Inspection on 24/10/06 for Priory Mews Nursing Home

This inspection was carried out on 24th October 2006.

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 16/04/07

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 24th October 2006 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.V311426.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.V311426.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 www.bupa.com BUPA Care Homes (CFHCare) Limited 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.V311426.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 bed space must not exceed 150 Date of last inspection 7th February 2006 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. Current fee charges range from £444 to £800 per week. Additional charges are payable for chiropody, hairdressing and newspapers. A copy of the latest inspection report is kept in the main reception of the administration building. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. All five houses were individually visited and inspected. However because Priory Mews is registered as one establishment, it is not possible to produce five individual reports. This report is a composite of the findings from all five houses. This is the first unannounced key visit to the home for the inspection period 2006/07. The visit was carried out over two days and lasted 17 hours. The visit on 24 October 2006 was carried out by Lead Inspector Elizabeth Baker and Regulatory Inspectors Mary Cochrane (Registered Mental Nurse/Registered General Nurse) and Mark Hemmings. Elizabeth Baker and Mary Cochrane carried out the visit on 25 October 2006. As well as touring each house, the visit consisted of talking with some residents and staff and inspecting some records for case tracking purposes. 22 residents, six visitors and eight members of staff were interviewed in private. A number of other residents, staff and healthcare professionals were also spoken with. Feedback of the visit was provided to the Senior Sisters and Care Manager of each house, as well as the Home Manager. At the time of compiling this report, in support of the visit, the Commission received comment cards about the service from five residents, 18 relatives/visitors, two GPs and one care manager. 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. At the time of the visit, 142 residents were residing at the home. The visit resulted in an immediate requirement notice being issued. A letter was subsequently sent to the home’s Operational Manager requiring urgent action to address the immediate requirement. Although the Commission has not received any direct complaints about the home, the Commission has been made aware of two formal complaints. What the service does well: Residents were complimentary of the home’s laundry service with one resident actually calling it an excellent service. The organisation actively encourages unregistered care staff to attain NVQ level ll or above in care. Indeed at the time of the visit 70 were so qualified. A healthcare assistant spoke enthusiastically about her role and her desire to commence on further healthcare qualifications. The rights and responsibilities of staying at Priory Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 6 Mews are now available to all residents. Previously it was only privately funded residents who had this information. The design of the home allows residents some independence in getting around the site. Those residents who frequently like to have their hair done appreciate the convenience of the onsite hairdressing saloon. Staff ensure residents’ dignity and privacy is maintained when assisting them with their personal care needs. The home’s routines are flexible enabling residents to choose when to go to bed or to get up. Residents are surveyed by the Provider to obtain their views and experiences of living at the home. Religious services are conducted at the home and residents are invited to attend if they want to. Comment cards received by the Commission from visitors/advocates included additional comments including “Very happy with service at home” and “All of the staff are very friendly and put my mind at rest with [my relative]. They are very helpful. Well done to them.” What has improved since the last inspection? What they could do better: It was a concern that the four survey forms sent to the residents on one house for residents with dementia, were initially returned to the Commission with the comment “the resident has dementia and is unable to answer”. All residents must be given the opportunity to express their views and opinions on the home’s services and facilities. Comment card responses from some relatives/visitors in support of the visit contained a number of negative views including “sometimes communication between some staff and relatives can be difficult to understand”, “sometimes seem short of staff” and “although it is said there is sufficient staff, I think this is only on paper, when in practice the amount of staff are under a lot of pressure dealing with all aspects of running the home and dealing with residents”. From the visit it was clear that the manager of the home was not always aware of events that were happening throughout the site. For example complaints, fire checks and adult protection. The manager did report that she did have difficulty in keeping abreast of events that are happening. Some senior staff reported that the manager was not a frequent visitor to all the houses. Some staff reported that they felt excluded and not involved in making decisions about the way the home was run. They felt on occasions undermined by the management team. However one staff member mentioned this is better now. The senior staff were undertaking management tasks within their own houses. Despite the organisation having systems in place to seek the views and opinions of residents, effective in-house quality assurance monitoring systems are not in place to provide a complete picture of the home’s practices and Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 7 performance. The situation does not promote a safe and happy environment for all residents and staff. Some longstanding requirements still need to be adhered to. These include a lack of storage facilities in a number of houses and an underlying odour problem on one particular house, which despite the best efforts of staff has still not been eradicated. The home has a range of care records for staff to record details of the care required and that to be delivered. Sadly these are not always maintained to a level to provide carers with all the detail required to ensure they provide appropriate care as per the residents’ assessed current needs, wishes and preferences. 