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Inspection on 01/04/08 for Priscilla Wakefield House

Also see our care home review for Priscilla Wakefield House for more information

This inspection was carried out on 1st April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Priscilla Wakefield House has been designed and built to a very high standard. The atmosphere is friendly and more like a hotel than a care home. The environment is comfortable and clean and contains all the aids and equipment needed to support people who live there. People who currently use the service told us they felt supported by the staff team. One person said, "We are alright, we are happy". Visitors are encouraged and made to feel welcome by staff.

What has improved since the last inspection?

This is the first key inspection since the home opened last year and so no previous requirements have been issued.

What the care home could do better:

Priscilla Wakefield HouseDS0000070770.V361289.R01.S.docVersion 5.2Page 7Since the home opened last year there have been several managers and this inconsistency of management has had a negative impact on both residents and staff. A manager must be recruited who has the skills and experience needed to run this home. The manager must also be given the autonomy to develop and improve clinical aspects of care at the home. There have been problems with admissions to the home and admission procedures must be more robust. People who use the service must be able to have more of a say in their plan of care. Care plans must be more "person centred" in approach to ensure that people are treated as individuals with individual needs and aspirations. Staff must accurately record the receipt of medication coming into the home so that residents always have a consistent supply of medication. In order to protect residents from potential abuse staff must undertake training in adult protection and recruitment procedures must be adhered to at all times. Seven requirements relating to the above have been issued as a result of this inspection. The newly appointed operations manager is working very hard to improve the clinical support people who use the service should be receiving. He is aware of the improvements that need to be made in order that people who use the service receive a good standard of care and support.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Priscilla Wakefield House Rangemoor Road Tottenham London N15 4NA Lead Inspector Mr David Hastings Unannounced Inspection 10:00 1 and 2nd April 2008 st X10029.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 Priscilla Wakefield House DS0000070770.V361289.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 and Care Homes for Adults 18 – 65*. 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. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priscilla Wakefield House Address Rangemoor Road Tottenham London N15 4NA 020 8341 9292 020 8967 3021 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) Flagswan Two Ltd VACANT Care Home 112 Category(ies) of Dementia (18), Dementia - over 65 years of age registration, with number (39), Learning disability (23), Old age, not of places falling within any other category (24), Physical disability (8) Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD (maximum number of places 8) Dementia - Code DE (maximum number of places 18) Dementia of the following age range: 65 years and over Code DE (E) (maximum number of places 39) Old Age not falling within any other category - Code OP (maximum number of places 24) Learning disability of the following age range: 65 years and over - Code LD(E) (maximum number of places 23) The maximum number of service users who can be accommodated is :112 This is the first CSCI inspection since the home opened. 2. Date of last inspection Brief Description of the Service: Priscilla Wakefield House is a large, newly built Nursing Home with 112 places for people with learning disabilities, dementia, physical disabilities and head injuries. The majority of places are for Older People. There are three floors, which contain different specialist units. As the home is relatively new only one floor at present is occupied. The building and environment have been built to an excellent standard and all bedrooms have en-suite facilities. There are a number of lounges and dining areas in each unit as well as outside terraces and gardens. The home has been very well designed. Priscilla Wakefield House has the equipment and facilities required to meet the needs of the people using the service. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 5 The stated aims of the home is, “To help service users remain in control of their lives as far as possible and thus, to maintain their personhood through Person Centred Care”. The home is situated in Tottenham, North London and although there is limited parking the home is near to local bus services and the Victoria Line Underground station. The range of fees for Older People is between £450 and £750 per week. The operations manager said that for Younger Adults and people with brain injury the cost of placements would be dependent on an individual assessment of needs and services required. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This Key Unannounced inspection took place on Tuesday 1st April and was completed on Wednesday 2nd April. The inspection was undertaken by one inspector and lasted eight hours. This is the first inspection of the home since it was registered with the Commission. Although the home has 112 places at the time of the inspection only seven people were residing at the home. Therefore this inspection concentrated on the outcomes for the people currently using the service. Long term issues were also looked at in order to assess future care provision when the home reaches full occupancy. Since the home opened a number of managers have been employed by the organisation. Currently the newly appointed operations manager is acting as he home manager until a new manager is appointed. The operations manager assisted us with the inspection and was very open and helpful. We spoke to all the residents, two visitors and seven staff. We also spoke with the managing director of the organisation who was present on both days on the inspection. We looked around the home and examined various care documents and procedures and policies. All of the residents we spoke with indicated that they were satisfied with the care and support they received from staff at the home. What the service does well: What has improved since the last inspection? What they could do better: Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 7 Since the home opened last year there have been several managers and this inconsistency of management has had a negative impact on both residents and staff. A manager must be recruited who has the skills and experience needed to run this home. The manager must also be given the autonomy to develop and improve clinical aspects of care at the home. There have been problems with admissions to the home and admission procedures must be more robust. People who use the service must be able to have more of a say in their plan of care. Care plans must be more “person centred” in approach to ensure that people are treated as individuals with individual needs and aspirations. Staff must accurately record the receipt of medication coming into the home so that residents always have a consistent supply of medication. In order to protect residents from potential abuse staff must undertake training in adult protection and recruitment procedures must be adhered to at all times. Seven requirements relating to the above have been issued as a result of this inspection. The newly appointed operations manager is working very hard to improve the clinical support people who use the service should be receiving. He is aware of the improvements that need to be made in order that people who use the service receive a good standard of care and support. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (Older People) 1 and 2 (Adults 18-65) (Standard 6 not applicable) People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents are given accurate information about the home so they can make an informed choice about where to live. Although the homes’ assessment procedures are satisfactory they are not always being followed correctly. This means that some peoples’ needs are not being fully met by the home. EVIDENCE: We examined the home’s “Statement of purpose” and “Service user guide”. These documents describe the aims and objectives of the home and the facilities available to people coming into the home. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 10 These documents were clearly written and described in detail the services and facilities available. The operations manager said that the organisation would be developing these documents in a variety of different formats. There are currently only seven people residing in the home. One person is in hospital. We looked at the initial assessments for all these people. The information was satisfactory and clearly outlined each person’ s individual needs. These needs incorporated physical, emotional and cultural issues. There was evidence that these identified needs were also being recorded in each person’s individual care plan. However recently there was an issue with one assessment undertaken by the home. An assessment was carried out by a Nurse from the home of a potential resident. Although the assessment indicated that the home could not meet the needs of this person this was overruled by the organisations’ business development manager and the person was admitted to the home. This is not satisfactory, as any assessment must be carried out by a person qualified to do so in order that individual needs can be fully assessed with the participation of the potential resident. Failure to properly assess someone can have a negative effect on the quality of their care provision as the staff may not be able to fully meet their needs. The operations manager acknowledged that this was not the correct procedure and has rewritten the clinical assessment procedure. A requirement that the home must follow the correct procedure for admitting people to the home has been made in the relevant section of this report. This issue will be monitored by the CSCI at future inspections. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 (Older People) 6, 9, 16, 18, 19 and 20 (Adults 18-65) People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are receiving the care and support they need in a way that respects their privacy and dignity. People are not always able to have a say about how they would like their care to be delivered. After some initial problems the home is making sure that everyone has access to health care professionals when they need to. People are getting the right medication at the right times by appropriately trained staff. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 12 EVIDENCE: We examined the care plans for all the people living at the home. The operations manager has recently changed the format of care plans to make them more accessible for staff and residents. Peoples’ individual needs were identified and contained clear information for staff on how to meet these needs. Staff interviewed had a good understanding of the needs of people they currently support. The operations manager told us that he was developing these plans in order to make them more “Person Centred” and to ensure that people who use the service have more input into their own plan of care. A requirement regarding this has been issued and will be assessed at future inspections. Individual risk assessments were seen on all care plans. These included risks associated with moving and handling, nutrition, falls prevention, dementia and pressure care. There has been an issue recently with pressure care practices at the home, which has led to a safeguarding adults referral. As a result the local tissue viability nurse has visited the home, reviewed all the residents, advised the home with regard to pressure care prevention and offered staff training. We were able to speak with the tissue viability nurse on the day of the inspection and she told us that pressure care prevention and practices have improved at the home. This improvement is also due to the work that the operations manager has undertaken to address this matter. As a result the residents at the home are now receiving a better standard of pressure care from the nurses and care staff. Apart from the person in hospital, no one has any pressure sores at the home. There was evidence that residents have access to health care professionals however the operations manager is still in the process of organising regular contracts with outside professionals such as chiropodists, dentists and opticians. Records we examined indicated that residents had visited the doctor or had been visited by a doctor at the home. There was a problem with accessing doctors for residents at the home but we were assured that this is being addressed as a matter of urgency. A requirement has been issued that all people who use the service have access to health care professionals as and when required so that all their health care needs are properly met. This will be assessed at future inspections. Satisfactory records were examined in relation to the storage, administration and disposal of medication at the home. In a few instances we found that medication coming into the home was not always being accurately recorded. This could cause problems with reordering medication for residents so a Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 13 requirement has been issued regarding the need to accurately record medication coming into the home. The interactions we observed between staff and residents were friendly and supportive. People told us that they were treated with respect and their right to privacy was being maintained. Staff we interviewed were able to give practical examples of how they maintain people’s privacy. Care plans also clearly identified the need to respect people’s privacy at all times. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15(Older People) 12, 13, 15 and 17 (Adults 18-65) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are being kept suitably occupied and engaged so that their social, cultural, religious and recreational interests and needs are met. Visitors to the home are made welcome and can visit at any reasonable time. Residents can exercise choice and control over their lives. People who use the service receive a wholesome and appealing diet in pleasing surroundings. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 15 EVIDENCE: Throughout the inspection we observed staff interacting with residents and carrying out a range of activities, which everyone was clearly enjoying. As there are only currently seven residents at the home staff were able to spend time with people, sitting and chatting or doing exercises. The operations manager told us that he would be employing specific activity workers when the number of residents increased. Some residents enjoy going out shopping with staff or for walks in the local area. There are a number of lounges throughout the home and residents can choose to spend time with each other or on their own. The atmosphere was relaxed and friendly. There have been some issues with one resident becoming aggressive and risk assessments have been put in place to limit the impact on other people. Currently all the people who use the service are residing on one unit. This seems to be working at present but the operations manager said that when more people are in the home other units will be opened and the younger adults will be on a different floor to the older people with dementia. We also saw residents helping out during the day and people seemed generally well occupied. We spoke to two visitors to the home during the inspection. They commented that staff were welcoming and that they could visit at any reasonable time. One visitor told us the staff were, “Very good” and “It’s a lovely place”. The home has an open visiting policy. We found evidence that people living at the home are able to exercise choice and control over their lives. Records indicated that staff were aware when residents wanted to get up in the morning and the cook was aware of peoples’ likes and dislikes with regard to meals. Individual’s likes and dislikes were recorded in their care plans. Staff we interviewed were able to give practical examples of how they offer choice to people who use the service. On the day of the inspection the kitchen was clean and well stocked with fresh fruit and vegetables. Fridge and freezer temperatures were being recorded. Lunch looked appetising and people told us there was always enough to eat. We spoke with the catering manager who had recently developed a four week menu for the home. He told us that he had developed this menu with reference to nutritional guidelines. All the residents we spoke with said they were happy with the food provided by the home. There was evidence that people were being offered a choice of menu. One person told us, “We get lovely meals”. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (Older People) 22 and 23 (Adults 18-65) People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and responded to in a professional manner. Residents are protected from abuse by clear policies and procedures. Staff have not however undertaken training in adult protection in order to fully identify and protect residents from potential abuse. EVIDENCE: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. The complaints procedure is on display throughout the home and people told us they knew what to do if they had a complaint about the service. There has been one recent complaint and records indicated that this was being dealt with appropriately and in an open and professional manner. There is currently an ongoing Adult Protection investigation regarding pressure care practices at the home. A strategy meeting has been held and the home is fully cooperating with the investigation. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 17 Staff have not undertaken Adult Protection training which would give them a better understanding of the issues faced by people living in a social care setting. The operations manager told us that this training would be undertaken soon. A requirement has been issued about this in the relevant section of this report. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26(Older People) 24 and 30 (Adults 18-65) People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is clean, safe and maintained to an excellent standard. The home has been designed for the comfort and well being of residents. Private and communal spaces for residents are of a high standard. The home has the aids and adaptations needed for the care of the people who use the service. People who use the service are now being protected by clear policies and procedures in relation to infection control. EVIDENCE: Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 19 Priscilla Wakefield House has been newly built and is decorated and furnished to a very high standard. People we spoke with said they were very happy with their rooms. Although there is furniture in each bedroom the operations manager said that people could bring in their own furniture if they wanted to. The home has a policy regarding this, which clearly outlines what furniture can be brought in to the home. All rooms are en-suite with a toilet and wash hand basin and some rooms have an en-suite shower. Rooms for those people with physical disabilities also have a tracking hoist fitted. The home has recently been short listed for a design award. Some bedrooms we saw contained people’s personal possessions, which made the rooms homely and individualised. There are a number of outside spaces for people to sit. As some of these are terraces above ground level they have been enclosed with a fence. The operations manager said that individual risk assessments would be carried out to ensure the safety of people using these terraces. There is a fulltime handyperson who checks and ensures that the building and equipment are maintained and repaired. There are suitable aids and adaptations throughout the home to ensure that people who use the service have as much independence as possible. There had been an issue with poor infection control and a lack of robust policies and procedures following a recent admission to the home. However the newly appointed operations manager has reviewed and rewritten the home’s infection control policy and procedure. Staff have undertaken training in infection control and were able to describe how this training has improved their work practice. This has now improved the standard of clinical care people receive at the home. The laundry area is well designed and contains the equipment needed to protect people from cross infection. The home has a laundry chute on each floor so staff do not have to walk through the home with soiled or infected linen. The laundry assistant has undertaken infection control training and understood the procedures for dealing with contaminated laundry. All areas of the home were clean on the days of the inspection and there were no offensive odours detected. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 and 30 (Older People) 32, 34 and 35 (Adults 18-65) People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff at the home work hard to meet the needs of residents and are now being provided with good training opportunities to further enhance their knowledge and skills so they can support residents more consistently and effectively. Recruitment practices are not always being adhered to in order to fully protect residents at the home. EVIDENCE: On the day of the inspection there were two care staff and one qualified nurse on duty to provide care and support to seven residents. Satisfactory staffing rotas were examined. Records indicated that there is a qualified nurse on duty at all times. The cultural diversity of people who use the service was reflected in the staff team. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 21 Residents were positive about the staff team and it was clear from discussion with staff that they understood the individual needs of the residents in their care. One person said the staff, “Are doing nice work”. Currently there are, in total, seven care workers and three qualified nurses working at the home. There are plans to increase the staffing numbers when more people are admitted to the home. The operations manager said that currently over 50 of staff have an NVQ level 2 or equivalent and the home is providing NVQ training for staff. Staffing files were examined for both nurses and care workers. These were generally satisfactory and included two written references, proof of identity and a completed CRB disclosure to ensure that staff are suitable to work with vulnerable people. One staff file examined did not contain a written reference from the person’s last employer and no indication was recorded regarding why this had not been carried out. It is very important that up to date references are obtained so the home knows that the person is still suitable to be working with vulnerable people. A requirement has been issued in the relevant section of this report. Staff interviewed were positive about the training offered by the home. The operations manager has completed a training matrix to identify the training needs of staff. This indicated that most staff have completed mandatory training such as infection control, moving and handling and fire training. As detailed elsewhere in this report not all staff have completed Adult Protection training. Regular, consistent and quality staff training is a very important issue and can have a direct impact on the quality of care residents receive. The development of staff training at the home will be monitored at future inspections. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 (Older People) 37, 39 and 42 (Adults 18-65) People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is currently no permanent manager at the home who has the skills and experience needed to support both residents and staff. A permanent, full time Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 23 manager would be able to provide a consistent management approach, which has been lacking in the past few months. Residents do have opportunities to have a say in how the home is run. Residents’ financial interests are being properly safeguarded. The health and safety of residents and staff are promoted and protected. EVIDENCE: The newly appointed operations manager has been taking on the role of the manager of the home until a full time manager is employed. Staff were positive about the operations manager and said they have confidence in his clinical experience. Staff also said they felt supported by the new management and that this consistency has been lacking in the past due to the number of managers who have come and gone in such a short space of time. The operations manager told us that a new manager has been recruited and the organisation is waiting for satisfactory recruitment information before they can start. This standard will be met when the new manager is in post and there is sufficient evidence to show that they have the skills and abilities including clinical experience to run this home. The home has a number of quality assurance systems including satisfaction surveys and periodic quality audits. A recent quality audit has been undertaken and the results of this audit indicate that the standard of care provided by the home is improving. There was evidence that residents and relatives meetings take place at the home. The home holds small amounts of money on behalf of residents. A sample of these accounts were examined. All money checked was being accurately recorded and all accounts contained a clear audit trail with individually numbered receipts. The operations manager said that a new system for dealing with peoples’ finances would be introduced shortly. Satisfactory records and certificates were seen in relation to fire safety, health and safety, Legionella, gas safety and electrical safety. As the home is very new there are no current issues with maintenance. Staff have received training in fire safety and undertake fire drills on a regular basis. The home is secure and has CCTV cameras on the outside of the building. Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 24 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 3 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 4 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 25 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) The registered person must ensure that the homes’ admission procedures are adhered to at all times. This should ensure that only those people who’s needs can be fully met will be admitted to the home. The registered person must ensure that care plans are more “person centred” and that people are able to be more involved in their own care planning. The registered person must ensure that that all people who use the service have access to health care professionals as and when required. The registered person must ensure that all medication coming into the home is being accurately recorded. The registered person must ensure that all staff working at the home undertake training in adult protection so they have a better understanding of the issues faced by people living in a social care setting. DS0000070770.V361289.R01.S.doc Requirement Timescale for action 01/05/08 2. OP7 15(2) c 01/05/08 3. OP8 12(1) 01/05/08 4. OP9 13(2) 01/05/08 5. OP18 OP30 13(6) 01/05/08 Priscilla Wakefield House Version 5.2 Page 26 6. OP29 19(1) 7. OP31 9(1) The registered person must ensure that staff recruitment procedures are adhered to at all times to protect residents from unsuitable staff being employed at the home. The registered person must ensure that a manager is recruited to the home who has the skills and experience needed to support both residents and staff. They must also be able to provide a consistent management approach. 01/05/08 01/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Priscilla Wakefield House DS0000070770.V361289.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Contact Team Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 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