the provision of Timescale for action 30 November 2005 2. 8 15 30 November 2005 3. 21 13,16,23 30 November 2005 4. 5. 26 27 16 18,24 With immediate effect. 31 October 2005 Page 28 The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 6. 38 24 7. 38 13,18 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. A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. (Previous timescale of 31 May 2005 not met). All the staff must be provided with updated training on food hygiene, fire safety and infection control. (Previous timescale of 31 May 2005 not met). 31 December 2005 31 December 2005 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. 4. Refer to Standard 11 15 18 22 Good Practice Recommendations The service users wishes concerning terminal care and arrangements after death should be discussed, recorded in their individual files and carried out. 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 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 advice of a qualified occupational therapist should be sought in order to ensure that the home provides all of the recommended disabilty equipment and environmental adaptations to meet the needs of the service users. Arrangements should be made for staff to receive training that will enable a minimum of 50 of the care staff to attaion a qualification at NVQ level 2 or equvalent by 31 December 2005. The two written references that are supplied on behalf of prospective staff should be obtained from people who are not direcly related to the applicants. E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 29 5. 28 6. 29 The Priory Care Home 7. 30 8. 9. 31 33 10. 33 11. 33 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 registered managers job description should be reviewed and updated where necessary. 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 Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 30 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 The Priory Care Home E52 S63578 The Priory Care Home V245230 190905.doc Version 1.40 Page 31 - 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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