Inspection on 16/04/07 for Priory Mews Nursing Home

This inspection was carried out on 16th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Priory Mews Nursing Home 24/10/06

Priory Mews Nursing Home 07/02/06

Priory Mews Nursing Home 04/10/05

Priory Mews Nursing Home 12/10/04

Priory Mews Nursing Home 25/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Priory Mews Nursing Home Watling Street Dartford Kent DA2 6EG Lead Inspector Elizabeth Baker Key Unannounced Inspection 16 April 2007 09:30 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 Mews Nursing Home DS0000026199.V327103.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 Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Mews Nursing Home Address Watling Street Dartford Kent DA2 6EG 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) 01322 292514 01322 281372 gricez@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited Miss Zoe Jane Grice Care Home 150 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (90) of places Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Patients detained under the Sections of the Mental Health Act may not be admitted to the home Of the 150 beds, 60 beds are registered for Dementia Nursing Care Of the 150 beds, 30 beds in one house are registered for dementia care Total number of bedspace must not exceed 150 That from time to time service users under the age of 65 may be admitted to the home. 24th October 2006 Date of last inspection Brief Description of the Service: Priory Mews Nursing Home is registered to accommodate one hundred and fifty Older People. Sixty of the residents are provided with nursing and dementia care, thirty with personal and dementia care and sixty with nursing care only. BUPA Care Homes Limited owns the home. Priory Mews is purpose built and was first registered in November 1993. The home comprises of five single storey houses, Cressenor, Marchall, Beaumont, Mountenay and Woodford. Accommodation in each house consists of thirty single bedrooms, a large communal day room/conservatory, an integrated dining area and kitchenette. A small quiet room is also available. All bedrooms have a television, telephone and staff call point. Each house is surrounded by a small garden. There is also a main building containing offices, the kitchen and laundry. Priory Mews is located near to the town centre of Dartford, close to the Bluewater shopping complex, and can be easily reached by public transport. Dartford is connected to main line train and motorway networks. The home has ample car parking facilities. Activities include arts and crafts, quizzes, bingo, reminiscence, interhouse tea parties and music. Current fee charges range from £454 to £840 per week. Additional charges are payable for chiropody, hairdressing, newspapers and external trips. A copy of the latest inspection report is kept in the main reception of the administration building. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key unannounced visit to the home for the inspection period 2007/08. Link inspector Elizabeth Baker and Regulatory Inspector Mary Cochrane RMN/RGN carried out the visit. The visit was carried out over two days on the 16 and 17 April 2007 and took over 17 hours in total. As well as touring each house, the laundry and main kitchen, the visit consisted of talking with some residents and staff and inspecting some records for case tracking purposes. A number of residents, visitors and members of staff were interviewed. Other residents and staff were spoken with. Feedback of the visit was provided to the Senior Sisters and Care Manager of each house. Feedback was also provided to the Home Manager and Operations Manager at the conclusion of the 17 April 2007 visit. The visit was also used to assess the Provider’s progress to the Improvement Plan issued by the Commission following the visit to the home on the 24 and 25 October 2006. At the time of compiling this report, in support of the visit, the Commission received survey forms about the service from 19 residents, 12 relatives/visitors/advocates, five care managers and 10 Healthcare Professionals. At the Commission’s request the home manager completed and returned a pre-inspection questionnaire. Some of the information gathered from these sources has been incorporated into the report. The report is a composite of the findings from visits to all five houses. At the time of the visit, 136 residents were residing at the home. Since the last visit, the Commission has not received any complaints about the service. What the service does well: The activities team are very motivated and keen to develop the service they offer to residents. Relatives are welcome at the home at any time and are involved in the care of their relatives. It is the view of Healthcare Professionals that specialist advice sought and provided is followed through appropriately for the benefit of residents. The design of the home promotes independence for all residents. Good interaction was seen between activities coordinators and residents. Views and opinions of respondents to comment cards and survey forms from residents, relatives, carers and advocates, contained additional complimentary comments such as “the service always calls promptly when there are concerns; “activity staff are very good”; “all the staff are very pleasant and helpful, always willing to listen”; “the staff are always very caring, friendly and helpful”; “the staff do an exceptionally good job”; “my Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 6 overall [professional] observations are that clients are well cared for”; “[staff] communicate well inter-agency disciplines”; “the laundry service is to a good standard”; “the managers on the houses are very open and friendly and any concerns can be discussed with ease”; “the care staff are always happy to receive any training if needed”; “I have never found my [relative] to be less than perfectly clean and comfortable”; “the house treats residents individually so that each resident spends their time how they want to”; “the food is presented well”; “best care home my [relative] has been in and I feel so relaxed when I am at home knowing they get the best of