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 Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 8 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.V311426.R01.S.doc Version 5.2 Page 9 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, 2, 3, 4, 5 and 6 Quality of this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. All residents are now informed of the rights and responsibilities for staying at the home. Not all prospective residents are appropriately assessed by suitably qualified and experienced staff prior to admission into the home. Residents transferred from one house to another do not undergo a proper reassessment. Both situations place residents potentially at risk. EVIDENCE: All residents are now provided with either a contract or terms and conditions of stay ensuring equality between sponsored and privately funded residents. The home has also produced a Statement of Purpose, Service User Guide and Welcome to Priory Mews documents. Included in the Welcome Pack is information on hospital admissions and transport arrangements for outpatient’s appointments. Despite this a comment card subsequently received by the Commission from a relative/advocate indicated in their experience there are no staff ever available to go with their relative to hospital visits. As the resident is unable to communicate the hospital will not allow examinations to be carried out. The resident has dementia. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 10 Prospective residents are usually assessed in their current environment as to their suitability of residing at Priory Mews. The deputy manager, senior sister or care manager would normally do this. However a GP recently complained direct to the home about a new resident being inappropriately admitted into one of the houses due to the complexities of their mental health. The resident was admitted to the home after being assessed in their current environment by a Registered General Nurse. The resident had mental health needs, as well as nursing needs. External specialist advice was subsequently sought and arrangements have been made to transfer the resident to an alternative home. A practitioner who is both suitable qualified and experienced, such as a Registered Mental Nurse undertaking pre admission assessments of residents with mental health needs may prevent future inappropriate admissions. Indeed being assessed by a Registered Mental Nurse may also have prevented the resident enduring the further trauma of having to be moved to another home. It was established on this visit that it has not been the home’s practice to reassess residents transferring from one house to another, when their condition changes. This situation may result in inadequate or incorrect care being provided due to pertinent information not being identified. Residents are no longer admitted into the home for intermediate care. Standard 6 is not applicable. Priory Mews Nursing Home DS0000026199.V311426.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality of this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. Not all residents can be sure their complete care needs, preferences and wishes will be met. EVIDENCE: Maintenance of care records varied from one house to another. Whilst some care records contained good information, others were deficient of important information. For example problems such as breathing, communication, body temperature, nutrition and pain had not always generated a care plan component. Where a plan had been generated it did not always contain specific intervention details. One resident had been identified as nutritionally at risk. However there was no accompanying chart to monitor what the resident was actually eating or indeed the amount and frequency of food supplements. A range of clinical risk assessments was seen in the care records inspected, including skin integrity (Waterlow model). However these had not always been completed in full. It was difficult to establish what actual pressure relief/preventative equipment had been provided when there was an assessed need. Neither the assessment nor the corresponding care plan contained this information. During an interview with a resident they described the discomfort they are currently experiencing when sitting down. This information was not Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 12 reflected in the resident’s care records. Some admission assessments contained information on residents’ likes and dislikes. Sadly this information had not always been accurately transferred to the residents’ care plans and in one case it was actually contradictory. Records contained falls risk assessments. However these were not always completed as required. During a conversation with a particular resident it was identified that the resident’s tastes with regard to food had changed. The information in the care records had not. The information was obtained in 2004. Although there was evidence in some houses of person centred planning, not all care plans evidenced they had been composed with input from the resident and or their advocate. Involving residents would ensure care staff have gathered all the necessary information accurately. Each house has a clinical room in which medications, nursing equipment and sundries are safely and hygienically kept. Room and drug temperatures