CARE HOMES FOR OLDER PEOPLE
Priory Court Nursing Home Priory Road Stamford Lincs PE9 2EU Lead Inspector
Tobias Payne Unannounced Inspection 20th August 2007 08:30 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.V344051.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 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 priorycourt@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Management Ltd 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.V344051.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of service users in Priory Court Nursing Home with nursing needs does not exceed 22 and the maximum number of service users with personal care only, does not exceed 40. To be able to admit into Priory Court Nursing Home the named person of category PD, SI and LD named in variation application number V35269 dated 22nd September 2006. To be able to admit into Priory Court Nursing Home the named person of category LD named in variation no. V36840 dated 28 November 2006 23rd April 2007 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. On the day of the inspection there were 50 people in the home. 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 20/8/2007 ranged from £550 to £775 per week. Extras were hairdressing, which ranged from £7.50 to £30, chiropody £12 personal newspapers and toiletries. Information about the home can be found in the entrance to the home and from the administrator and manager. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This second key inspection was unannounced and started at 8.30 am. It was undertaken using a review of all the information available to us about Priory Court Nursing Home. We spoke with 30 residents, 5 visitors, 7 staff and the manager. The commission is trying to improve the way we engage with people who use the service, so that, we can gain a real understanding of their views and experience of social care services. We are using a method of working where the Expert by Experience is an important part of the inspection team and helped the inspector to get a picture of what it is like to live in or use a social care service. The Expert by Experience spoke with 29 residents on their own, contributed to the inspection process and provided a separate report. Comments and observations are reflected in this report. The main method of inspection was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. What the service does well: What has improved since the last inspection?
The manager is no longer managing other Southern Cross Healthcare homes within the company structure and has since the 16/4/2007 managed this home only. This has improved the overall direction of the home. Additional training has been provided for staff to ensure that they understand how to meet all the needs of the residents. Since the last inspection new carpets have been provided to the ground floor corridors and they have been made brighter with lighter paint and a programme to update the lighting is taking place. This will ensure that the corridors are brighter and more inviting. In addition 10 bedrooms have been repainted, 2 new alternating pressure mattresses have been provided and 8 new fire evacuation mattresses have been provided.
Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to ensure that the home is able to meet all the assessed needs of the residents. There is information available to enable residents to make a choice as to whether or not to enter the home. People received an assessment, which resulted in their needs being met. EVIDENCE: Since the last key inspection the statement of purpose has been reviewed and made more clear and detailed. It also contained details of the scale of charges. The philosophy of care mentioned a non-discriminatory approach and the document had a clear complaints process with reference to the commission. Information about the home including leaflets, statement of purpose and service user’s guide was in the entrance to the home. Information could be made available in audio and CD format and a Braille edition on request. As a result of concerns from the previous key inspection the staff had received training about valuing individuals, equality and diversity and the Mental
Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 9 Capacity Act 2005. For residents who had a communication problem staff had received training from the learning disability team about how to communicate. Records for 2 recent admissions showed a detailed signed and dated preadmission assessment with written confirmation that the home could meet their needs. We also spoke to a resident who commented, “I met the manager, who explained about the home and then received a friendly welcome when I came to the home. I am quite satisfied”. The home did not provide intermediate care. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have taken place and residents health and welfare needs were now being met. Medication was safely given by staff who knew what they were doing EVIDENCE: Care records had improved since the last inspection. All residents had care plans, which described their health and welfare needs. Care records included a pre-admission assessment, client profile with date of assessment, client’s signature, physical and social assessment, admission checklist, pressure ulcer assessment, dependency assessment, moving and handling assessment, named nurse/key worker, client’s belongings, personal care plan covering personal hygiene, nutrition, moving and handling, elimination, communication, risk assessment, daily record and monthly review involving relative/service user. The reports were dated with a signature. There were also records of eating and drinking, weight and nutritional assessment. Care plans had clear care directions. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 11 There was sufficient information to enable staff to know how to care and support each resident. The last pharmacy visit was on the 8/8/2007. There were no concerns. Staff who were responsible for medication were studying for a Safe Handling Medicines Foundation qualification. A medication round was observed on the ground and first floor. The home had protected medication rounds with staff wearing distinctive tabards with “do not disturb medication round”. Medication was undertaken in a professional manner by nurses and senior care assistants who had received specific training. Staff were seen to be going about their work in a professional manner. No one had any complaints about the staff in the home. Staff were observed to be able to meet the needs of the residents. Residents commented, “staff are very kind as usual”, “everyone is very nice” and “I am very, very happy here”. There were specialist nurses who had responsibility for Nutrition, Palliative Care, Infection control, Continence and Tissue Viability. These nurses met up with specialists from Lincolnshire Primary Care NHS Trust to share and learn about current practice. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have taken place in the range of social activities provided. They are varied and provide daily stimulation and interest for people living in the home. Visitors were made to feel welcome. Meals provided were nutritious and varied. EVIDENCE: The home employed 2 activity organizers. There was an activities programme displayed for the week commencing the 20/8/2007. This showed activities Monday to Friday. This included, craftwork, news and views, visit from the mobile library, board games and carpet bowls. For those residents who had a learning disability arrangements had been made for them to attend the Gateway club every 2 weeks. Activities provided also included hairdressing weekly (the home has its own hairdressing room and the hairdresser was in the home during our visit), outside entertainment weekly and 2 church services each month and occasional trips out. The home also had a mini-bus. We spoke with 5 visitors. All were satisfied about the home. Comments were, “I can visit whenever I wish”, “we always receive a warm welcome”, “staff are very friendly, mother is well looked after and always looks nice” and “the home is clean and tidy and mother is well looked after”.
Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 13 The catering service was awarded 5 stars “excellent” following the last inspection by South Kesteven District Council. The previous inspection had showed concerns about the temperature of food provided to residents in their rooms. Since then efforts had been made to monitor the temperature at which food was served. The chef monitored food temperatures. We saw food being put onto trays stacked outside the dining room and staff then took the plated food to resident’s rooms. This was done with little delay. The menu was fish and faggots, mashed potatoes and faggots. Comments from residents were, “we have had fish 3 days running. I do not know what is going on” and “I like the food, I find it enjoyable”. None of the other residents had any negative comments about the food. Food was served in 2 dining rooms at tables with clean tablecloths by staff wearing aprons and meals were in a relaxed atmosphere. However during our inspection visit we were shown a container with a sample of lumpy mashed potato and we were told that the meat was occasionally tough. We discussed these observations with the manager and were told that the company were to introduce a nutritional assessment tool, which would enable the chef to know the nutritional content of food. This had not been introduced yet. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints received were treated properly and residents and visitors knew that any complaints they had to make would be addressed and taken seriously. Staff were recruited correctly to ensure that residents were protected from abuse. Improvements have taken place to ensure that all staff know about adult protection. EVIDENCE: There was a complaints procedure in the service user’s guide and statement of purpose with a clear process including contact with the commission. A copy was also available at the entrance to the home. Each person received a copy. We examined the complaints register and could see that since the last inspection visit 2 complaints had been received by the home. Records showed that all complaints were fully investigated with a clear audit trail. As a result of concerns about staff knowledge of adult protection issues the manager had arranged for additional training to take place for all staff on the 21/6/2007. The home also had a copy of the new Lincolnshire Adult Protection policy issued on the 1/5/2007. We spoke to 2 staff members who had confirmed this training had taken place and knew what they should do if abuse was suspected. None of the residents or staff had any complaints about the home and felt they could discuss any concerns with staff or the manager. We saw that staff were polite and respectful when talking to or undertaking care duties with residents.
Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 23, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lived in clean, well decorated, homely and safe accommodation. Any maintenance was promptly addressed. EVIDENCE: The home was clean, tidy, well decorated and odour free throughout. There was a decoration programme. There were lounge and sitting areas throughout the home. The home had under floor heating. This prevented any resident from being scalded by being in contact with a hot surface. All the residents spoke highly of the accommodation and how much they liked their bedrooms. Residents were encouraged to bring into the home small items of furniture, television, pictures and personal items. We were informed on the 23/7/2007 of an incident, which occurred on the 20/7/2007 in the kitchen as a result of serious flooding. A build up of
Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 16 rainwater on the flat roof had caused water to come through the ceiling of the kitchen. The fire brigade were informed and pumped water away. The electrics were isolated. Prompt action took place and emergency action was carried out to ensure hot drinks could be made by staff and food provided by another Southern Cross Care Home. Since then new freezers had been provided and food continued to be provided from the homes’ kitchen. Quotations had been obtained for the installation of a new roof above the kitchen. During the inspection we saw housekeeping staff cleaning the home, including cleaning under beds. None of the residents or visitors had any negative comments about the cleanliness of the home, condition of their room or about the laundry. Residents commented, “the cleaning is excellent” and “there are never any odours in the home”. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by robust recruitment practices. Improvements have taken place to the range of training provided to ensure that residents benefit from a staff team who are well trained and work well together and compliment each other’s skills. EVIDENCE: Since the last inspection the staffing levels had been reviewed. The manager monitored dependency and was able to employ more staff where required. Staff and residents and visitors felt there were sufficient staff in the home. We observed staff throughout the inspection visit. They went about their work in a calm, friendly and professional manner assisting one another. Although staff admitted to being busy they felt they were able to cope with the workload. Residents commented, “Staff are very kind but very busy” and “my key worker is very nice and understanding”. Additional training had been introduced since the last inspection. This had included adult protection training, Mental Capacity Act 2005, support for people with communication difficulties, skin care, moving and handling, care planning, infection control, MAKATON sign language, food hygiene and equality and diversity. In addition there were 53 of the care staff who had obtained or who were studying for a care qualification (National Vocational Qualification). The home
Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 18 was accredited by Paisley University to provide an Overseas Nurse Training programme as well as a placement for Nursing Students. There were 2 full time vacancies. Staff commented, “I have been here 2 weeks. I was recruited with a full CRB (Criminal Records Bureau) check and supported induction. I received a warm and friendly welcome and have settled in the home”. “The home has improved recently. I feel there is more direction and support” and “We are still busy at times but have a good team”. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have taken place in the overall management of the home. Residents, visitors and staff benefit from the positive leadership of the management in the home. The home ensures that that the residents have the opportunity to voice their views and opinions. There are good and efficient quality assurance systems in place. Feedback from questionnaires is obtained from residents/visitors and professional visitors. EVIDENCE: The manager had been in post for many years and is a registered nurse with care and management experience. She had obtained a management qualification. She was also an assessor. Staff, residents and visitors had confidence in the manager. The manager was no longer managing other Southern Cross Healthcare homes within the company structure and had since the 16/4/2007 managed this home only. This had improved the overall
Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 20 direction of the home and she had made efforts to address the shortcomings since the last inspection. She continued to be supported by a deputy manager. Staff received supervision regularly and spoke of the support received from the manager and deputy manager. Staff commented, “It is good we have a manager, we now have more direction”. Visitors commented, “we are very satisfied”, “nothing is too much for the staff”, “the home is always clean and tidy” and “mother is well looked after”. The manager made herself available to meet with relatives, had regular meetings with residents the last being on the 7/6/2007 and had regular staff meetings. There was a detailed quality assurance policy. This included, a detailed internal manager’s audit of the environment, medication, care documentation, accidents, complaints, health and safety and social activities. The most recent report showed an overall rating of 82 . There were also monthly monitoring visits made by the company and reports were sent to us. In addition, a survey of a sample of residents had taken place and of professionals. Positive responses had been received. There was a detailed equal opportunities policy, which referred to discrimination, disability and victimisation. Staff had received training on equality and diversity, communicating with people who have communication problems and the Mental Capacity Act 2005. There were no communication issues. There were no concerns about equality and diversity The home had detailed health and safety procedures. There were also infection control policies and staff made use of alcohol hand rub bottles throughout the home to further prevent infection. Where required risk assessments had been carried out and documented. There were a range of policies and procedures available in the home relating to fire safety and fire risk assessments. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 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 3 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP15 Good Practice Recommendations The views of residents in the home should be obtained about the quality and variety of food provided in the home, including fish, vegetables and fruit. This will ensure that residents’ views are taken into account in the provision of food. Priory Court Nursing Home DS0000002565.V344051.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lincolnshire Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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