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Inspection on 27/09/05 for Priory Court Care Home

Also see our care home review for Priory Court Care Home for more information

This inspection was carried out on 27th September 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The relaxed, friendly and supportive atmosphere of the home helps service users feel that the home is their own. They are supported in a safe way to have choices and to participate in activities to suit their needs and abilities. Service users looked well cared for, with clean, brushed hair and wearing appropriate clothing. Call bells were within reach and drinks were at hand. A relative had written: ` Thank you very much to all the nursing team for the kindness, friendliness and care that was given to my aunt. She was made very welcome at Priory Court for the five months that she lived there.` And another wrote `my wife, and myself have been impressed by the diligence and dedication showed by the staff at Priory Court.`

What has improved since the last inspection?

Since the last inspection staff files now contain copies of UKCC Pin number cards of Registered Nurses, the original certificate of registration was displayed, and fire doors were not wedged open on inspection of the building. The deputy manager informed the inspector that a recent recruitment drive was successful and six carers, one kitchen assistant, two domestics and a housekeeper had been employed.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Priory Court Care Home Old Schools Lane Ewell Village Surrey KT17 1TJ Lead Inspector Catherine Campbell-Ace Unannounced 27 September 2005 10:00 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. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Priory Court Care Home Address Old Schools Lane, Ewell Village, Surrey, KT17 1TJ 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) 02083930137 St Cloud Care Plc Ms Susan Elizabeth Crayden CRH Care Home 60 Category(ies) of DE(E) Dementia - over 65. 7 registration, with number OP Old age, 53 of places Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 2 The age/age range of the persons to be accommodated will be: 65 YEARS AND OVER 3 Of the 60 service users accommodated, 30 may be accommodated for residental care and 30 may be accomodated for nursing care. 4 The Category Dementia - over 65 years of age DE(E) is a decreasing category, no further service users within category DE(E) must be admitted to the home. Date of last inspection 21 Jun 2005 Brief Description of the Service: Priory Court is a detached property with its own gardens. The service is currently registered for sixty older people providing both residential and nursing care. The service provides a range of activities and facilities for service users and in the local community. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection lasted two and a half hours. The deputy manager, service users and staff assisted the inspector, who was made welcome during the inspection. Training files, policies, staffing numbers and the record of complaints were evidenced. Staff and service users were interviewed. The inspector viewed the building and found it clean, tidy and airy. What the service does well: What has improved since the last inspection? Since the last inspection staff files now contain copies of UKCC Pin number cards of Registered Nurses, the original certificate of registration was displayed, and fire doors were not wedged open on inspection of the building. The deputy manager informed the inspector that a recent recruitment drive was successful and six carers, one kitchen assistant, two domestics and a housekeeper had been employed. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 6 What they could do better: Following the inspection, requirements were made: • The registered person ensures that there is a simple, clear and accessible complaints procedure, which includes the stages and timescales for the process, and that complaints are dealt with promptly and efficiently. The registered person ensures that written information is provided to all service users for referring a complaint to the CSCI at any stage, should the complainant wish to do so. The registered person ensures that Policies are updated. • • A recommendation was made for the registered manager to keep the complaints received in a designated folder. 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 Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Standards 3 and 5 were assessed at the last inspection. This home does not provide intermediate care. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 10 Personal support in this home is offered in such a way as to promote and protect service user’s privacy and dignity. EVIDENCE: The deputy manager stated that keys were available for service users to lock their doors if they so wish. They were able to consult with the general practitioner in private and receive visitors in their bedrooms. A small room was available for service users to have meals in private with friends or relatives. Staff files were viewed and it was evidenced that staff were taught to respect privacy and dignity with regard to personal care, on entering bedrooms and following death. Care plans stated the term of address the service user preferred to be used. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 10 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) 14 Service users were observed to live a full life with opportunities to take part in varied activities. Service users are able to exercise choice and control over their lives. EVIDENCE: The deputy manager said that service users have a choice of meals, and she was working on new menus where there was even more choice. Service users could choose to eat meals in their bedrooms or in the dining room. An activity coordinator arranges activities for service users and she plans out a monthly programme with service users choosing the activities they would like to participate in. Activities for August included exercises, bingo, quizzes, communion, outings to the local pub and park. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 11 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 complaints process in this home is very poor with no complaints information available to service users. EVIDENCE: Service users in this home do not have access to a complaints procedure. There is some evidence that complaints are dealt with, but no process or timetables were available at the time of inspection. Service users spoken to said that they would speak to their family if they had a complaint. The Priory Court Information guide stated that a copy of the complaints procedure was issued with service user’s contracts on admission, however, no complaints procedure was identified in service user’s files viewed. Service users did not have written information for referring complaints to the CSCI should the complainant wish to do so. Complaints viewed were written on complaints forms and were investigated with recorded actions taken. However, these complaints were stored loosely in a complaints book. A recommendation was made to place these records in a dedicated folder. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 12 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) 19,26 The standard of the environment is high, providing service users with a safe, attractive and homely place to live. EVIDENCE: The home is attractive and affords bright airy communal rooms. Service users’ bedrooms were personalised with ornaments, photographs and small pieces of furniture. Furnishings were of good quality and suitable for service use’s needs. The home was very clean, with 3 new domestic staff employed. No fire doors were wedged open and all door - closing mechanisms were working. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 13 The laundry was viewed, and the floor and walls were seen to be readily cleanable. Staff were trained in infection control procedures which included safe handling and disposal of clinical waste. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 14 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) 27,30 Good progress has been made in addressing staff recruitment and as a result, service users receive consistent care. Staff are trained well and are competent to do their jobs. EVIDENCE: The duty rota was evidenced and showed which staff were on duty at any time during the day and night. The deputy manager stated that she used the advice from the Residential Forum to calculate staff numbers in relation to dependency levels. Waking staff are present in adequate numbers. The senior carer stated that no care staff provided personal care are under the age of 18, and staff in charge of the home are over 21 years of age. The deputy manager stated that a successful recruitment campaign had recently been held which resulted in 6 carers, 1 kitchen assistant, 1 housekeeper and 2 domestics being employed. It was evidenced that over 50 of staff had achieved NVQ awards, all staff had attended induction training and the deputy manager stated that mandatory training was attended by all staff. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 15 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) 33 The systems for service user consultation are good with evidence that service user’s views are sought. EVIDENCE: The deputy manager stated that service users views are sought through regular meetings, self monitoring and surveys. The views of family, GP and Social worker are sought in multi disciplinary care reviews. Policies and procedures were evidenced and required updating. Previous requirements from CSCI are actioned within timescales given. Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 16 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x x x 3 x x x x x Priory Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 17 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 16 Regulation 22 Requirement The registered person must supply a written copy of the complaints policy to every service user and to any person acting on behalf of a service user if that person so requests, and shall contain stages and timescales for the process, withassurances that they will be responded to within 28 days. The registered manager must include the name, address and telephone number of the Commission in the complaints policy The registered manager must review policies and procedures in the home Timescale for action 27/10/05 2. 16 22 27/10/05 3. 33 24 27/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 16 Good Practice Recommendations the registered manager is recommended to identify a designated folder for complaints received. H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 18 Priory Court Care Home Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Court Care Home H58 s13850 Priory Court v246920 300805 Stage 4.doc Version 1.40 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!