are monitored to ensure medications are stored in accordance with manufacturer’s instructions to maximise effective treatments. There was some confusion as to whether the arrangements for the safe disposal of waste medicines, complies with new legislation. Currently the home’s dispensing pharmacy collects the waste medications from each house and then arranges for them to be disposed of. After telephone intervention by one of the Commission’s Pharmacy Inspectors the home manager has agreed to clarify the legality of the arrangements. To assist care homes providing nursing care in complying with new legislation the Commission published a document “Professional Advice: Safe Disposal of Waste Medicines from Care Homes (Nursing)” (19/09/05). This document is available on the Commission’s website www.csci.org.uk. Whilst inspecting the clinical rooms it was noted that two of the houses keep the waste medicines in a locked cupboard whilst waiting disposal. In the other houses they had been left in open containers on a worktop, thereby presenting a potential safety risk. A sample of medication administration record charts was inspected. Again the maintenance of these varied from house to house. On some houses charts had been completed appropriately. However other charts contained unexplained gaps. Where variable dose medications had been prescribed not all practitioners recorded the actual dose administered. Where pain relief is administered, pain assessments to monitor the effectiveness of the treatment plans were not seen. This was even the case where a resident’s care needs analysis assessment required a pain chart to be used. For a resident prescribed antipsychotic medication on a PRN (administer when required) basis, there was no corresponding care plan to inform staff when to administer this. On a visit to one house, some tablets had been “potted up” by a registered nurse for a particular resident. The tablets were then taken to the resident on a breakfast tray by a health care assistant. The registered nurse had already initialled the resident’s chart as having seen the resident take the medications. The resident may have decided to refuse the medications, thereby having incorrect details on the chart. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 13 It was again noted that care plans do not cover all the important aspects of residents’ wishes and preferences with regard to death and dying. In one case the resident’s admission details included the resident’s religion, but inferred it could not be practised because there was no appropriate clergy. However during the visit the resident was visited by a layperson from a church reflecting the resident’s religion. In another case it was identified that a resident requiring specific after death interventions because of their religious and cultural needs did not have this important information recorded in their care records. However in another house an end of life plan was in place. It is disappointing that the Provider published a policy and procedure “Meeting the Spiritual and Cultural Needs of Residents” (May 2000) informing residents that their plan of care should demonstrate an understanding of their religious spiritual, cultural and ethnic needs. Care files inspected contained details of visits from other healthcare professionals such as GPs, Tissue Viability Nurse and District Nurses. Medical examinations and treatments are carried out in residents’ own rooms to maximise their privacy. Some files contained details of residents preferred term of address, while others did not. In one house staff were heard addressing residents by names such as “darling, love and sweetheart”. Although some staff may consider these terms as friendly, some residents may consider them patronising. In the same house a resident was noted to be distressed during a hoist transfer. Sadly staff did not offer any reassurance to minimise the resident’s anxieties until such time as the transfer was complete. In the houses registered for dementia care, the majority of residents were calm and content with evidence of wellbeing in that they were smiling and looked relaxed. Residents said staff assist them in a manner, which protects their privacy and dignity when providing personal care. Care records on two houses contained references such as “offer residents at least one bath per week”, although it was said that a resident on one of the houses does usually have two a week. Sadly this is not offered to other residents on this house. A staff member said staffing levels would not allow this. Priory Mews Nursing Home DS0000026199.V311426.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality of this outcome area is good. The judgement has been made using available evidence including a visit to the service. Although the home offers a range of activities and a variety of meals, this does not guarantee that all residents are able to enjoy activities, occupation or meals as per their individual choice. EVIDENCE: Weekly activity programmes were seen displayed on all houses. However the provision of activities on each house is currently provided on an adhoc basis. The home currently employs three activities co-ordinators. The home manager reported that two more activities co-ordinators have just been appointed. A full complement of staff would ensure residents on all houses receive equitable levels of social care and occupation. Residents are able to choose whether to participate in group activities or receive one to one input. However not all care records contain details of the actual content of the one to one sessions. It was of a concern that the care records for a particular resident who is currently experiencing communication difficulties included the comment that they had asked for more one to one time. The entry recorded this was not possible. The senior nurse was not aware of the request or comment. Good social life history details were seen in the care files inspected and generally reflected the information gathered during interviews with residents. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 15 Residents are able to choose when to go to bed and when to get up. Visitors are made welcome and offered refreshments. During the visit a religious service was taking place on a particular house. Residents from other houses were invited to attend if they so wished. A layperson was visiting a resident to provide spiritual support. Visitors were seen coming and going throughout both visit days. Rooms visited had been personalised to make them more homely. Each house has a small quiet room in which residents can use to meet their visitors for private conversation, or indeed some private time for themselves in a room other than a bedroom. Houses had been decorated in preparation of Halloween. The visit to some houses coincided with lunches being served. Tables had been nicely laid in preparation. Care staff were seen assisting residents with their meals in an unhurried manner. Although the lunch was not sampled, an appetising smell was apparent around the houses. Residents expressed mixed views about the quality and variety of meals. Whilst some residents said “quite good food really”, “nice meals”, “very good breakfasts”, “pretty good meals”, “very nice food” and “marvellous food” others considered the meals not so good. Adverse comments included “food could be hotter”, “cold food on cold days”, “food not very varied”, “food not tasty enough”, “only one curry since I have been here”, “prefer hot milk on cereals but sometimes given cold milk” and “sometimes soup is not very hot”. Menus were seen on display boards in the dining areas. However they could be difficult to view for wheelchair users because of the height. Indeed a resident made this point also. The Commission’s InFocus document “Highlight of the day? Improving meals for older people in care homes” (March 2006) may assist the home in developing its menus further. This document can be obtained from the Commission’s website www.csci.org.uk. Priory Mews Nursing Home DS0000026199.V311426.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality of this outcome area is poor. The judgement has been made using available evidence including a visit to the service. Not all complainants can be assured their complaints are listened to and acted upon. Not all staff are aware of the County’s adult protection procedures, potentially placing residents at risk. EVIDENCE: A copy of the provider’s complaints procedure was seen displayed on each house. The returned pre inspection questionnaire records the home has received seven complaints in the last twelve months. However the number of complaints/adverse comments seen in the complaints/comment books on the four houses which had them, far exceeded that number. Indeed in one book a serious allegation of abuse towards a resident by a carer was recorded. The home manager was unaware of this. The incident occurred in August 2006. The matter had not been reported in accordance with the County’s Adult Protection procedures. The situation resulted in an immediate requirement notice being issued with a request that the matter be urgently reported to the AP Co-ordinator. The matter had not been reported to the Commission as required. Staff spoken with in another house demonstrated an understanding of the need to investigate complaints. Priory Mews Nursing Home DS0000026199.V311426.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality of this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. Each house would benefit from more investment, making Priory Mews a more comfortable place for residents to live in. EVIDENCE: The kitchenettes visited on each house were tidy and clean. The Commission is aware that Dartford Borough Council carried out an environmental health inspection on the 26 October 2006. The home manager is now required to provide the Commission with a copy of the findings of the visit when available. A Health Premises Technical Adviser of Kent Fire and Rescue Service carried out a fire safety audit of the home on 2 June 2006. This resulted in some work needing to be done to ensure compliance with the Fire Precautions (Workplace) Regulations 1997 (as amended). The home manager was initially unaware that this inspection had taken place. However after clarifying the matter with the onsite maintenance person, the home manager established that the resultant reports had been sent to the Provider’s Estate Property Department, Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 18 for their attention. The home is now required to inform the Commission as to the progress of the necessary work identified in the reports. Although fire safety logbooks on all houses were not inspected, there was some confusion as to the frequency of fire drills on one particular house in that the logbook stated the last one took place in October 2005. The care manager of this house seemed to recall a more recent event had taken place, but could not state where it was recorded. Clarification as to who is responsible for recording such details needs to be established. The home manager reported that the home has a five-year refurbishment plan for the home. The home was first registered in 1993 and was furnished and equipped to a good standard at that time. However apart from one house, which was refurbished to reflect a change in its registration in 2001 into a residential care unit, there has been minimal refurbishment. Although all houses were clean and tidy, carpets and flooring were marked and/or stained. Doors, doorframes and skirting boards were scored, chipped and scratched. This damage detracted from the general appearance and made the houses look institutional. Some armchairs and commode chairs looked worn out by the amount of cleaning they have had. Although all bedrooms are for single occupancy, there are no ensuite WC facilities. Each house has been provided with sufficient WCs and bathrooms/shower rooms. However it was again noted on some houses that a number of bathrooms are still being used to store nursing aids and sundry