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Inspection on 12/04/06 for Priory Court Nursing Home

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

This inspection was carried out on 12th April 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.

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 home has a comprehensive programme of activities, which are enjoyed by people who live in this home. Staff are appropriately recruited and they receive a comprehensive induction. The homes administration is generally well organised with a wide range of policies and procedures to safeguard residents. Staff receive training to enable them to meet the needs of people living in the home.

What has improved since the last inspection?

Staffing levels have been increased. Staffing deployment has been reviewed to include a twilight shift to help at busy periods. New wooden flooring has been laid in the dining rooms. Six new beds have been purchased to enable staff to deliver safe care to people who require nursing care. Two bedrooms have been redecorated.

What the care home could do better:

Although an additional person on the nursing floor has increased staffing levels during the morning staff and residents still felt there was a shortage of staff.The home needs to demonstrate to CSCI that there are sufficient levels at staff over the 24-hour period to meet the needs of the residents in the home. Although staffing supervision has been introduced this needs to involve all nursing and care staff.

CARE HOMES FOR OLDER PEOPLE Priory Court Nursing Home Priory Road Stamford Lincs PE9 2EU Lead Inspector Mr Toby Payne Key Unannounced Inspection 12th April 2006 08:05 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 Court Nursing Home DS0000002565.V289163.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 Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Priory Court Nursing Home Address Priory Road Stamford Lincs PE9 2EU 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) 01780 766130 01780 766148 www.schealthcare.co.uk Southern Cross Healthcare Services Limited Mrs June Walters Care Home 62 Category(ies) of Old age, not falling within any other category registration, with number (62), Physical disability (3) of places Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition of registration The maximum number of service users in the home with nursing needs does not exceed 22 and the maximum number of service users with personal care only, does not exceed 40. 4th October 2005 Date of last inspection Brief Description of the Service: Priory Court Care Home is purpose built and provides nursing and personal care for 62 persons including older persons aged 65 years and over and up to 3 physically disabled persons under the age of 65 years. The home is one of a number of homes owned by Southern Cross Healthcare Services Ltd. It is within half a mile of the centre of the town of Stamford and within easy reach of a wide range of services and facilities. Car parking is available in the grounds of the home. There are also garden and patio areas. All bedrooms apart from 2 are single and most have en-suite facilities. Accommodation on the first floor is served by two shaft lifts. Fees at the home on the 12/4/2006 range from £550 to £675 per week Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and started at 8.05 am. It was undertaken using a review of all the information available to the inspector regarding our service history about Priory Court. It took place over 7½ hours. The inspector spoke to 10 residents, 3 visitors, 7 staff, one nursing student on placement in the home, a visiting community nursing assistant and the deputy manager. The main method was called “case tracking”. This involved selecting 2 residents and tracking the care they received. This was done through the checking of records, discussion with them, the care staff and observation of how care was delivered. What the service does well: What has improved since the last inspection? What they could do better: Although an additional person on the nursing floor has increased staffing levels during the morning staff and residents still felt there was a shortage of staff. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 6 The home needs to demonstrate to CSCI that there are sufficient levels at staff over the 24-hour period to meet the needs of the residents in the home. Although staffing supervision has been introduced this needs to involve all nursing and care staff. 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 Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 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 the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Procedures for the assessment of people coming into the home has been reviewed and shows that their needs can be met. EVIDENCE: The care records have improved since the last inspection and showed detailed records were now being kept concerning the needs of residents. Every person receives a comprehensive assessment before being admitted to the home and written confirmation that the home can meet their needs. Signatures were evident to show that wherever possible residents or their representatives had been consulted regarding there care plan. The home does not provide intermediate care. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. There is better care planning in this home. Care plans however need to be further developed in order to ensure all care needs are fully met. Medication is safely administered. EVIDENCE: Care plans have improved since the last inspection and showed more detailed information being recorded. Care records showed information in the main of a detailed assessment being carried out and recorded, which included nutritional, continence, dependency and moving and handling assessments. Where required this also included risk assessments. There was evidence of review. However, despite these improvements one person’s care plan required a monthly risk assessment but there was no written evidence to show that this was taking place. The same person required to have a change of position every 2 to 4 hours when in bed but there was no turning chart completed. The home has nurses who specialise and link with other nurses concerning nutrition, infection control, tissue viability and palliative care. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 10 Medication was administered by nurses and care assistants. All these people had been assessed as competent to administer medication and had received training. A visiting community nursing assistant commented, “I always receive a friendly welcome and when I go to see a resident I am accompanied by a member of staff who introduces me and explains to them what I am doing”. Residents felt that staff respected their privacy and dignity and the home had policies and procedures covering this important subject. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Residents are provided with a wide variety of activities and a varied selection of foods of which there is a choice. However attention needs to paid to providing suitable activities for people who have a physical disability. Visitors are made to feel welcome and supported. Residents have choice and receive varied and nourishing meals EVIDENCE: The home employs an activities organiser and assistant to provide activities. Activities are varied and involve all residents. The people have been trained to provide a varied programme. The programme for both Easter and April was displayed on the notice board and a copy put in each bedrooms. A resident’s meeting was taking place on the day of the inspection. For residents who cannot take part in group activities the person spends individual time with them. There was a detailed activities programme including outside trips in the homes mini bus displayed on a notice board in the corridor of the home. Comments from residents were “I enjoy doing things which I want to do” and “there are activities available if you want take part”. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 12 Visitors are welcome to visit whenever they wish to do so and local churches have links with the home. Visitors commented, “I can visit when I wish to do so and always receive a warm welcome” and “I am very satisfied with the home”. One visitor however commented, “my relative needs more stimulation”. Residents also said they could spend their time when they liked. Residents in the main were satisfied with the homes provision of meals. Comments were “ the food is excellent”, the food is poorly served, “I enjoy the food: “ Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 13 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. People living in the home can express their views regarding the care and know that their concerns are taken seriously. There are systems in place to ensure that residents are safe as a result of abuse training for staff. EVIDENCE: Complaint policies and procedures are in place and a copy of the complaints procedure is given to each person when entering the home. Residents spoken with said that they felt able to voice any opinions regarding life within the home and that their views would be acted upon. Comments included: “I find most of the staff approachable” and “I have no complaints”. The home has received a number of complaints since the last inspection and records examined showed that all issues had been addressed to the satisfaction of the person who made the complaint. The CSCI has received complaints regarding staffing levels and pressures from staff and a further inspection was made on the 26/1/2006. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 14 The care staff have received abuse awareness training and the staff spoken with were aware of what they should do if abuse was suspected. Abuse and whistle blowing policies and procedures are in place. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 15 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): 19 and 26 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home is well maintained, clean and attractively decorated. Furnishings are of a high standard and any maintenance required is attended to swiftly. Residents are also safe. EVIDENCE: Residents said how satisfied they were with the decoration and cleanliness of the home. They all spoke of how much they liked their bedrooms. The housekeeping staff monitors how clean the home is. The home has under floor heating. This further reduces the possibility of any resident being scalded by being in contact with a hot surface. Since the last inspection new wooden flooring has been installed to the dining rooms and carpets been cleaned. Comments from residents were “I like my room”, “I am very comfortable” and “the home is always clean and tidy”. The home was also noticed to be odour free throughout. Staff had gloves and aprons when attending to residents. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 16 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Despite improvements in the level of staff available in the home and reviews of deployment there are still insufficient levels of staff to meet the needs of the residents. Robust recruitment procedures are in place and the staff receive induction when starting at the home. EVIDENCE: As a result of concerns about staffing levels in the home an inspection by CSCI took place on the 26/1/2006. As a result of this the manager and company were required to ensure that there were sufficient staff to meet the needs of the residents. Reviews were carried out and a member of staff now works 7 am to 1 pm and a further member of staff works a twilight shift between 4 pm and 10pm. There is now an additional member of staff working on the first floor in the morning. However despite these improvements staff and residents still expressed concerns about the level of staff. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 17 Comments from residents were “staff are very frenzied”, “we need more staff in the morning to help wash and dress ourselves” and “sometimes staff are too busy to talk, though they do their best”. Comments from staff were “we are sorting staffing issues out ourselves”, “we are still short of staff especially at night”, “the staff are very busy” and “we have difficulty meeting the complex needs of the residents”. The staff records viewed were well maintained and evidenced that appropriate recruitment procedures had been followed. All staff receive a comprehensive training programme following their induction and individual training issues are identified and a training plan is produced. Each employee is given a mentor to assist them through their induction and ongoing training programme. This training is in addition to National Vocational Qualification training. The home has 61 of staff who have obtained a care qualification or undertaking this training. This has exceeded the required standard of 50 . The home is also a centre for nurses from other European countries undertaking an adaptation programme to enable them to be registered by the Nursing and Midwifery Council. The home also provides training for nursing students. Comments from one nursing student were “I received a warm welcome and a comprehensive induction and a mentor for my placement here, “I am very satisfied”. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 18 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): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Since the last inspection the morale of staff has improved and there is now more direction since the appointment of a deputy manager. Staff supervision needs to be increased to involve all care staff. Quality assurance is addressed in this home. EVIDENCE: Since the last inspection a new deputy manager has been appointed and considerable efforts have been made to improve communication and the morale of staff. The manager has nearly completed a management qualification. Comments from residents were, “the management is approachable”; “staff are polite and helpful”. Visitors commented, “I am very satisfied” and “I have confidence in the staff”. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 19 Staff commented, “I love it here”, “the morale of staff has improved since the appointment of a deputy manager”, “the managements is more approachable and supportive” and “we have become more appreciated”. There are regular staff, resident and relatives meetings together with internal audits of care records, medication, care practice and pressure areas. The home also receives monthly unannounced monitoring visits by the company and copies of the reports are sent to CSCI. Surveys are also carried out to obtain the views of people living in the home. Staff supervision has been improved but does not yet include all nursing and care staff. Residents personal monies were well maintained, kept securely and records audited regularly. The home had comprehensive health and safety procedures which included risk assessments and essential equipment serviced regularly. Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 20 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 N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Priory Court Nursing Home DS0000002565.V289163.R01.S.doc Version 5.1 Page 21 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 OP27 Regulation 18 (1) (a) Requirement Despite improvements the company and manager needs to demonstrate to the CSCI that there are sufficient staff to meet the assessed needs of the people living in the home over the 24 hour period. Timescale for action 12/07/06 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 OP12 Good Practice Recommendations It is recommended that the manager arranges for the activities organizer to receive training in order to provide suitable activities for the younger people who have a physical disability. Efforts should be made to provide specific activities for these people in consultation with them or their relatives/advocates. It is recommended that the manager ensures that all nurses and care staff receive formal supervision 6 times a year. The sessions need to include all aspects of practice, the philosophy of care in the home and their career development needs. Records should be kept DS0000002565.V289163.R01.S.doc Version 5.1 Page 22 2 OP36 Priory Court Nursing Home Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisky Road Lincoln LN6 3QN 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. 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