care”. What has improved since the last inspection? The manager’s commitment, with support from the provider, to improve the home was noticeable. Indeed the majority of requirements and recommendations made at the last key unannounced visit on 24/25 October 2006 have been or are almost met. The requirements formed the basis of the Improvement Plan and included three long outstanding requirements. Residents whether new to the home or transferring from one house to another are properly assessed to ensure they are suitable for the care provided on the individual houses. The new assessment tool is being used to develop care plans so better care can be given to residents. The new care documents encourage more information to be sought and recorded on all aspect of care and support, including residents’ spiritual and cultural wishes and preferences in respect of death and dying. A new contract has been arranged between the home and waste management contractors allowing waste medicines to be disposed of in accordance with current legislation. A new system of recording, handling and analysing all types of complaints has been introduced. This enables the home manager and provider to monitor trends and take appropriate action where there is an identified need. Staff have a better understanding of what constitutes abuse and the action to be taken if this is suspected. The provider continues to demonstrate commitment to staff training. Although there has been a drop in the percentage of unregistered care staff now trained in NVQ level II care or above, the current level still exceeds the National Minimum Standards recommendations. More equipment is available for staff working on all houses to safely handle residents. All work identified by a Fire Safety Officer as requiring to be done at the home has now been carried out. Bathrooms are no longer cluttered with in appropriate items, which enables residents to freely and safely access toilet and bath facilities. The flooring in some bedrooms on a particular house has been replaced, making the rooms fresher and more hygienic for residents. However the cleaning agent in use on one of the visit days provided a slippery surface. The redecoration and replacement of armchairs and carpets to two of the houses will improve the environment for the residents. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 7 The home’s internal quality assurance systems are much improved due to more frequent monitoring and increased meetings between the home manager and senior staff. The process of running and managing the home has changed for the benefit of residents and staff. What they could do better: There has been an improvement in the maintenance of care records. However the documents are still new to staff and many records still do not yet give clear instructions on how staff are to provide assessed needs. Care staff should endeavour to continue to improve their record keeping skills further to ensure all details of care assessed and that delivered are actually recorded. Many of the care plans identify needs but do not give clear instructions on how staff are then to meet the assessed need. Registered Nurses must ensure they maintain residents’ medicine records as per the requirements of their professional body. Where a decision taken for safety reasons has infringed residents’ liberty, recorded evidence must be available to justify the decision. Although recruitment procedures are being followed, more scrutiny of forms and information provided by applicants would enhance the process further. Residents would benefit from a better system of being informed of their meal and menu choices. The home’s system of managing the supply of pressure relief and preventative equipment needs to be reviewed to ensure sufficient equipment is available to residents where there is an assessed need. All staff working on the dementia units need to undertake specialist training. The home must continue its attempts to recruit and retain more Registered Mental Nurses. The individual interests, expectations of the residents need to be considered more. Although likes, dislikes and preferences are contained in some records, there is little recorded evidence to show that they are acted on. Some care staff are task orientated and not using a person centred approach when caring for the residents. Activities/leisure pursuits need to be further developed and tailored to meet the individual needs of all residents. Cleaning of bedrooms needs to be monitored to ensure they are kept in a clean state. Garden maintenance hours need to be reviewed to ensure the grounds are kept looking nice. Views on how the service could improve received from respondents to survey forms and comment cards included “I feel there is scope for more activities”; “we have experienced several incidences of property disappearing from our relative’s room”; “not all staff say something to residents about what they are about to do to them”; “sometimes more staff are needed as those on duty are run off their feet”; “residents to have more baths (not just once a week)”; “I believe my [relative] gets bored easily and it would be good if they could get some more stimulation”; “more menu choice”; “my [relative] has a desire to have more than one shower a week”; “sometimes the house is understaffed Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 8 and I have to wait for someone to come”; “staff cannot always come when they are needed – they have too much to do”. 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 Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 9 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 Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 10 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): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be sure that the home will undertake a full assessment of need prior to a decision of admission being taken. EVIDENCE: Where practically possible prospective residents are assessed in their current environment by a suitably qualified member of staff prior to a decision of admission being made. Residents transferring from one house to another are also now assessed to ensure their new identified needs can be properly met. The information gathered is then transferred to the new Individual Assessment, which document informs the resultant care plan. Where a council or primary care trust sponsors a resident, information is also obtained from these sources. The home no longer admits residents requiring intermediate care. Standard 6 is not applicable. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new care planning system has improved the maintenance of care records. The new system of disposing of waste medicine ensures they are safely and legally disposed of. The involvement of other health care professionals when required ensures residents receive maximum support with their individual care needs. EVIDENCE: Since the last visit new care documents have been introduced. Care records inspected for this visit contained care plans and supporting clinical and health and safety risk assessments, including tissue viability, nutrition, pain, moving and handling and consent forms. Daily records are maintained and these varied in content from house to house. Although some daily records provided a good picture of a resident’s quality of day and health condition, others contained brief statements and focused mainly on health conditions. A particular resident had been assessed as requiring one to one care. Despite staff saying this was being provided, neither the care plan nor daily record evidenced this. Where challenging behaviour had been identified in care plans Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 12 there was no information to guide staff on how to manage the situation. Good social detail was seen in some records. However where there had been input from the activity co-ordinator on a one to one basis, the information had not always been recorded. Where it had been recorded it did not always describe the actual input provided. Indeed a survey respondent made the point that they would like to know what activities the relative attends. Some of the care records inspected evidenced they had been composed with input from the resident and or their advocate. However the document used for this purpose had been used for other purposes in some of the other records inspected. Residents receive treatment and support from other clinicians where there is a need, such as GPs, dietitians, tissue viability nurse, Community Psychiatric Nurses and Psycho-geriatrician. Nutritional screening takes place where there is an assessed need and supplements and extra snacks are given if necessary. However where a particular resident was assessed as being at high risk, accurate records were not kept of the actual diet intake. As is expected of homes providing nursing care, the home has a range of pressure relieving and preventative equipment. Indeed a range was seen in use. However it was also identified that there had been a recent incident, which although there was an assessed need, the appropriate equipment was unavailable in-house or through the primary care trust. To maximise the resident’s comfort and safety, the resident’s family took the responsibility of financing the hiring of the equipment. Having sufficient equipment easily identifiable on site is important, as primary care trusts no longer automatically provide specialist equipment for residents requiring it. A number of medication administration record charts were inspected. Again the maintenance varied from one house to another. A number of charts had unexplained gaps. Frequency and or doses had been changed but there was no information as to who authorised or made the change. Codes for variable dose and administer when required medications (PRN) were not consistently followed. Where variable dose medicines are administered not all care records contained specific prescriber’s instructions as to when this should be administered. A GP has authorised the home to administer homely remedies when required. However there was no evidence the list had been reviewed since May 2004. Details of medications are also described in residents’ care records. However some practitioners are recording the frequencies in Latin terms, which is contrary to current guidance issued by their professional body. Medications, nursing aids and sundries are kept in designated rooms for safety purposes. Temperatures of the rooms and drug fridges are taken daily to ensure medicines are maintained in accordance with manufacturers instructions. New contracts for disposing of medicines no longer required are now in place. However it was identified on one house that controlled drugs no longer required for a particular resident have not yet been disposed of. They had been dispensed in November 2006. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 13 Treatments to residents are carried out in the privacy of their own bedrooms. Residents spoken with indicated that they are treated with respect when care staff assist them with personal hygiene needs. In two of the houses it was noted that some bathrooms and bedrooms had been locked to prevent residents wandering into other bedrooms and protecting them from risks associated with bathrooms. However there were no assessments as to how the risks and infringements had been determined. More details in respect of residents’ individual spiritual and cultural wishes and preferences in respect of death and dying were seen in the new care records. However during an interview the importance of a resident’s spiritual needs were emphasised. However the information was not wholly reflective in the respective care records. Some residents and or their advocates do not wish to discuss this sensitive subject. However this decision had not been recorded on the care records. To assist the home in providing appropriate care in the residents’ last stages of life, support is available from Ellenor Foundation palliative care nurses. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all residents who use the service are sufficiently encouraged, assisted and supported to make choices about their lifestyle. Recreational and occupational activities do not always meet individual expectations. EVIDENCE: The home employs four activities organisers who provide occupation and stimulation to residents across all five houses. The range of activities include arts and crafts, quizzes, bingo, reminiscence, inter-house tea parties and music. Transport is hired to take some residents on external trips. At the time of the visit lounges were decorated in preparation of St George’s day. Indeed a number of themed activities had been planned to celebrate this day. Four of the units have a daily activities person. However the provision for the other house is currently fragmented. A number of comment card responses were complimentary of the range of activities including comments about the “lovely parties” and “sing-a-longs”. However other residents and visitors felt the range and frequency could be improved. Indeed visitors spoken with on one house said there was little going on at the moment and there was no recorded evidence of meaningful activities taking place. One resident said Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 15 they felt bored and would like more to do. And a relative on another house said they would like the relative to go out more to garden centres or just for a walk. Religious services are arranged on site for residents to attend if they wish to. Visitors were seen coming and going throughout the visits. Each house has a small quiet room in which residents can meet and talk with their visitors in private, as opposed to using their bedroom. While some residents have baths and showers as often as they wish to, others do not. Indeed a comment card respondent added the additional comment that their “relative has a desire to have more than one shower a week but this is not offered”. Rooms inspected had been individualised with personal effects. In some units pictures and memorabilia have been fixed on areas outside bedrooms to assist residents in finding their own room. Some bedrooms have patio or bay windows, giving residents good views into the garden. However gardens were in need of attention because the grass needed cutting and borders where overgrown. One resident was seen enjoying watching a tennis match on her satellite TV. However details of this property were not included in her respective care records. Each house has a separate dining area in which residents can use to eat their meals if that is their choice. Other residents choose to have their meals in the privacy of their own bedrooms. Menus are included in the information files provided in each bedroom. Some houses had the menus displayed. However it was evident from the visit that the current arrangement does not provide all residents with the information they need to make informed choices. Most residents spoken with did not know or could not remember what the day’s meal was. Not all staff knew either. There was some confusion as the availability of soup at lunchtime. While the menu does not state this and a particular resident is of the opinion that the provision has been withdrawn, the Chef indicated that soup is available at lunch and supper times. Survey responses from residents about their meals were mixed and included comments such as “more menu choice” and “I do not think chicken nuggets are particularly suitable for older people as they can be very chewy”. As stated previously, one particular resident had experienced a significant weight loss. The GP was aware and a nutritional assessment had been undertaken. The information had been transferred to the care plan. However there were no actual records of the meals the resident had been given, whether or not the meals had been eaten and whether supplements had been offered. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 16 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and advocates now know that their complaints and niggles will be listened to and acted upon. Arrangements for protecting residents have been improved thereby minimising potential risks of harm. EVIDENCE: The home has a complaints procedure, a copy of which is displayed on each house. The maintenance of complaints has improved. The new system should ensure the home manager is made aware of all types of complaints, including niggles, which each house may receive. Residents and visitors spoken with indicated what they would do if they had a concern. Indeed one relative said they had made a complaint quite recently and the matter was dealt with immediately. Since the last visit 41 members of staff have received POVA training. Future training is planned for other staff requiring this. New procedures have been introduced to inform staff of the action they must take if they suspect abuse has occurred. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 17 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): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the residents who use the service are benefiting from the current redecoration and replacement programme made by the provider on two particular houses. The proposed extension to the other three houses will provide improved facilities for the residents living in these houses. More attention to the home’s grounds would improve residents’ enjoyment of outside areas. EVIDENCE: As stated previously the grounds were in an unkempt condition. Indeed a survey respondent commented that the state of the grounds gives a bad impression to visitors. The local council carried out a food hygiene inspection at the home on 26 October 2006. A number of requirements and recommendations were made. These matters have been complied with. The home is now working through a refurbishment and replacement programme. So far the lounges on two houses have been redecorated, and the corridors on Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 18 one house re-decorated. Corridor carpets in one house are about to be replaced and a number of bedrooms in another house have had the flooring replaced. The surface of the flooring was very slippery on the day of the first visit and presented a hazard to residents and staff. However the surface was not slippery on the second day visit to the house. New armchairs and a number of adjustable height beds have been ordered. Redecoration and replacement of the other three