equipment, which hinders residents’ access to the toilets when needed. The home has been designed with wide corridors to enable residents to move independently around the houses. Corridors are fitted with handrails for added safety. Apart from one house, hoists are available to safely transfer residents when there is an assessed need. The exception is because of a decision made at some point that residents requiring hoist transfers could not be admitted into the house previously registered with the local authority to provide personal care. However there may be occasions when an ambulant resident requires hoist assistance not just for their safety, but also staff. Bedrails were seen in use in four of the five houses. Although there was an identified need for bedrails to be used in the other house, they had not been provided because of an instruction that bedrails could not be provided in a house providing personal care. Safety equipment, including bedrails, must be available to all residents where there is an identified need. To determine this, an assessment of all the risks must be carried out in collaboration with the resident, GP, local authority care manager, advocate and the home. The assessment should also contain contra indications to the decision. Some residents are provided with variable height beds. A visit to one house identified problems for the staff in ensuring a particular resident is kept safe and comfortable because of the resident’s current condition. It was said that a hospital type bed had been ordered. However there had been no specialist Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 19 input by an Occupational Therapist to establish whether the hospital type bed would actually be appropriate. Although the home has a range of pressure relief and preventative equipment, it is the opinion of a specialist nurse that the home does not have a sufficient supply to provide the equipment when required. Indeed the care plans of two particular residents indicated they should sit on pressure relieving cushions. Neither resident was sitting on such a cushion. Bedrooms are fitted with low surface temperature radiators. The temperature of the hot water available from resident’s wash hand basins in their bedrooms, as well as bathrooms, is appropriately controlled. This ensures residents are protected from burns and scalds. Apart from one house, bedrooms and lounges were tidy, clean and odour free. The malodour in the particular house has been a problem for some considerable time. The care manager indicated that the problem may be resolved if the bedroom carpet was changed to more suitable flooring. However the care manager said she had been prevented from changing it to a non-slip type. She could not recall who or why the comment had been made. The home has a well-equipped laundry. Residents spoke well of the laundry service and complimented staff on how efficient the service is. A comment card respondent indicated it would have been useful to be told not take in any woollen clothes as they always got mixed up in the laundry. Although some details of personal laundering limitations are included in the Welcome to Priory Mews document, more detail may prevent such situations arising again. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality of this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. Residents could be at risk because robust vetting for recruiting new staff is not always carried out. The arrangements for induction are in place with staff demonstrating a good understanding of their roles. EVIDENCE: As well as care staff, staff are employed for catering, cleaning, administration, reception, activities and maintenance. Staff rotas are maintained and demonstrate the home is staffed 24 hours a day. The staffing levels on each house generally follow the staffing levels required by the former regulatory authorities at the point of registration, namely 1993 and 2001. However it was identified on this visit that it is not the home’s practice to use dependency assessments to ensure the levels actually reflect the assessed needs of the current residents. Residents indicated that staff usually respond to the nurse call system quite quickly. However one resident mentioned there are occasions when they are told to “wait a minute”. Five of the 18 returned comment cards from relatives indicated in their opinion there are not always sufficient staff on duty. A healthcare professional respondent was of the same view. The pre inspection questionnaire form indicates that 70 of unregistered care staff are now trained to NVQ level II care. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 21 Four staff files were reviewed, two of which were inspected. The maintenance of the files was good and allowed for easy auditing. Systems are in place for recruiting and appointing staff. As part of the process two references were sought and two supplied. In one case the referee was a former colleague, albeit a senior carer/supervisor. However the referee was unable to provide answers as to the applicant’s suitability to eight of the 13 questions. The reference was therefore inadequate. In the other case there was no reference from the person’s current care home employer as stated on the application form. The Commission’ publication “Safe and sound? Checking the suitability of new care staff in regulated social care services” (June 1006) might be useful with regards to vetting of staff. The publication can be obtained from the Commission’s website www.csci.org.uk. A staff member interviewed described their induction programme, which is based on the Skills for Care training requirements. New staff commence at the home on a supernumerary basis as part of their initial induction. The training matrix provided with the pre inspection questionnaire records some staff having received training in subjects including fire, moving and handling and health and safety, since the last visit. However it was difficult to establish the currency of other training topics including infection control, dementia, food hygiene and adult abuse, as the details had been grouped together under one heading. The home is now registered to admit up to 90 Older People with dementia. 