CARE HOMES FOR OLDER PEOPLE
Priory Court Nursing Home Priory Road Stamford Lincs PE9 2EU Lead Inspector
Mr David Bacon Unannounced Inspection 4th October 2005 08:00 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.V255875.R01.S.doc Version 5.0 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.V255875.R01.S.doc Version 5.0 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 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.V255875.R01.S.doc Version 5.0 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. 26th July 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. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was undertaken by two inspectors over 4.5 hours. A tour of the premises was conducted, service users care records and staff records were inspected. The inspectors spoke with the registered manager and six staff members. Five service users were spoken with and two service users representatives. Comments included: “The staff are splendid, marvellous”. “I like the food, there is a choice and there’s plenty”. “There are occasions when you have to wait a long time, they seem very short staffed sometimes”. “The care staff are friendly and helpful but they work very hard, we don’t have much time to talk with them”. What the service does well: What has improved since the last inspection? What they could do better:
Staffing levels are inadequate overall resulting in service users care needs not being met and increased risks to service users. Also, the deployment of staff during busy periods is not sufficient to meet service users care needs. For example, some service users are not receiving assistance to get up during the morning and others are waiting for unacceptable periods of time after requesting assistance. Also, the inadequate deployment of some staff is resulting in some of the care staff not being aware of each service users care needs. Staff said that morale is low at present due to there being insufficient staffing levels and that there was a break down of communication with the homes management, which was initially identified during the previous inspection, and prior to this inspection although some action is being taken regarding this.
Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 6 A comprehensive assessment of each service users care needs is not undertaken and care plan information does not clearly document individual’s care needs or instruct staff regarding how these are to be met. Records must be reviewed regularly and as service users needs change and service users must be invited to be involved in this. It is acknowledged that some action has been taken regarding this. Hospital style beds must be provided for those residents who require them, which was identified during the previous inspection visit. The environment is homely and comfortable for residents, but some carpets require to be replaced. Bathrooms and shower rooms do not have adequate ventilation, which was identified during the previous inspection. The food provided is varied and enjoyed by service users although a record of the food provided to each service user must be maintained. Some of the homes confidential care records not stored securely. Staff receive supervision although the frequency of these must be increased and records must be maintained. 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.V255875.R01.S.doc Version 5.0 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.V255875.R01.S.doc Version 5.0 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): 1, 3, 5 Procedures for the assessment of service users upon admission to the care home are not being fully followed, therefore service users cannot be assured that their care needs will be met. EVIDENCE: A statement of purpose and service users guide have been produced and these document the homes current provision of care are provided to service users. The care records viewed did not clearly evidence that each service users care needs had been fully assessed and the information within the assessments was not sufficient to inform a detailed plan of care. For example, there was no continence assessment for a service user who had continence needs. Risk assessments had not been completed for a service user needing bed rails and another who was at risk of falling. There was no record of each service users personal belongings. Records partially documented where service users or their representatives had been consulted regarding their care plan.
Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 9 The manager said that the written confirmation is sent to service users prior to admission where the home is able to meet their care needs. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 Service users are not all having their needs met and the care plans and risk assessments do not provide staff with sufficient information to meet each service users care needs. EVIDENCE: A care plan is devised for each service user although the information within those inspected did not adequately document how individuals assessed care needs were to be met. A comprehensive risk assessment had not been undertaken for each service user. Care records were generally updated daily although recently there were gaps where no information was recorded and records were not fully reviewed on a regular basis or signed as reviewed. The care plans seen did not adequately identify service users health care needs or evidence how these were being met. One service user had an assessed risk of developing a urine infection although no action was noted following this. Other records did not detail how service users personal hygiene needs were met and one service user having specific dietary needs had not been referred to a dietician. A turn chart had been initiated for one service user having pressure areas although this was not fully completed.
Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 11 One service user, who had accidentally spilled some drink over them, was left waiting for twenty minutes despite calling for assistance. Another service user had called for assistance and was left waiting for a similar period of time although staff were aware of this service users needs. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 Service users are supported to express their views regarding life within the home and the care they receive and they can maintain and develop community links, as they prefer. Service users are provided with a wide variety of activities and a varied selection of foods of which there is a choice. EVIDENCE: The service users spoken with confirmed that they were able to spend their time as they liked, that there were no real restrictions and that any visitors were made welcome. Service users were also satisfied with the homes provision of meals. Comments included: “I’m comfortable here, I do as I please”. “The staff are all approachable, yes, and you can talk with them”. “There are activities and things happening regularly”. “I’m satisfied as there is a good variety of things to do”. “I like the food, yes, you have a good selection and there’s a choice”. A rotating four-week menu is in place, which identified a variety of foods being provided and the available alternatives. Kitchen cleaning rotas are in place and meal temperature records are maintained although a record of the meals provided to each service user must be maintained. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 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, 18 The service users spoken with feel able to express their views regarding the care they receive and complaint guidelines are in place regarding this. Staff are not fully aware of the homes whistle blowing policies and procedures. EVIDENCE: Complaint policies and procedures are in place and information regarding these is provided to service users and staff. The service users 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 don’t need to complain but I could do and I’m sure it would be listened to”. “The staff are all approachable and they will listen”. “No, they hear you and would not treat you badly if you complained”. The care staff have attended abuse awareness training and the staff spoken with were aware of the required action to be taken in the event of an issue of abuse being suspected although one staff member was unaware of the homes whistle blowing policy. Abuse and whistle blowing policies and procedures are in place. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 14 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, 22, 23, 24 The home is well maintained overall and mostly provides a comfortable and homely environment for residents although some carpets require to be replaced or specialist cleaned. EVIDENCE: Service users personal accommodation was seen and the bedrooms viewed had been personalised and were clean and tidy. The service users spoken with were satisfied with the physical environment. Comments included: “Yes, I like it, it’s homely”. “I am satisfied with things here, its comfortable enough”. Carpets in the dining areas and some areas of the hallways require replacing, which was identified during the previous inspection. The shower and bathrooms have no windows, and rely on small extractor fans for ventilation. During the previous inspection it was recommended that a design solution for these problems should be looked into although no action has been taken regarding this. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 15 Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 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, 30 Robust recruitment procedures are in place and the staff receive induction when starting at the home. There are insufficient numbers of staff, who are not appropriately deployed to allow them to meet service users care needs. EVIDENCE: The staff records viewed were well maintained and evidenced that appropriate recruitment procedures had been followed. The staff members interviewed stated that there were not sufficient staff on duty to meet the high needs of residents, which was further evidenced as service users were not having their care needs fully met and other service users, after calling for assistance were left waiting for unacceptable periods of time before being attended to. Other residents, just prior to lunchtime had not received assistance to get up, as staff had not had the time to assist them. The staff members observed during the visit were clearly struggling to achieve all of their duties within the given time. One service user accommodated upstairs in the care home requested assistance, staff were then called from downstairs by telephone to attend to their care needs, on one occasion it was 15 minutes before a carer attended to the service users needs. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 17 The manager and staff said that a rolling programme of training is in place although this was not inspected and most staff have been trained to National Vocation Qualification levels. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 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): 32, 36, 37 The morale of staff is low overall and there is a breakdown of communications between the staff and management which is impacting on the care provided. The homes systems for maintaining the confidentiality of information regarding service users are not adequate. EVIDENCE: The morale of some staff is low, which was initially identified during the previous inspection visit and prior to this inspection. The staff spoken with stated that this was due to there being insufficient levels of staff overall and that staff deployment during daytime hours was inadequate, which was clearly evidenced during the visit. The staff receive supervision although this is not held on at least 6 occasions each year.
Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 19 Some confidential information regarding service users is being stored inappropriately and not securely. Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 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 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 3 2 X X STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 2 2 X Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 21 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 14(1)(c) 13(4)(c) Requirement Timescale for action 30/11/05 1 OP3 12(1)(a) 15(1)(2) 2 OP7 13(4)c 14(2) 15(1)(2) A full needs assessment must be completed for all service users who are admitted. Care assessments must detail all items included within standard 3. A comprehensive risk assessment must be completed for each service user. A full needs assessment must be 30/11/05 completed for all service users who are admitted. Care assessments must detail all items included within standard 3. A comprehensive risk assessment must be completed for each service user. A comprehensive care plan must 31/12/05 be completed for each service user, which must clearly identify each service users needs and demonstrate how these are met. The plan for every service user must be reviewed each month and updated on a regular basis and signed. Service users and their representatives (where appropriate) must be involved in the devising of care plans where possible.
DS0000002565.V255875.R01.S.doc Version 5.0 Priory Court Nursing Home Page 22 3 4 5 6 7 OP8 OP10 OP15 OP18 OP19 13(1)(b) 8 OP24 9 OP27 10 OP27 11 12 OP36 OP37 Service users health care needs must be met. 12(4)(a) Service users dignity must be maintained. 16(2)(i)(j) The home must demonstrate the variety and choice of foods provided to service users. 13(6) All staff must be aware of whistle blowing policies and procedures. 23 (2) The registered person must arrange for the replacement of carpets in the dining areas, and areas of hallway that are showing signs of wear and tear. 12 (1) The registered person must ensure that all residents receiving nursing care are reassessed, and nursing beds provided as required. 18 (1) The registered person must review staffing levels to reflect the dependency levels of service users, to ensure that they are adequate. 18 (1) The registered person must review the deployment of staff within the home to ensure service users care nneesdare appropriately met. 18 (2) All staff must receive regular supervision and records of these must be maintained. 17 Information regarding service users must be securely maintained. 30/11/05 30/11/05 30/11/05 30/11/05 31/12/05 31/12/05 05/11/05 11/11/05 31/12/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 23 Priory Court Nursing Home DS0000002565.V255875.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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