Inspection on 05/05/05 for Priory Park Nursing Home

This inspection was carried out on 5th May 2005.

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 Park Nursing Home 14/11/06

Priory Park Nursing Home 10/11/05

Priory Park Nursing Home 20/10/04

Priory Park Nursing Home 30/06/04

Priory Park Nursing Home 28/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Priory Park Nursing Home Priory Crescent Penwortham Preston, Lancashire PR1 0AL Lead Inspector Vivienne Morris Unannounced 5 May 2005 09:30 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 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 Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Priory Park Nursing Home Address Priory Crescent Penwortham Preston Lancashire PR1 0AL 01772 742248 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Highfield Care Homes Limited Care Home 45 Category(ies) of DE(E) Dementia - over 65 (30), MD Mental registration, with number Disorder (1), OP Old Age (34) of places Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) Within the overall total of 45 a maximum of 34 service users requiring either nursing or personal care who fall into the category of OP - Old age, not falling within any other category. 2) Within the overall total of 45 a maximum of 30 service users requiring either nursing or personal care who fall into the category of DE(E) - Dementia aged over 65 years. 3) Within the overall total of 45 a maximum of one service user requiring either nursing or personal care who fall in the category MD - Mental Disorder, ecluding learning disability or dementia. 4) Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 5) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registerd with the Commission for Social Care Inspection. Date of last inspection 20/10/2004 Brief Description of the Service: Priory Park is a three story, purpose built home, which is registered to care for service users with a variety of needs. The home is located in a quiet residential area of Penwortham, close to local shops, Churches and public transport and is a short car journey into the centre of Preston. Although some shared rooms are available at Priory Park, these are used for single occupancy. Although en-suite facilities are not provided at Priory Park, toilets and bathrooms are located at convenient intervals throughout the building. All areas of the home are easily accessible to service users by the use of a passenger lift and ramps to the outside of the building. A variety of communal areas are available at the home and separate dining areas are provided. Service users cared for on the Dementia Care unit, have safe, easy access around the unit and into the garden area. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over two days during May 2005. The inspection process focused on the outcomes for people living at the home. During the course of the inspection service users, relatives and staff were spoken to, relevant records and documentation were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas and service areas were seen. The Commission for Social Care Inspection had received one complaint since the previous inspection, which was referred back to the provider for investigation. The concerns raised in the complaint were in relation to the cleanliness of the home, staffing issues, the weight loss of a service user, the lack of service equipment, lack of activities and no manager at the home. The outcome of the providers investigation resulted in some elements being upheld, others partially upheld and some not upheld. What the service does well: The service provides those that live at Priory Park with a clean, comfortable and homely environment, which is tastefully furnished and pleasantly decorated to a high standard. The premises, both internally and externally are well maintained. The pre-admission process ensures that those who wish to live at Priory Park have been appropriately assessed, so that the staff at the home can adequately meet their individual needs. The home conducts a very detailed social history and therefore a lot of information is obtained in relation to individual hobbies, leisure interests sand preferences. Care plans are individualised and well written, providing staff in general with clear guidance as to how service users’ specific needs are to be appropriately addressed. The dependency levels of individual service users are determined and the skill mix and numbers of staff are appropriate to assessed needs. A detailed induction programme is provided for new members of staff on the commencement of employment, which involves the completion of a detailed workbook. New staff are assigned a mentor to guide them through the induction process. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The service could improve by ensuring that the outcome of the risk assessing process is appropriately addressed, in accordance with risk assessment indicators, such as seeking dietetic advise for service users who are at risk of malnutrition and dehydration. Although the plans of care were well written and detailed social histories had been obtained the care planning process could be improved by ensuring that all assessed needs are recorded and guidance is provided as to how service users’ can be supported to maintain their individual interests and hobbies. Although the chiropodist was on site at the time of the inspection, the need for foot care could be determined prior to admission. The provision of leisure activities could be improved, with a more structured activities programme and the employment of staff to specifically undertake on the role of activities co-ordinator, so that some continuity is provided and so that those living at the home are able to plan their days in an organised manner. Meal could be managed in a better way to ensure that meal times are an enjoyable experience for everyone. The home could identify the individual training needs of staff in a more structured manner, through formal supervision sessions, providing staff with the relevant training which they require in order to assist them in understanding the individual requirements of service users and therefore meeting their assessed needs. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 7 The recruitment procedures need to be improved to ensure that all appropriate checks are conducted prior to appointments being made. 