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Inspection on 23/04/07 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 23rd April 2007.

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

There was a recreational and activity programme provided which provided stimulation for the majority of residents. Those residents who were spoken to were very pleased with the care provided by the home. There was a comprehensive programme of education provided which should ensure that staff knew how to care and support people living in the home. People living in the home lived in clean and safe accommodation.

What has improved since the last inspection?

The deputy manager was working more days in a managerial role whilst the manager continued to work in the home 2 days a week. The other days the manager was required to manage another home owned by Southern Cross Healthcare.

What the care home could do better:

Before any resident is admitted to the home, the person responsible must ensure that the staff understand how to care and support all aspects and needs of any person entering the home. People must have an up to date, detailed care plan, which clearly reflects their needs including culture. All staff must understand what there role is if they suspect any issues regarding safe guarding adults. This includes the procedure for notifying organisations outside the home. Call bells must be placed within reach of residents so that they can summon help when they wish. There must be sufficient staff at all times to meet the needs of the residents as detailed in the care plans.

CARE HOMES FOR OLDER PEOPLE Priory Court Nursing Home Priory Road Stamford Lincs PE9 2EU Lead Inspector Toby Payne Key Unannounced Inspection 23rd April 2007 09:00 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.V337337.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.V337337.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 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.V337337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 8th February 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. 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 23/4/2007 ranged from £600 to £750 per week. Extras were hairdressing, which ranged from £7.50 to £30, chiropody £12 to £15 personal newspapers and toiletries. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit was unannounced and was carried out by a regulation inspector and regulation manager. The inspection took place on to follow up concerns following the previous key inspection on the 8/2/2007. This key inspection was started at 9.00 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 4 hours. The inspectors spoke to 6 residents, 3 visitors, 5 staff, and the deputy manager. The main method was called “case tracking”. This involved selecting one resident 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: Please contact the provider for advice of actions taken in response to this inspection. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 6 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.V337337.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.V337337.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 and 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People coming into the home receive information to allow them to make a choice whether or not to come to the home. People are assessed by a competent person before coming into the home. However staff do not always understand and meet the person’s needs. EVIDENCE: The statement of purpose states, “care is tailored to meet individual’s specific wishes and choices”. This was not the case with one resident who said that she had not been asked about her needs and what she wished for. The assessed needs of a resident were not being met which resulted in an unnecessary admission to hospital. The statement of purpose did not provide evidence that the staff working at the home could meet the needs of one person; the equipment required was not provided at the home and the management arrangements were not in place. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not accurately describe the needs of the residents, which as a result could pose a severe risk to them. Staff as a result of lack of specialist knowledge are unable to meet the needs of some residents. Medication is safely administered. EVIDENCE: Each resident had a care record. One resident was admitted to the home after undergoing an assessment by the registered manager; upon admission the staff were unable to meet her health and personal care needs. Staff reported that they had received no training about her condition and were not advised about how to care for her, also the care plan did not give sufficient detail to enable staff to meet her complex needs. The assessment states that “a service user should have a member of staff caring for her at all times”, this was not happening at the time of the inspection visit and staff confirmed that this has not always been happening due to them being so busy. Risk assessments identified a risk of choking, however the care plan stated that there were ‘there are no problems with eating or swallowing. A previous Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 10 report about a service user stated that due to risk, special equipment might be required; this equipment was not available for this person. Previous reports clearly identified that there was a risk of a service user ‘falling’ resulting in injury; there was no plan of care relating to this. One risk assessment referred to staff being advised to refer to the behaviour management policy. The staff spoken with on the day of the inspection were unaware of this policy and how to access it. Staff were unaware of the cultural and religious needs of one person, the care plan lacked any information relating to this other than to state ‘be respectful of cultural needs’ and staff had received no training on different religions and cultures. The statement of purpose states ‘each service users needs and values are respected in matters of religion, culture, race or ethnic origin’, there is a mention of regular visits being made by the local churches, however there had been no arrangement to meet the needs of one service users religious needs. This resident said that the food was not good; staff said that she ate pizza and chips a lot of the time, although a staff member did state that she was offered Halal meals. A medication round was observed at 09.30 hours on the ground floor. The home has 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 have 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 unable to meet the needs of the residents. By 12.45 pm there were some people who had not had their personal care needs met and they remained in bed. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 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. 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. Residents are provided with a wide variety of activities and a varied selection of foods of which there is a choice. Visitors are made to feel welcome and supported. Residents have choice and receive varied and nourishing meals. EVIDENCE: There was a written programme of activities, which was displayed throughout the home. A relative commented, “the activities are good and the activities staff are very helpful” and comment cards stated, “the activity staff are always busy involving as many residents as possible. I admire their enthusiasm” and “There a lot of activities and the staff try to involve everyone”. The catering service was awarded 5 stars “excellent” following the last inspection by South Kesteven District Council. Comment cards stated, “excellent puddings, meat and fish products variable”, “the meals are ok but take along time to arrive. For example lunch for 12 midday arrived at 12.55. It was cold, they heated it in a microwave and it was then too hot” and “the food is very good and all home made. It is the kind of food I like”. The menu was displayed in the dining room. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Although people living in the home can express their views regarding the care there is concern that although complaints may be dealt with promptly the same issues may arise in the future. This causing frustration to the complainant. Not all staff know about adult protection procedures therefore residents may be at risk. EVIDENCE: The complaints procedure was very detailed in the service user’s guide. A copy was given to each resident and made available at the entrance to the home. A visitor commented, “I am fed up with complaining to the manager. Promises are made and acted on immediately until the next time” and “I have no confidence in the manager”. Visitors did say they could visit whenever they wished and that the “staff communicate with me and keep me fully informed about my mother”. Staff working in the home did not know how to respond to an allegation of abuse, one staff member said she last had training 3 years ago. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has a variety of communal areas. However not all bedrooms are individual, clean or safe. This is affecting the dignity of the some people living in the home. EVIDENCE: Some residents said they were satisfied with the decoration of the home. They all spoke of how much they liked their bedrooms. The housekeeping staff monitor 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. There were however areas of the home, which require redecoration in the future and some carpets and furnishings, were worn. A visitor said, “my mother’s room was clean and her clothes were well looked after and in some cases returned the same or the next day”. Another visitor said, “I have had cause to complain about the cleanliness of my mother’s Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 14 room”. A comment card stated, “My daughter is always asking for extra cleaning”. The provider has been informed of the state of one service users bedroom which was not clean and well maintained. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 15 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 and 28 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There continue to be times when there are insufficient levels of staff to meet the needs of the residents. Residents could be put at risk as result of delays in answering call bells. This affects resident’s dignity. EVIDENCE: One of the inspectors observed care practice throughout the inspection. The response to call bells for 3 bedrooms was monitored. They ranged from 90 seconds to 12 minutes. Comment cards stated, “the bells from other bedrooms seem to ringing constantly but it is worrying in case of an emergency” and “the call bell can take between 4 and 35 minutes for staff to attend. I can wait ages before anyone comes to help me then no one takes any notice”. Staff commented that on the day of the inspection visit there was one member of staff who was off sick but that they were coping. Again, they felt frustrated that if all staff did not turn up for work this affected how they could care for the residents. This was echoed by comments by a relative on the day of the inspection who said, “there are not as many staff as there were 4 years ago.” Comment cards stated, “Sometimes they are too busy to help but when my daughter complains things improve. When my daughter rings the home the office administration finds it hard to get someone”, “when I ring the bell it is quite a long time before anyone comes to help me out of bed. I have asked Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 16 for more help to go to the toilet but there does not seem to be enough staff” and “they are usually understaffed but at £680 per week this is unacceptable”. Comment cards, relatives views and residents all confirmed however that “staff were lovely” and the home “friendly” and staff “very patient”. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 17 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 and 33 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The continued lack of effective leadership, guidance and direction in the home is affecting the staff, residents and visitors to the home. There is lack of consistency, which is affecting the lives of the people living in the home. EVIDENCE: Since November 2006 the manager has been required by the company to both manage this home and another home operated by the company. On the day of the inspection visit the deputy manager confirmed the manager was still managing both Priory Court and another home operated by Southern Cross Healthcare. The manager worked in Priory Court two days a week Monday and Friday and since the last inspection the deputy was when this was occurring working supernumerary Tuesdays, Wednesdays and Thursdays. She Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 18 commented that she did not have enough handover time and would find written messages from the manager. She felt this could be improved. Relatives commented, “I have confidence in the staff who are aware of my mother’s needs. Comment cards stated, “The staff are very nice and do their best but I feel they are badly managed”, “the manager is non existent and never calls to say hello. It is not a home but a place” and “the role of the manager is not clear and that person is frequently unavailable for long periods. Hence issues do not get resolved”. A recurring theme was the lack of consistency. One person spoke of complaining to the manager about the state of cleanliness of the room and the state of towels. Another person spoke of the frustration of asking for the call bell to be placed near her mother and finding as she showed the inspector that it was tied up at the back of the bed beyond her reach. She had also requested that the walking frame was placed near her mother but often came in to find it was out of her reach. The person did not feel it was something they should be constantly asking for, as this should be done when staff were attending to a resident. When the senior management of the company were informed of the findings on the the day of the inspection they responded immediately. Internal systems were put in place to ensure that any actions that needed to be done to protect service users and to ensure that care was delivered in accordance with care plans were carried out. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 19 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 2 x 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X X X X x Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 20 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 OP3 Regulation 10 (1) Requirement The manager must ensure that before a new person is admitted to the home that the staff are knowledgeable about how to support and care for all the needs of the person being admitted. Also that the correct equipment is available. This will ensure that staff have the confidence, knowledge and correct equipment to meet all the residents needs. The manager must ensure that all staff receive training on equality and diversity. This will ensure that each member of staff respects each persons’ needs with regard to sex, religious persuasion, racial origin, cultural and linguistic and disability. The manager must ensure that service users can contact staff at all times. This will ensure that their needs can be promptly addressed and their dignity and personhood promoted Timescale for action 25/05/07 2 OP4 12(4)(b) 25/06/07 3 OP22 13(4)(c) 25/05/07 Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 21 4 OP17 13(6) 5 OP7 15(1) 6. OP27 18(1)(a) The manager must ensure that 25/05/07 all staff know about what abuse is and what they should do if they suspect abuse is taking place. This including how to contact organisations outside the home responsible for investigating such occurrences. This will ensure that residents are protected at all times from possible abuse to their rights and person hood. The manager must ensure that 25/05/07 all people have an accurate and up to date care plan. This will ensure that they receive person centred care and support which meets their needs 25/05/07 The manager must ensure that at all times there must be arrangements in place to ensure that there are sufficient staff to meet the assessed needs of the residents. This will ensure that residents are able to get up when they wish to do so and staff have enough time to care and support people living in the home in accordance with their plan of care and care needs. 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 time meals are delivered to residents bedrooms should be reviewed/monitored to ensure that meals delivered are hot and people not kept waiting for an inconvenient period of time. Priory Court Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Lincoln 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 © 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 Nursing Home DS0000002565.V337337.R01.S.doc Version 5.2 Page 23 - 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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