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Inspection on 21/10/08 for Priscilla Wakefield House

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

This inspection was carried out on 21st October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Seven requirements were issued at the last inspection. The registered person has complied with all of these requirements. Standard 1 The pre assessments of potential residents to the home have improved. This means that the service will only admit people if all their needs can be met by the staff at the home. We examined four assessments of recent admissions to the home. All of these had been completed by the manager and were detailed, covering all aspects of care. Risk assessments had also been carried out and included pressure care, manual handling, the risk of falling, nutritional assessments and other risks associated with the individual resident. Standard 7 Care plans have improved and people who use the service are now more involved in their plan of care. We examined five care plans. These plans were detailed and had been signed by the resident to indicate that they had agreed with their own plan of care to be provided. Care plans looked at the person as an individual with individual needs and wishes. The manager told us that she would be developing these plans further to make sure they were more person centred. People who use the service told us they were generally happy with the care and support they receive. Standard 8 Residents now have better access to outside health care professionals. The manager told us that all residents are now registered with a doctor and people we spoke to confirmed this. We saw records of visits by the doctor, dentist, optician and chiropodist on peoples files we examined. Standard 9 We examined satisfactory records in relation to the receipt, storage, administration and disposal of medication at the home. These records indicated that people receive the right medication at the correct times and from suitably qualified staff. Standard 13 We were able to speak with two visitors to the home. They praised the service and told us that their relative had made improvements since being at the home. They were also positive about the staff at the home. They did tell us that as the home has a number of locked doors, they needed assistance from staff to leave the building. The manager told us that due to the very vulnerable nature of some of the residents it was necessary to maintain a secure environment at the home. Standard 15 An anonymous concern was made to the Commission regarding the quality and amount of food available at the home. The kitchen was clean and the new cook had a good knowledge of the needs and wishes of residents at the home. The lunch provided on the day of the inspection looked and smelt appetising. There was a good choice of meals available and staff were asking residents what they wanted for lunch. People told us that the food was nice at the home and that there was always enough to eat. One person commented. They give me the food I like. Lunchtime was relaxed and staff were offering discreet assistance where required. Standard 18 We saw training records that indicated that all staff at the home have now undertaken training in adult protection and staff we interviewed had a good knowledge regarding this issue. It was clear from discussion with the manager and operations director that safeguarding issues are taken seriously and acted upon in a professional manner. Standard 26 The anonymous concern we received alleged that the home was dirty and smelled. We could find no evidence to support this allegation. The home was clean and tidy on the day of the inspection. The systems for dealing with incontinence issues were satisfactory and no offensive odours were detected throughout the home. There were three domestic staff on duty including a laundry worker. Standard 27 On the day of the inspection there were 17 residents at the home. The Commission received an anonymous concern about the staffing levels at the home. However there appeared to be good staffing levels at the home on the day of the inspection. To support seventeen residents there were two registered nurses, four careworkers, one activities coordinator and four domestic staff on duty. People we spoke to said they were happy with the staff and we saw supportive and friendly interactions between staff and residents. Staff told us they were happy working at the home. Standard 29 Recruitment procedures and the home have improved and are now more robust. This should ensure that only suitable staff are employed at the home. The manager and operations director told us that they are now more involved in staff recruitment and staff files we examined contained all the information required to protect residents. This information included two written references, proof of identity and satisfactory criminal record checks. Standard 31 It was clear from discussion with the manager that she has the skills and experience to run this service. We were very impressed by the work the manager and the operations director have carried out so far to improve the quality of care to the residents at the home. After a number of managers have come and gone at Priscilla Wakefield House since it opened, we hope that the present management can provide the consistent approach that the service needs.

What the care home could do better:

We did not assess all the key standards at this inspection. we have made one new requirement as a result of this inspection. Standard 38 As a result of a recent safeguarding issue arising at the home, the manager has highlighted the need for more robust reporting of incidents that affect the well being of residents. The home must report any incident that affects the well being of people who use the service under Regulation 37 of the Care Home Regulations 2001. These reports must be carried out within given timescales and must contain detailed information about the incident. The manager and operations director are well aware of the improvements needed and are working hard to implement these improvements. A requirement relating to this has been made in the relevant section of this report. An issue regarding the running of the home was raised at the last inspection. This was regarding the need for the manager to have more autonomy regarding operational issues at the home. It appears from discussion with the manager and operations director that this is still problematic. This was discussed with the registered provider of the home who agreed that it was vital that the manager and the operations director have more autonomy regarding the day to day running of the service. The Commission will be monitoring this issue at future inspections.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Priscilla Wakefield House Rangemoor Road Tottenham London N15 4NA The quality rating for this care home is: The rating was made on: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: David Hastings Date: 2 1 1 0 2 0 0 8 Information about the care home Name of care home: Address: Priscilla Wakefield House Rangemoor Road Tottenham London N15 4NA 02088264343 02089673021 mitesh@precious-homes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Flagswan Two Ltd care home 112 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability 18 23 0 8 Over 65 39 0 24 0 Conditions of registration: 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 , over 65 years of age - 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 - Code LD (maximum number of places: 23) The maximum number of service users who can be accommodated is :112 Date of last inspection Brief description of the care home Care Homes for Older People Page 2 of 9 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 two floors at present are 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. The stated aims of the home are, 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 four hundred and fifty pounds and seven hundred and fifty pounds 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. Care Homes for Older People Page 3 of 9 What we found: We carried out an unannounced inspection of Priscilla Wakefield House on Tuesday 21 October 2008. We were assisted by an Expert by Experience who spoke with a number of residents at the home to see if they were happy with the care they received. The reason for this inspection was to check compliance with the requirements we made at the last inspection in April this year. The Commission also received an anonymous concern regarding the care of the people who live at Priscilla Wakefield House. These concerns indicated that the service was in breach of the Care Homes Regulations 2001. We needed to check that residents were receiving a satisfactory service. We met with the recently appointed manager and operations director who were open and helpful throughout the inspection. We were able to speak with most residents at the home who said they were generally happy with the care and support they received. The expert by experience commented that the majority of comments from residents were positive. One resident commented. My family come to visit me on the weekends. They are satisfied with the services provided here. Any time I wish to see my family, the manager calls them and they come. When I came to live here they checked with me and they follow my food instructions. One resident commented that it was sometimes difficult to communicate with staff who do not have English as their first language. It may be prudent for the organisation to assist some staff to take up free English language training, which may be available in the local area. The manager and operations director have had a very positive impact on the service provision. Residents are better protected and clinical procedures have improved. The overall care and support of people who use the service has improved considerably since the last inspection. What the care home does well: Seven requirements were issued at the last inspection. The registered person has complied with all of these requirements. Standard 1 The pre assessments of potential residents to the home have improved. This means that the service will only admit people if all their needs can be met by the staff at the home. We examined four assessments of recent admissions to the home. All of these had been completed by the manager and were detailed, covering all aspects of care. Risk assessments had also been carried out and included pressure care, manual handling, the risk of falling, nutritional assessments and other risks associated with the individual resident. Standard 7 Care plans have improved and people who use the service are now more involved in their plan of care. We examined five care plans. These plans were detailed Care Homes for Older People Page 4 of 9 and had been signed by the resident to indicate that they had agreed with their own plan of care to be provided. Care plans looked at the person as an individual with individual needs and wishes. The manager told us that she would be developing these plans further to make sure they were more person centred. People who use the service told us they were generally happy with the care and support they receive. Standard 8 Residents now have better access to outside health care professionals. The manager told us that all residents are now registered with a doctor and people we spoke to confirmed this. We saw records of visits by the doctor, dentist, optician and chiropodist on peoples files we examined. Standard 9 We examined satisfactory records in relation to the receipt, storage, administration and disposal of medication at the home. These records indicated that people receive the right medication at the correct times and from suitably qualified staff. Standard 13 We were able to speak with two visitors to the home. They praised the service and told us that their relative had made improvements since being at the home. They were also positive about the staff at the home. They did tell us that as the home has a number of locked doors, they needed assistance from staff to leave the building. The manager told us that due to the very vulnerable nature of some of the residents it was necessary to maintain a secure environment at the home. Standard 15 An anonymous concern was made to the Commission regarding the quality and amount of food available at the home. The kitchen was clean and the new cook had a good knowledge of the needs and wishes of residents at the home. The lunch provided on the day of the inspection looked and smelt appetising. There was a good choice of meals available and staff were asking residents what they wanted for lunch. People told us that the food was nice at the home and that there was always enough to eat. One person commented. They give me the food I like. Lunchtime was relaxed and staff were offering discreet assistance where required. Standard 18 We saw training records that indicated that all staff at the home have now undertaken training in adult protection and staff we interviewed had a good knowledge regarding this issue. It was clear from discussion with the manager and operations director that safeguarding issues are taken seriously and acted upon in a professional manner. Standard 26 The anonymous concern we received alleged that the home was dirty and smelled. We could find no evidence to support this allegation. The home was clean and tidy on the day of the inspection. The systems for dealing with incontinence issues were satisfactory and no offensive odours were detected throughout the home. There were three domestic staff on duty including a laundry worker. Standard 27 On the day of the inspection there were 17 residents at the home. The Commission received an anonymous concern about the staffing levels at the home. However there appeared to be good staffing levels at the home on the day of the inspection. To support seventeen residents there were two registered nurses, four care Care Homes for Older People Page 5 of 9 workers, one activities coordinator and four domestic staff on duty. People we spoke to said they were happy with the staff and we saw supportive and friendly interactions between staff and residents. Staff told us they were happy working at the home. Standard 29 Recruitment procedures and the home have improved and are now more robust. This should ensure that only suitable staff are employed at the home. The manager and operations director told us that they are now more involved in staff recruitment and staff files we examined contained all the information required to protect residents. This information included two written references, proof of identity and satisfactory criminal record checks. Standard 31 It was clear from discussion with the manager that she has the skills and experience to run this service. We were very impressed by the work the manager and the operations director have carried out so far to improve the quality of care to the residents at the home. After a number of managers have come and gone at Priscilla Wakefield House since it opened, we hope that the present management can provide the consistent approach that the service needs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 37 The registered person must 01/12/2008 ensure that any incident that affects the well being of residents at the home is reported within given timescales and is completed in sufficient detail so a judgment can be made if further action is needed. Regulation 37 reports give the Commission vital information about the service. The Commission needs to know the details of any incidents to judge if the home is taking the appropriate action to protect residents from potential risks. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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