60 of these residents also have general nursing needs. The one qualified and experienced Registered Mental Nurse has tendered their resignation. The home manager reported that a newly qualified nurse with this registration is currently on the site to gain more experience. The home manager also said that the home is currently advertising for more Registered Mental Nurses. Other care staff are undertaking distance-learning courses for dementia care. However there is an expectation that the home employs sufficient numbers of suitably qualified and experienced staff to provide the specialist care required for residents with dementia. Indeed the home currently employs adequate numbers of Registered General Nurses to meet the general nursing needs of residents. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36, 37 and 38 Quality of this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. The home is not properly managed which could have a detrimental impact on residents’ care. EVIDENCE: Since the last visit a new home manager has been appointed. The manager is a Registered General Nurse, has over 21 years experience of working in nursing home management and achieved the Registered Managers Award in July 2004. Residents and staff spoke openly throughout the visits. Residents said they had recently been asked to complete BUPA survey forms seeking their opinions on the services provided by Priory Mews. When collated BUPA provides the home with the results of the survey, which the home manager would be expected to share with residents and other interested parties. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 23 Some staff said they receive supervision and appraisals from senior staff. However there was some confusion about the frequency of these meetings. The home manager said supervision for senior staff is about to start, as the sessions had not been taking place, as she would have liked. Staff said they attend staff meetings and find these sessions useful for voicing their views. Similar meetings are also arranged for residents and relatives. During the visits to a number of houses it was identified that information on residents’ falls, accidents, complaints and other incidents are recorded. However the home manager inferred that there is currently no strategy in place to audit, analyse and manage the findings from these sources. The home manager explained that she is unable to visit each house as regularly as she would like because of administrative duties. However the current practice of relying on staff to pass vital information to the home manager is not effective and indeed on this visit led to an immediate feedback notice being left at the home because of unreported serious allegation of abuse. The Commission had not been informed of this serious matter either, as is required by regulation. Disappointedly none of the senior nurses or the care manager has a management qualification. Whilst acknowledging that senior staff are not required to be individually registered with the Commission, having a number of senior staff with managerial qualifications may assist the home manager in ensuring the whole site is appropriately run. The returned pre inspection questionnaire indicates that the home has a range of policies and procedures, but some of these are out of date. Indeed in some cases there has been no recorded review since implementation dates of 1999, 2000, 2001, 2002, 2003, 2004 and 2005. This situation may prevent staff working in accordance with current good practice and indeed current legislation. The home is currently responsible for maintaining personal monies on behalf of 15 residents. Computer records are maintained of transactions made and receipts are obtained. Monies are held collectively in a separate residents’ interest bearing account. BUPA has devised a system which enables it to calculate and distribute interest accrued proportionately. The Commission has agreed this system. When additional funds are required the home writes to the advocates/appointees. BUPA finance staff, as part of the provider’s quality assurance programme, regularly audit these records. It was established on this visit that current accessibility arrangements could prevent residents accessing their monies, if required, out of normal working hours and weekends/bank holidays. Restricted access is not mentioned in the service user guide. Including this would enhance the current provision. As stated throughout the report, not all records relating to residents’ care and well-being are completed as is required. The daily progress notes on one Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 24 particular house were difficult to decipher because of the practitioner’s handwriting. Sensitive and personal details relating to individual residents are held collectively in complaints/comment books kept on each house. This practice compromises confidentiality. Some records contained property lists. Sadly the one inspected on a particular house was incomplete and inaccurate of the items seen in the bedroom at the time of the interview. Care records inspected included various risk assessments. Some of these were blank and in other cases incomplete. A particular resident no longer sleeps in their bed because staff considered the resident in danger of falling out. This decision had been taken without a proper assessment of the all the risks. The returned pre inspection questionnaire indicates that the home’s equipment is checked and or serviced as required. The form also states that 23 members of staff hold a current first aid certificate. Accident books are maintained on each house. However a review of the book on one particular house identified that an entry made in August 2006 had not been fully completed as required. There was no recorded evidence the entry had been reviewed or signed off by a manager. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 25 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 2 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 3 2 3 3 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 2 2 3 3 2 2 2 Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 26 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 OP11 Regulation 15 Requirement The service users’ care plans are recorded in greater detail and cover the holistic care provided including service users wishes and preferences regarding death and dying. Visits 25 May and 12 October 2004, 4 October 2005 and 7 February 2006. The registered person shall ensure that service users have access to all bathrooms. They must not be used for the storage of mobile hoists and other items preventing service users from accessing facilities. Visits 25 May and 12 October 2004, 4 October 2005 and 7 February 2006. Timescale for action 31/01/07 2 OP22 23 (2) (1) 31/01/07 3 OP26 16( 2) (K) 31/12/06 The registered person shall ensure that having regard to the size of the home and the number of service users keep the home free from offensive odours. Visits 25 May and 12 October 2004, 4 October 2005 and February 2006. Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 27 4 OP3 5 OP7 6 OP9 7 OP16 8 OP18 9 OP19 10 OP19 The registered person shall not provide accommodation to a resident at the care home unless, so far as it shall have been practicable to do so the needs of the resident have been assessed by a suitably qualified or suitably trained person. 15(1) and Unless it is impracticable to carry (2)(a) and out such consultation, the (b) registered person shall, after consultation with the resident, or a representative of his, prepare a written plan as to how the resident’s needs in respect of his health and welfare are to be met. The registered person shall make the resident’s plan available to the resident and keep the plan under review. 13(2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposable of medicines received into the care home. 22(3) The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. 13(6) The registered person shall make arrangements, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. 23(4) The registered person shall after consultation with the fire and rescue authority take adequate precautions against the risk of fire including the provision of suitable fire equipment 23(2)(d) The registered person shall having regard to the number and needs of the residents ensure that all parts of the care home are kept clean and reasonably decorated. DS0000026199.V311426.R01.S.doc 14(1)(a) 30/11/06 30/11/06 30/11/06 25/10/06 31/12/06 31/01/07 31/03/07 Priory Mews Nursing Home Version 5.2 Page 28 11 OP22 13(4)(c) The registered person shall ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. The registered person shall having regard to the size of the care home and the number and needs of residents provide in rooms occupied by residents adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of residents. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of residents ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents. Where the care home provides nursing to residents the registered person shall ensure that at all times a suitably qualified registered nurse is working at the care home. The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home. 30/11/06 12 OP22 16(2)c 30/11/06 13 OP27 18(1)(a) and 18(3) 31/01/07 14 OP29 19(1) Sch 2(3) 30/11/06 15 OP32 12(5) The registered provider and 30/11/06 registered manager shall in relation to the conduct of the care home maintain good personal and professional relationships with each other and with residents and staff Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 29 16 OP33 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. (This refers to the inhouse monitoring systems). 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 7 8 9 10 11 12 Refer to Standard OP2 OP3 OP8 OP8 OP9 OP9 OP9 OP10 OP10 OP12 OP15 OP15 OP27 Good Practice Recommendations The home’s information for prospective residents could be enhanced by more information in respect of escorting residents to hospital and other appointments Residents should be re assessed and the findings recorded when transferring from house to house. Skin integrity assessments should include details of any pressure relief and/or preventative equipment supplied. Charts to monitor nutritional intake should be used when there is an assessed need. Details of the prescriber’s instructions for medicines administered on a “when required” basis should be clearly stated in the resident’s care plan. Pain assessments should be used to monitor the effectiveness of treatment plans, where there is an identified need. Clarification of the disposal of waste medicines must be sought to ensure compliance with legislation. Residents should be addressed in a non-patronising manner. Residents should be offered more than one bath per week. All residents should be provided with meaningful support and occupation as per their choice. Details of residents likes and dislikes with regard to drinks and meals should be regularly reviewed, and the findings recorded. Menus should be easily accessible to all residents. Dependency assessments should be used to assist in determining staffing levels Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 30 13 14 15 OP35 OP36 OP37 Restrictive access by residents to their personal monies should be recorded. Prospective residents should be informed of such restrictions. All care staff should receive supervision at least six times a year. All records relating to residents should be accurate, complete and recorded with due regard to residents’ confidentiality. Fire safety logbooks should be kept up to date of fire drills. 16 OP38 Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Priory Mews Nursing Home DS0000026199.V311426.R01.S.doc Version 5.2 Page 32 - 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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