Inspection on 01/09/05 for Prospect House Care Home

This inspection was carried out on 1st September 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Prospect House Care Home 11/02/09

Prospect House Care Home 16/04/08

Prospect House Care Home 02/10/07

Prospect House Care Home 18/04/07

Prospect House Care Home 08/01/07

Prospect House Care Home 25/05/06

Prospect House Care Home 20/12/05

Prospect House Care Home 18/10/04

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

CARE HOMES FOR OLDER PEOPLE Prospect House Nursing Home Blundells Lane Rainhill Merseyside L35 6NB Lead Inspector Mrs Trish Thomas Unannounced Inspection 1st September 2005 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Prospect House Nursing Home Address Blundells Lane Rainhill Merseyside L35 6NB 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) 0151 4931370 0151 4932626 Ms Maureen Bromley Mr Neil Malkhandi Ms Maureen Bromley Care Home 24 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (12), of places Terminally ill over 65 years of age (4) Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The Service should, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. The service is registered to provide personal care to twelve older people with Dementia The service is registered to provide nursing care up to a maximum of 16 service users in the category of Older People and Terminal illness (4) The service is registered for a maximum of twenty four older people in total. Date of last inspection Brief Description of the Service: Prospect House is a care home for 24 older people with dementia, and the registered manager is Mrs. Maureen Bromley. The home is a large converted dwelling house, which has been extended. Prospect House is set in beautiful grounds a short car journey from local amenities and bus routes. The home provides single accommodation and is staffed throughout the day and night. All residents are registered with a local G.P. and the service includes personal care, home cooked meals and a laundry service. The grounds include a car park, paved areas and extensive gardens with beautiful views. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was my first visit to the home. The registered manager, Mrs. Maureen Bromley, has many years nursing experience. The registration of this home has recently transferred from nursing care to dementia care/(non nursing). Residents present varying levels of dementia and the majority spoken with had short-term memory loss and were unable to express their opinions on the services provided in the home. They looked well cared for, and all residents had been registered with a G.P. and had a care plan. Some residents were spending time in their bedrooms, one having had a lie in. Another was smartly dressed and was relaxing in his room in an armchair. He joined the other residents in the dining room for his meal. A number of residents appeared to spend their time seated at tables in the dining room, which incorporates a lounge area, consisting of a row of easy chairs against one wall. Staff said that residents also use the television lounge, near the front of the building. They said that in-house activities are arranged, including board games and crafts. Mrs. Bromley said that a summer fair had been arranged for the following weekend. The manager said that such events are usually well supported and enjoyed by residents and staff. What the service does well: What has improved since the last inspection? Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 6 This was my first visit to the home. Requirements from the last inspection were not assessed during this visit. What they could do better: 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. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Standard 3. The home was meeting Standard 3. Residents care files contained professional assessments on admission to Prospect House and there was evidence of ongoing assessment post admission by home’s staff. Standard 4. A shortfall was noted with regards to staff skills in relation to provision of services for people who have dementia. The home will not be measured against standard 6 as intermediate care is not within the registered category. EVIDENCE: Standard 3. Prospect House is registered as a care home for dementia. A sample of care files was inspected and these contained social work assessments and mental health assessments, which formed the basis of each individual’s admission to the home. There was no evidence of inappropriate admissions, all residents having been assessed with needs within the category of dementia. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 9 Standard 4. One member of staff on duty, who has been employed in Prospect House for about six months said she had not undertaken training in dementia care. She has previous experience in the care sector, not in dementia services. With regards to the remainder of staff, Mrs. Bromley said that some have undertaken a distance-learning course in dementia. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The home was not meeting Standard 7, as care plan reviews were out of date in some instances. The home was meeting Standards 8,9 and 10. No shortfalls were noted with regards to healthcare, medication and respect for privacy. EVIDENCE: Standard 7. Care plans were in place for all residents and had been formed on the basis of a comprehensive assessment of need carried out by home’s staff. A sample of three care plans was referred to in detail. The care planning process in place, was addressing personal care, social and mental health needs. The home specialises in dementia care and there was reference in the care plans to residents’ cognition, mood, communication and responses, in addition to bathing, continence, mobility and pressure care. Risk assessments were on record, to address behaviour patterns which would cause a risk to self and others and the general risks associated with limited mobility. Care plans had been signed by the manager, Mrs. Bromley, and individual residents’ representatives. There is a review format included in the care plans. In addition to the care plans sampled, review dates were checked. A number of reviews were out of date (over 28 days). Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 11 Standard 8. Reference was made to residents’ care files, which confirmed that the home makes referrals to G.Ps., district nursing services, and paramedical services in accordance with residents’ needs. Mrs. Bromley confirmed that all residents are registered with a G.P. and receive health services as necessary. Standard 9. The medication room was visited. This room is locked when not in use and prescribed medication is held in a locked and secured trolley a locked metal cupboard or fridge as appropriate. There were no controlled drugs prescribed to residents at the time of inspection. The senior on duty (deputy) gave a good account of medication procedures followed in the home and confirmed that further instruction in medication administration had been arranged for the following week (5/9/05). Medication Administration Records were satisfactorily maintained. To avoid error, in certain instances, the information on residents’ medication containers is photocopied and forwarded to the home’s supplying pharmacist for ongoing supply of the drug and a printed MAR sheet. Changes to prescribed Warfarin doses are checked on with the clinical record and administered accordingly. Standard 10. Ten residents were spoken with during the inspection. Due to their presenting levels of understanding, it was not possible to fully establish their opinions on respect and privacy. Five visiting relatives were spoken with who said they had observed no problems with this aspect of service and were satisfied with standards in the home. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not fully assessed at this inspection. EVIDENCE: N/A Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The home was meeting standard 16. The home has a satisfactory complaints procedure which is available to residents’ representatives. EVIDENCE: Standard 16 was discussed with a visiting relative. He said he had been supplied with the complaints procedure. He said he had no cause for complaint (on his relative’s behalf), but would feel comfortable in approaching the manager if the occasion was to arise. Concerns had been raised about Prospect House to CSCI in a letter from a previous visitor to the home. The contents of the letter were discussed with the manager, and as a result of her responses and findings of this inspection, (which are related), requirements and recommendations have been made relating to staff vetting, staffing levels, fire safety and supervision of residents. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 The home was not meeting standards 19 and 26. Shortfalls were observed in the kitchen, bedrooms with regards to replacement of equipment and control of offensive odours. The home was not meeting standard 25 with regards to ventilation in the kitchen. EVIDENCE: Standard 19. The kitchen was visited, and part of the floor covering was observed as being worn and likely to become a tripping hazard. One of the freezers was damaged, (the front panel at ground level had become detached and the motor was visible). The headboard in a vacant bedroom was stained and there was a faulty lamp (property of the resident) in another bedroom. Due to the behaviour of some of the residents, the décor in the dining room was badly damaged (wallpaper torn). The dining area looked gloomy and uninviting, at the time of inspection. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 15 Remaining areas of the home (including bedrooms and the residents’ lounge) were in generally good condition. Remedial work had been carried out on the top floor as a result of a leaking the roof. The resulting internal decoration had not been completed at this time but had been planned. Some break-glass fire panels had been replaced and one was due for replacement. Standard 25. A shortfall was noted with regards to ventilation. On a visit to the kitchen, it was noted that the area around the cooker was very warm whilst cooking was in progress. The extractor fan was on. The cooker is adjacent to the window and exterior doorway. Provision of a fly screen to the window/ doorway would allow either to be opened to lower the temperature. Standard 26. COSHH assessments were observed in the Health and Safety file. The home employs domestic staff who are provided with protective clothing. The building was clean in the areas, which were visited, and cleaning materials secured. There is a designated laundry assistant (25 hours a week) and a oneway system in the laundry to protect against cross contamination between soiled and clean linen. The laundry is well equipped, and a disinfecting system had recently been fitted to the washing machine. According to staff, this has minimised ironing. Care staff carry out laundry duties at the weekend. There was a strong smell of urine in a number of the bedrooms, which were visited, (as discussed with Mrs. Bromley). Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The home was not meeting standards 27,29 and 30. Shortfalls were noted in the following aspects of service. Agreed staffing levels had not been maintained, staff files did not contain all the information required in Schedule 2, Care Home Regulations 2001, and shortfalls were noted in staff training. EVIDENCE: Standard 27. Reference was made to the staff rosters, which were discussed with the manager, Mrs. Bromley. Some shifts had not been covered in accordance with resident numbers. Mrs. Bromley said that recruitment of staff was progressing and two interviews had been arranged for care assistant posts. Standard 29. A sample of staff files was inspected and shortfalls were noted with regards to staff employed from outside the United Kingdom. The manager said she had requested this information from the agency who arranges their recruitment, and the clearances had not yet arrived. Information on satisfactorily maintained files, which were read, included individual training action plans, induction, supervision, verification of identity, training certificates, application forms, employment history, two references, CRB clearance, contract of employment, staff survey. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 17 Standard 30. Training was discussed with the manager and staff and training certification observed on staff files. One member of staff said she had not received updates in the mandatory training undertaken with a previous employer. First Aid training in general was in need of updating. Mrs. Bromley said that over 50 of staff have achieved NVQ2 the home’s deputy was due to undertake NVQ4. Mrs. Bromley said that a number of courses have been arranged, including moving and handling. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 The home was not meeting Standard 38 with regards to fire safety procedures. Health and Safety Certification inspected was in date. EVIDENCE: Health and Safety certification was contained in a file and the documents seen were in date. Last fire instruction and drills recorded in the fire book was 25/2/05. The last weekly fire systems test was recorded as 5/8/05. (Both were out of date). Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 2 X X X X X 2 2 STAFFING Standard No Score 27 2 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Not assessed. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Requirement The manager must ensure that all care plans are reviewed and that reviews are ongoing within a twenty-eight day period (maximum). The manager must arrange for all care staff to undertake dementia training. The manager must arrange for the repair/replacement (where worn) of the kitchen floor covering. The manager must arrange for the damaged freezer to be replaced. The manager must ensure that the faulty lamp is repaired/removed from a resident’s bedroom. The manager must arrange for the dining room to be decorated. The manager must ensure that the home is maintained free of offensive odours. The manager must ensure that staffing levels are maintained in accordance with resident numbers and dependency. The manager must ensure that DS0000005467.V253557.R01.S.doc Timescale for action 01/11/05 2. 3. OP4 OP19 19(5)(b) 23(2)(b) 01/01/06 01/12/05 4. 5. OP19 OP19 23(2)(c) 13(4)(a) 01/12/05 02/09/05 6 7. 8. OP19 OP26 OP27 23(2)(d) 13(3) 18(1)(a) 01/12/05 14/09/05 02/09/05 9. OP29 19 02/09/05 Page 21 Prospect House Nursing Home Version 5.0 10. OP38 23(4) the information required in Schedule 2(1-7) is obtained for all staff and made available for inspection by CSCI. The manager must arrange for fire drills and instruction to be accurately recorded in the fire book and that fire system tests are carried out weekly. 02/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP19 OP25 OP30 Good Practice Recommendations The manager should replace the headboard in one bedroom as discussed. The manager should provide a fly screen for the kitchen door/window. The manager should ensure that staff receive First Aid training and mandatory updates where these are out of date. Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Prospect House Nursing Home DS0000005467.V253557.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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