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 Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 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 standard(s) 3. Standard 6 was not applicable to this service on this occasion. Adequate procedures had been adopted which ensured that the people living at the home had been appropriately assessed prior to admission. The majority of care plans were very well written, providing staff with clear guidance as to how individual needs were to be met. EVIDENCE: At the time of the inspection there were 40 people living at Priory Park. The care of three of these people with varying needs was ‘tracked’ during the course of the inspection. The care records showed that in all three cases the home had obtained detailed information prior to admission in order to determine the needs of each person admitted to the home. A very informative social history had also been obtained. However, the assessed needs of those admitted to the home were not consistently recorded within the care plan and there was no evidence to demonstrate that the service user or their representative had any input in the pre-admission process to enable them to ensure that the home could meet their needs. This requirement remained outstanding from the previous inspection. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 10 The service users’ guide demonstrated that adequate information about the facilities and services provided by the home was given to those wishing to live at Priory Park, this being confirmed by one relative. However, this document could be provide more information to interested parties, including the relevant qualifications of staff working at the home. Although each service user had a detailed plan of care in place, which were well written, the information was not consistent in relation to their psychological and dietary needs. One relative stated that the deputy manager had explained the plan of care in detail and that the care provided met the service user’s individual needs. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 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 standard(s) 7, 8 and 9 The people living at Priory Park Nursing Home were receiving appropriate health and personal care, which involved input from a variety of external professionals. However, individual assessed needs were not consistently recorded within the plans of care. Medications were being appropriately administered, in accordance with the policies of the home. EVIDENCE: Three plans of care were examined, which were found to be extremely detailed and very well written, providing in general clear, up to date instructions for staff as to how individual needs, in relation to personal and health care were to be met. However, the psychological needs of one service user with mental health problems were not recorded within the plan of care, neither were the dietary needs of another whose risk assessment showed a very high risk nutritional status, indicating that Dietetic advice should have been sought to ensure specific health care needs were fully met. Although a detailed social history had been obtained, the plans of care did not reflect how service users were being supported to continue their individual leisure interests and hobbies. Representatives had been involved in the care Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 12 planning process and reviews had taken place, which reflected the changing needs of the service user. A variety of risk assessments had been conducted, with particular attention to pressure relief, nutrition, moving and handling and the prevention of falls. It was noted that freedom of movement within the home was promoted and appropriate specialised equipment was seen to be provided in accordance with the assessed needs of people living at the home. The care records examined demonstrated that a holistic approach to care was being delivered, including, where possible, the promotion of independence and involving input from a variety of external professionals. Although one staff member was overheard speaking to two service users in an unprofessional manner, comments from service users included ‘ the staff are very friendly and caring’, ‘staff are lovely and very courteous’ and ‘ ‘we are treated very well’. Staff were seen to be knocking on service users doors before entering and providing care in a dignified manner in order to promote their privacy. Medications in general were well-managed and written policies and procedures were in place, providing staff with appropriate guidance in relation to the correct procedures for the receipt, storage, administration and disposal of medications. However, any hand written transcriptions should be signed, checked and counter signed to minimise the potential for medication errors. Eye preparations and local applications had not been signed on the MAR charts as having been administered, which could pose a potential hazard for the over administration of such medications. The transcriptions on some MAR charts were obliterated due to the holes made in order to accommodate the ring binders metal rings. This needs to be addressed to ensure the safe administration of medications. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12 and 15. The routines of daily living were flexible, offering those who lived at the home a variety of choices. Limited activities were provided on an ‘ad hoc’ basis by the care staff. Meal times were not well managed. EVIDENCE: A detailed social history for each service user had been obtained. However, the plans of care did not demonstrate that individuals were supported in maintaining their interests and hobbies. Service users spoken to stated that there was not much going on. One member of staff was overheard speaking to two service users in an unprofessional manner in the dining room at lunchtime, with other service users and staff present. This action did not promote service users’ dignity and demonstrated a lack of respect. The manager of the home dealt with this matter effectively at the time of the inspection. An activities co-ordinator was not employed at the home, although active recruitment was in progress. A planned programme of activities was not in place. Care staff were providing limited activities on an ‘ad hoc’ basis. Notices were displayed in the reception area showing some activities, which were being provided. However, those living at the home did not routinely access this area of the home. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 14 The plans of care showed that the preferences of those living at the home had been taken into consideration, including specific spiritual needs and the routines of daily living were seen to be relatively flexible. A menu was in place, which showed that those living at the home were offered a choice of meals. Fresh fruit and vegetables were readily available. Three full meals a day were offered and service users confirmed that a cooked breakfast was available, should they require it. The recently appointed manager was in the process of reviewing the dietary needs of service users and was planning to spend some time in the kitchen working alongside the catering staff. Soft diets could have been presented in a more attractive manner in order to maintain appetite and nutrition. It was noted that one member of staff visited each dining table, serving cabbage from a large bowl after the meals had been plated and served, which demonstrated that meal times were not well organised. Those dining were not provided with cutlery until after their meal had been served and beverages were not provided with their food. Condiments were not available on the dining tables and one service user needed to ask for some salt. The dining room should be prepared prior to service users being taken to eat. A conducive setting should be created so that meal times are relaxed, unhurried and enjoyable periods of the day and so that service users are able to eat at their own pace and have easy access to implements, condiments and beverages. Staff were seen to be assisting those who required some help with their meals, although independence was also encouraged, as much as possible. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16 and 18. The management of complaints received by the home was satisfactory. The systems in place demonstrated that those living at the home were protected, as far as possible from abusive situations. EVIDENCE: A clear complaints procedure was incorporated within the Statement of Purpose and records showed that complaints were dealt with effectively. However, this did not include contact details for the Commission for Social Care Inspection and although these details were prominently displayed within the reception area of the home, the people who lived there did not routinely access this area and were therefore not party to this information. However, those spoken to were aware of whom to speak to within the home, should they wish to make a complaint. The home had received one complaint since the last inspection, which involved missing spectacles and slippers damaged in the laundry, which was upheld. The policies and procedures of the home defined action to be taken should an allegation of abuse be reported. However, the relevant authorities involved in the protection of vulnerable adult procedure should be clearly identified. At the time of the inspection the guidance document ‘No Secrets in Lancashire’ was not available, although a ‘whistle blowing’ policy had been developed to ensure that staff were aware of their responsibility in ensuring any concerns were reported. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 16 Policies were in place at the home and were followed in day-to-day practice in relation to the protection of service users’ money and valuables and facilitating access to their personal records, if they so wished. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 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 standard(s) 19, 24 and 26. The home was comfortable and well organised. The environment was tidy, clean and in general pleasant smelling. The bedrooms and communal areas were well furnished and tastefully decorated. The home was well maintained and service users were seen to be living in a safe environment EVIDENCE: Although a current programme of routine maintenance was not in place at the time of the inspection, the furnishings, fittings and decoration were seen to be of a good quality and the maintenance of the environment was of a high standard. A schedule of decoration was in place, which promoted individualisation by identifying specific colour schemes. A record was maintained of on going work, which needed attention and evidence was available to demonstrate that these jobs were addressed within a reasonable time scale. It was noted that bolts had been fitted to the outside of the bathroom doors, which were considered to be a safety hazard, as there was a potential for services users to be locked in. These were removed at the time of the inspection. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 18 Grounds were seen to be tidy and safe, with a pleasant patio area to the rear of the building. Sturdy garden furniture was available for the use of those who lived at the home. The Lancashire Fire and Rescue Service had recently conducted an inspection, following which several requirements were made, which had either been attended by the home or were in the process of being addressed. The use of Close Circuit Televisions were restricted to entrance areas for security purposes only and did not intrude on the daily life of those living at the home. A random selection of bedrooms were viewed at the time of the inspection, which were seen to be bright, airy and comfortable, well furnished and tastefully decorated, providing a homely, hazard free environment for those who lived at the home. Those spoken to were happy with their private accommodation. Doors to service users’ private accommodation were fitted with locks and it was evident that some people who lived at the home were provided with keys, where appropriate. Lockable storage facilities were also provided for the retention of valuables and medications, should service users be self-medicating. Where keys for bedroom doors and lockable facilities were not provided for service users, the reason should be recorded within the plans of care. Adjustable beds were provided for those requiring a high level of nursing intervention to ensure that their comfort was maintained and to ensure that adequate care was given. The hot water being provided at the hand basin in the bathroom opposite bedroom 8 was recorded at 46.8C. Hot water must be delivered at temperatures close to 43C to ensure service users’ safety. Policies and procedures were in place in relation to infection control. Staff were seen to be disposing of clinical waste appropriately and washing soiled linen at acceptable temperatures. The laundry department was appropriately sited and equipped and was seen to be well organised. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The numbers and skill mix of staff were appropriate for the assessed needs of the people living at Priory Park. Initial training on employment was adequate. Little up to date training had been provided for staff following the induction period. The recruitment procedures were not adequate to ensure that those living at the home were sufficiently protected. There were sufficient numbers of ancillary staff employed at the home to ensure that the environment was well presented and was maintained to a good standard of cleanliness. EVIDENCE: There was a clear duty rota in place demonstrating which staff were on duty at any time of the day or night. The staffing levels were calculated in accordance with the minimum requirements of the previous regulating authorities. Although a recognised tool for determining individual dependency levels of service users was utilised, the home had not considered these levels when calculating the staffing requirements. Service users spoken to felt that their care needs were being appropriately met, although staff always seemed to be busy. There were a total of 20 care staff employed by the home, 2 of whom had achieved a National Vocational Qualification. The recently appointed manager was aware that the home needs to achieve a minimum ratio of 50 of care staff with an NVQ, excluding managers and registered nurses. The home was seen to be well organised, clean and tidy and in general pleasant smelling. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 20 Three staff files were examined at the time of the inspection. It was found that recruitment procedures were not being adequately followed in day-to-day practice. Insufficient checks had been undertaken on staff prior to employment, in terms of references and Criminal Record Bureau disclosures. All staff had been issued with a statement of terms and conditions of employment. Individual training and development assessments and profiles for staff had not been developed. However, there was evidence that a structured, mentor based induction programme was in place. Although the provision of core training was being arranged, there was little recorded evidence to demonstrate that there was a skilled workforce and that people had the necessary underpinning knowledge to meet the needs of the people they were caring for. Staff spoken to stated that the newly appointed manager was keen to develop appropriate training in accordance with the individual needs of staff. The manager stated that she intended to provide regular core training and up dates, which would be compulsory for all staff. At the time of the inspection a training company visited to discuss the specific needs of the home. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 and 38 Some effective quality assurance monitoring systems had been implemented to measure success in meeting the aims and objectives of the home. Staff were not sufficiently formally supervised following the induction period. In general the registered person ensured safe working practices and the health and safety of service users and staff. EVIDENCE: Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 22 At the time of this unannounced inspection, a reasonable judgement could not be made in relation to some of the standards from this section, as the manager of the home had only been in post for two weeks. Staff spoken to stated that the new manager was approachable and very supportive and had implemented some positive changes since her recent appointment. Relevant policies and procedures were in place, which had been reviewed and up dated to reflect changing legislation and good practice guidance. The home had achieved an externally accredited quality assurance award and was therefore audited by a professionally recognised quality assurance system. Some internal audits had been commenced, including care planning processes and medication procedures. A monthly quality assurance audit had been conducted, the results of which had been submitted to the Commission for Social Care Inspection, in order to demonstrate how the home was achieving goals for service users. There was no evidence available to demonstrate that staff had received formal supervision on a regular basis, to incorporate all aspects of practice, philosophy of care and career development needs and formal foundation training had not been provided. Appropriate lifting equipment was provided. None of the staff held a current moving and handling certificate and there were no qualified first aiders employed to ensure that the service users were adequately protected. The systems and equipment within the home, in general had been appropriately serviced and tested, in accordance with relevant legislation in order to ensure the health, safety and welfare of service users and staff. However, solutions to control the risk of Legionella had not been conducted since April 2004, when the water tanks had been cleaned and chlorinated. The water system had not been analysed and tested for Legionella since November 2003. A random selection of hot water temperatures were tested and recorded. At the time of the inspection the hot water being delivered to the hand basin in the bathroom opposite bedroom 8 was in excess of the recommended temperature of close to 43C and therefore posed a risk to residents. A variety of environmental risk assessments had been conducted. However, the fire officer had recently identified that the risk assessment in relation to fire safety was inadequate and had issued the home with a number of requirements. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x 2 x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 2 x x 1 x 2 Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14(1)(c) Requirement Timescale for action 30.06.05 2. 3, 7 15(1) 3. 8 12(1)(a), 13(1)(b) 4. 9 13(2) The registered person must not provide accommodation for a service user unless, so far as it has been practicable to do so, there has been appropriate consultation regarding the preadmission assessment with the service user or their representative. (Timescale of 31.12.04 not met) The service users written plans 30.06.05 of care must identify how all the assessed needs of the people living at the home are to be met. The registered person must 30.06.05 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users, including making arrangements for service users to receive, where necessary advice and treatment from other health care professionals, including the dietician. The registered person must 31.05.05 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines. All prescribed medications must be signed on Version 1.30 Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Page 25 5. 