houses has been postponed. This is because there are now proposals to extend these houses. The additional accommodation will include bedrooms with ensuite facilities and day rooms. Following a fire safety audit carried out by Kent Fire and Rescue Service last year, all requirements and recommendations have now been completed. Although bedrooms do not have en suite facilities, each house has an adequate number of bath/shower rooms and WCs for the current registered bed numbers. The practice of using some of the rooms to store excess nursing aids and equipment has ceased, freeing up the rooms for the purpose intended. The design of the home and grounds allow residents to move freely around. Handrails are fitted in corridors and baths and toilets are appropriate for residents with impaired mobility. To ensure care staff safely assist residents with moving and handling, the home has a range of lifting/moving equipment. All rooms used by residents are connected to the nurse call system. Radiators are of the low surface type and hot water temperatures are controlled. This ensures that residents are protected from burns and scalds. Residents were complimentary of the home’s laundry system and indicated that the service has improved in that fewer items get lost. This is quite an achievement as the home launders on-site linen and personal clothes for upto 150 residents. Overall the home was found to be clean, tidy and odour free. However during a visit to one particular bedroom ‘red’ spillages were noted on a radiator and cantilever table. It was reported that the spillages had been there since the previous week. Indeed a relative on another house did say they thought standards of cleanliness were slipping. Comment card and survey respondents added additional comments about the home’s standard of cleaning including “the shelves in bedrooms are sometimes dusty and there are knobs missing from cupboards and drawers, which could easily be replaced”; “sometimes the house and toilets are not always clean and smelly too”; “cleaning not up to standard owing to lack of domestic staff, not enough time allowed to do each room thoroughly like dusting and window cleaning inside”. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All staff working at the home need to have skills, training and competencies to meet all the individual needs of the residents. Arrangements for staff induction are good with staff demonstrating a clear understanding of their roles. EVIDENCE: In addition to care staff, staff are employed for activities, cooking, housekeeping, maintenance and administration. Staffing levels generally exceed the minimum levels set by the original regulatory authority in 1993. Care records contained dependency assessments, which are used to ensure staffing levels reflect the assessed needs of the current residents. Despite this, staff are not always available when residents require support. Comment card and survey respondents commented “due to lack of staff they often have to wait to be toileted”; “carers should be given more time to talk with residents who are confined to bed – they are left out of things that go on in the lounge” and “staff cannot always come when they are needed – they have too much to do”. Generally, staff morale appeared good. However following some recent changes in working practices and cover for housekeeping responsibilities, some staff are anxious that they are not now afforded the time to carry out their Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 20 duties as thoroughly as they would like. Indeed one housekeeper was seen juggling between sweeping bedroom floors, hoovering corridors and washing a bathroom floor. This resulted in debris being left in the corridor giving the impression the carpets had not been swept for some considerable time. The member of staff was working extremely hard. As stated previously a red spillage seen on a radiator in a particular bedroom was reported to have been there since the previous week. The manager intends to meet with housekeeping staff to discuss the new practices and rationale behind the changes. The pre inspection questionnaire indicates that 59 of unqualified care staff are now trained to NVQ level II or above in care. New care staff are required to undertake an in-depth induction, which follows the General Social Skills Council training programme. A newly appointed member of staff spoke enthusiastically about commencing on her NVQ training, as she would like to eventually undertake nurse training. Information provided at the inspection indicates that since the last visit, staff have received training in subjects including dementia care, PEG feeding, moving and handling, fire, syringe drivers, bedrail safety, food hygiene and POVA. However, not all staff are up to date with their mandatory training but short falls have been identified and training planned. Despite efforts to recruit more Registered Mental Nurses, the home only employs one registered nurse with this qualification on a permanent basis. The two dementia care nursing units would benefit from more Registered Mental Nurse input. The operations manager said the posts would again be advertised. To compensate for the short fall, two registered general nurses have completed a six-month Dementia Training Level III course and another four are currently undertaking the course. Systems are in place for recruitment and appointment of staff. The procedures require new staff to be appropriately vetted before they actually commence work at the home. However more scrutiny of the information provided by applicants so that any unexplained gaps in employment histories are identified and explored would enhance the system further. And although the requisite two references are obtained, the most appropriate choice of referee where the applicant provides this is not always sought. This may result in some pertinent information being missed. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 21 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): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management of the home has improved for the benefit of residents and staff. EVIDENCE: The home manager is a registered general nurse, has over 22 years experience of working in nursing home management and has achieved the Registered Managers Award. The process of running and managing the home has improved. The home manager facilitates more meetings between herself and heads of unit and other senior staff. Wednesday afternoon “surgeries” have been introduced. This allows easy access to the home manager by any member of staff. Staff reported that there have been improvements with the relationship with the Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 22 manager and she does visit each house more often. The deputy manager now visits daily. Staff said communication has improved but it could still be better. Formal supervision of staff is now rolling out and records are maintained of points discussed. The provider has recently re-issued and provided the home with new policies and procedures. Each house has been provided with a copy. The home facilitates residents and relatives meetings. Issues discussed are recorded and minutes circulated. Sadly, the minutes in one house recorded that many of the people who attended were disappointed that the registered manager did not attend as they had been expecting her to. Relatives meetings tend to be held in the evening, which from conversations with some visitors at the time of the visit, are not convenient to them. Whilst acknowledging that the home has held meetings at other times in the past, which were not well attended at that time, seeking the views of the current relatives may assist the home in reaching a compromise. The home’s inspection report is kept in the main reception for public information. Availability of the document is displayed on each house. The provider’s representative visits the home regularly as part of the quality assurance programme. External resident and relative customer satisfaction surveys were carried out on behalf of BUPA in November 2006. The findings are available on request at the home. The home manages personal monies on behalf of residents if there is a need. Computer records are maintained. An appropriate interest bearing bank account has been opened specifically for this purpose. Safeguards are in place in respect of access to these funds. The provider ensures that the records are appropriately audited. Since the last visit information packs kept in each bedroom now include information of access restrictions covering out of hours and bank holiday periods. Where the home purchases or provides items or services on residents’ behalf, receipts are obtained. Records relating to residents and staff are maintained with due regard to confidentiality. However as indicated throughout the report, not all records provided a clear picture of care, support and preferences. The maintenance of accident books has improved and staff are now expected to provide the manager with weekly returns so that trends can be monitored and action taken where there is an identified need. Fire drill books were inspected. Generally these were completed as required in that remedial action was stated when shortfalls were identified. The pre inspection questionnaire form indicates that the home’s equipment is maintained and serviced. Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 23 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 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 X 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation Requirement Timescale for action 30/09/07 2 OP7 3 OP8 4 OP9 5 OP26 15(1) and Care plans must contain all the (2)(a) and information required for care (b) staff to provide appropriate care and support to residents, including details of the prescriber’s instructions for PRN medication. 13(4)c Care records must contain risk assessments for any action taken for residents’ safety but which infringes on their liberty. 16(1)(2)c Appropriate pressure relief/preventative equipment must be readily available on site to meet the assessed needs of residents. 13(2) Medication administration record charts must provide clear evidence of actual medicines administered; details of who has made changes to the prescriber’s instructions and maintained in accordance with the Nursing and Midwifery Council guidance for record keeping. 13(3) Daily cleaning of bedrooms must ensure that dirty surfaces and areas are identified and appropriately cleaned. DS0000026199.V327103.R01.S.doc 31/07/07 30/06/07 31/05/07 31/05/07 Priory Mews Nursing Home Version 5.2 Page 25 6 OP27 18(1)(a) and18(3 7 OP29 19(1) Sch 2(3) The provider must continue to strive to employ more suitably qualified registered mental nurses to work on those houses that provide dementia nursing care. Not completely met. Information provided by applicants should be scrutinised so unexplained gaps are identified and investigated; References should be taken from the most appropriate referees. Not completely met. 30/09/07 31/05/07 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 3 3 Refer to Standard OP8 OP10 OP11 Good Practice Recommendations Daily records should provide meaningful evidence of the actual support and care provided. All residents should be offered more than one bath or shower per week. Care records should evidence that residents/advocates have been invited, but have declined, to contribute to spiritual and cultural wishes and preferences in respect of death and dying. All residents should be provided with meaningful support, stimulation and occupation as per their preferred choice. All residents should be provided with appropriate information about meals and choices. Records should be maintained of actual meals given, the amount eaten, and whether supplements have been offered, where there is an assessed need. External grounds should be kept in a good state for residents’ enjoyment. Care records should be complete of necessary details for staff to provide appropriate care and support. 4 5 6 7 8 OP12 OP15 OP15 OP8 OP19 OP37 Priory Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Mews Nursing Home DS0000026199.V327103.R01.S.doc Version 5.2 Page 27 - 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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