12 16(2)(n) 6. 12 12(4)(a), 12(5)(b) 7. 15 16(2)(i) 8. 16 22(5), 22(6)(a) 9. 19, 38 23(4)(b), (c) 13(4)(a), (c) the MAR chart when administered, including eye preparations and local applications. The registered person shall having regard to the size of the care home and the number and needs of service users consult service users about the programme of activities arranged by or on behalf of the care home. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users and shall encourage and assist staff to maintain good personal and professional relationships with service users. The registered person shall having regard to the size of the care home and the number and needs of service users provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared, including soft diets. The registered person shall supply a copy of the homes complaints procedure to every service user or their representative, which shall include the name, address and telephone number of the Commission. The building must comply with the requirements of the local fire service. The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety, including the safe provision of hot water and the 31.07.05 31.05.05 30.06.05 30.06.05 31.07.05 10. 19, 38 31.05.05 Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 26 11. 29 19(1)(a), (b) Schedule 2 12. 30 18(1)(a), (c) implementation of solutions and analysis of water systems for the control of Legionella. The registered person must not employ a person to work at the care home unless:- the person is fit to work at the care home and information and documents, listed within Schedule 2 have been obtained. The registered person must, having regard to the size of the care home, the statement of purpose and the number and needs of service users:- 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 service users and that the persons employed by the registered person to work at the care home receive:- training appropriate to the work they are to perform, including moving and handling and first aid, and suitable assistance should be provided, invcluding time off, for the purpose of obtaining further qualifications appropriate to such work. 31.05.05 30.09.05 13. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 1 Good Practice Recommendations The service users’ guide should clearly identify the qualifications of staff working at the home, in accordance with standard 1 of the National Minimum Standards for Care Homes for Older People. F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 27 Priory Park Nursing Home 2. 3. 3 7, 8, 12 4. 9 5. 6. 12 15 7. 18 8. 9. 19 24 The homes own needs assessment should be in accordance with standard 3 of the National Minimum Standards for Older People, including foot care. The service user’s plans of care should incorporate the social care needs and abilities of the individual and should demonstrate that service users are supported to maintain their leisure interests and hobbies, if they so wish. Any hand written medication transcriptions should be signed, checked and countersigned. The registered person should consider replacing the MAR chart binder with a more suitable one to avoid holes being made at the site of the prescription. Information in relation to social activities should be clearly displayed in prominent positions within the home allowing easy access for those living at the home. The dining room should be prepared prior to service users being taken to eat. A conducive setting should be created so that meal times are relaxed, unhurried and enjoyable periods of the day and so that service users are able to eat at their own pace and have easy access to implements, condiments and beverages. The relevant authorities involved in the protection of vulnerable adult procedure should be clearly identified within the written policies of the home. The manager of the home should obtain a copy of the guidance document ‘No Secrets in Lancashire’. Written policies should be developed to ensure that physical or verbal aggression by service users was understood and dealt with appropriately and that physical intervention would only be used as a last resort. A current programme of routine maintenance should be developed, to include renewal of the fabric and decoration of the premises. Where keys for bedroom doors and lockable facilities were not provided to service users, this should be recorded within the plans of care. The home should be able to demonstrate compliance with the Water Supply (Water Fittings) Regulations 1999. The ratios of care staff to service users should be determined according to the assessed needs of service users, and a system operated for calculating staff numbers required, in accordance with guidance recommended by the Department of Health. The home should be working towards achieving a minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent), excluding managers and registered nurses. F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 28 10. 11. 26 27 12. 28 Priory Park Nursing Home 13. 30, 38 14. 33 15. 16. 33 36 All staff should receive a minimum of three paid days training per year (including in-house training), and have an individual training and development assessment and profile. All staff should receive structured foundation training within the first six months of appointment, which equips them to meet the assessed needs of the service users accommodated, as defined in their individual plan of care. Formal feedback from staff and stakeholders in the community should be sought about the quality of services provided and how the home is achieving goals for service users. Feedback from service users should be published anonymously. An annual development plan should be developed for the home, based on a systemic cycle of planning - action review and reflecting aims and outcomes for service users. Care staff should receive formal supervision at least 6 times per year, which should cover all aspects of practice, philosophy of care in the home and career development needs. All other members of staff should be supervised as part of the normal management process on a continuous basis. Priory Park Nursing Home F57 F08 S25580 Priory Park Nursing Home V223889 050505 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection Leven House Ackhurst Business Park Foxhole Road Chorley PR7 1NW 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. 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