Inspection on 16/04/08 for Prospect House Care Home

This inspection was carried out on 16th 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.

Other inspections for this house

Prospect House Care Home 11/02/09

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 01/09/05

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 Mike Perry Key Unannounced Inspection 16th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 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 maureen@malkhandy.com Ms Maureen Bromley Mr Neil Malkhandi Ms Maureen Bromley Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 24 older people with Dementia 2nd October 2007 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 its own 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 views of the countryside. The fees in the home are £399 per week. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 5 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 inspection took place over a period of 8.5 hours over 2 days. The inspector met with the majority of residents and spoke with visitors. The inspector also spoke with members of care and ancillary staff on a one to one basis and the registered manager [also the Registered provider]. A pre inspection questionnaire and self-assessment [AQAA] aimed at eliciting information before the site visit was completed and returned by the management. Survey forms aimed at getting the views of relatives were sent out and comments have been used in the report. A tour of the premises was carried out and this covered all areas of the home including the resident’s rooms [not all rooms were seen but a sample]. Records were examined and these included two of the resident’s care plans, staff files, and staff training records and health and safety records. In addition the inspector also spoke to social care professionals external to the home. What the service does well: The policy of the home is for all residents to receive a preadmission assessment prior to entering the home so that their care needs can be assessed. Admission assessments were present and covered mental state assessments as well as personal care needs. The relatives spoken with said that the home had been helpful at the time of admission and staff had explained any details. They also felt that they had received enough information. Relatives interviewed were clearly satisfied with the care and spoke well of the staff’s attention and general attitude: ‘I’m very happy with care. My relative is always clean and tidy. The food is good and he eats well.’ Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 6 ‘We are always informed what’s going on. 12 months ago x had a bad infection and staff were very quick to get the doctor and get reviewed. Always clean and tidy and clothes are always fresh’. The health care of residents is met with consistency in terms of appropriate referral to health care professionals. The social care professional spoken with said that the home had been proactive in reporting changes in the behaviour of one resident and a referral for review had been appropriately made. Residents reviewed were receiving their medications safely. The records seen were up to date and the training of the staff that administers medicines is appropriate. The personal care carried out by staff was observed and residents were treated with patience and respect. The home has a relaxed atmosphere and staff are friendly and welcoming. Social interactions were observed and the general interactions of staff were positive. Staff were supportive to residents and there was a relaxed pace to the care with staff acknowledging residents feelings. Over the dinner time period there was a good staff presence and residents were offered plenty of support so that those residents who had difficulty were enabled to take their diet. Residents enjoyed the meal and one commented ‘we always get plenty of food here’. Information from relatives is that the home has an open policy of visiting and that staff are always welcoming. There is good complaints process and relatives reported that hey feel the can approach the manager and staff with concerns. There were no complaints recorded since the last inspection visit. What has improved since the last inspection? There were three requirements and ten recommendations on the last inspection report. There has been progress made by the managers with some of these. The internal environment of the home has been developed so that, overall, the home is much more comfortable and homely. There is still work to do [and this is planned] but the décor of the home has improved as well as the upgrading of certain areas such as the shower room on the ground floor. There is now no evidence of the malodour that previously pervaded the home. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 7 The home was found to be clean [despite staffing problems meaning that there are currently reduced domestic hours] and the maintenance in the home is currently up to date with the necessary checks carried out. The owners have upgraded the heating system in the home so that this is now consistent. The care records examined were generally improved in that the overall care of the residents could be followed. There remains some work to do however in terms of detailing and reviewing records more thoroughly. There has been some introduction of orientation aids such as appropriate signage to assist residents in getting about the home. Although there are still some gaps in the staff care files the overall standard of the pre employment checks is now satisfactory compared to previously and the manager is making sure that staff employed are suitable to work with vulnerable people. Staff files also included copies of staff supervision notes evidencing that care staff are getting suitable support to enable then to do their job. Staff interviews also confirmed this. What they could do better: A copy of the service user guide [SUG], which is the information guide to the home, could not be produced for the inspector without the manager having to access her computer and print one off. This facility is unavailable when the manager is not available and therefore it is recommended that copies of the SUG are left easily accessible for staff and visitors. The plan of care for residents varied in the amount of detail recorded as necessary to carry out the care. For example one care plan covers a period of over 2 years. Some care needs are dated from 2005 and more recently January 2008. This is over four care plan sheets. The care can be followed in broad outline but sometimes details are missing so that it was not possible to tell whether some care needs were still current. On another care plan the moving and handling assessment was included on the plan and had last been updated on 27.11.07 and states that two care staff can move and transfer the resident. Staff interviews indicated that the hoist is used for some of the time however and the observations by the inspector and relative comments clearly indicate that the resident cannot bear his own weight. It is a requirement that this residents care plan be updated accordingly. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 8 Evaluations of the care are sporadic and there is no real indication that relatives are included in this on an ongoing basis. A social care professional was also consulted and felt hat the home had overall given good care to one resident reviewed although comments were made about some of the detail in the care records. Medication administration standards are good but there are a few recommendations for good practice listed at the end of the report. Some residents were observed t be not as appropriately dressed as others. For example one resident with very creased trousers and others who looked a little dishevelled. This did not maintain his or their dignity. It was noted that the home was short of care staff on that particular morning and the general good standard as evidenced by comments from relatives had not been maintained. It was observed that the vegetables served at dinner were cooked from frozen. The inspector was informed by the manager that the home does not order any fresh vegetables. This needs to be reviewed in terms of offering choice and quality. There remains a lack of orientation aids available despite the introduction of some signage to assist residents. There should be much more in terms of brightening up the environment and providing visual [and auditory – radio for example] cues and prompts so that residents who are disorientated can be enabled to both find their way around and to be more aware of their surroundings. Access to the garden area has only partially been addressed with the introduction of some fencing. This area needs to be assessed for risk and an action plan made so that the garden can be made more accessible to residents and therefore improves their quality of life. At the time of the inspection the home were experiencing staffing difficulties with reduced care and ancillary staff input. There was some discussion with the manager around the issue of staffing as this seems to be the main barrier to any continued progress in the home and is cited by the manager as such. There needs to be regular and consistent staff to ensure the home meets consistent standards. It was difficult for the manager to evidence some of the ‘statutory’ training such as fire safety and manual handling that all staff should receive. Similarly the induction programme for staff was evidenced from staff interviews but these were inconsistent and there was a lack of further evidence from any staff records. It remains a requirement that accurate training records are maintained. NVQ training is offered to staff but presently there are only 30 that have at least at level 2 in this qualification. This should be developed further over the Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 9 next 6 – 12 months so that a higher percentage of the staff are trained to care for the people in the home. There is a general lack of any further development in terms of quality assurance systems in the home. The development of further quality assurance processes and internal auditing can serve to both monitor and provide feedback for improvements. The fire records still need to be tightened up with respect to regular recorded checks on a monthly basis for fire extinguishers and the recording of fire safety training. The records could not be produced on this inspection. Overall the management systems and documentation are patchy and need organising. 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. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 10 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.V361858.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Appropriate assessments are carried out by the home, which include social service and / or health assessments so that the home is better able to ensure care needs will be met. EVIDENCE: The policy of the home is for all residents to receive a preadmission assessment prior to entering the home so that their care needs can be assessed. Three care files were inspected including one resident who was a new admission. The admission assessments were present and covered mental state assessments as well as personal care needs. There were also referring assessments from social workers. This is to establish the care needs and draw up a care plan. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 12 The relatives spoken with said that the home had been helpful at the time of admission and staff had explained any details. They also felt that they had received enough information. The manager stated: ‘We invite prospective residents to visit without an appointment and invite the prospective SU to stay with us for an appropriate time to enable a choice to be made. If possible at the time of the vist we will introduce them to service users or visitors at the time. We always try to give the number of the room at the time of the initial visit At that time we provide a Service User Guide and a Brochure and encourage self funders to contact social services for a financial assesment and guidance’. The manager stated that a copy of the service user guide [SUG] was always given to any person making an enquiry. A copy of this could not be produced for the inspector however without the manager having to access her computer and print one off. This facility is unavailable when the manager is not available and therefore it is recommended that copies of the SUG are left easily accessible for staff and visitors. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home manages the health and personal care needs of residents satisfactorily so that care needs are respected and met safely. EVIDENCE: The plan of care for two residents was seen on the inspection. These varied in the amount of detail recorded as necessary to carry out the care although it was possible to track the overall care over a large time frame. For example one care plan covers a period of over 2 years. Some care needs are dated from 2005 and more recently January 2008. This is over four care plan sheets. The care can be followed in broad outline but sometimes details are missing so that it was not possible to tell whether some care needs were still current. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 14 A good example of how the home manages health care needs for example was the comment ‘sleepy and off food’ made on the care plan sheet. This was very quickly actioned and the GP was called in the same day and appropriate treatment was given. The home also ‘encouraged fluids’. The evaluation of this was again on the care plan and records: ‘good intake now well’. A good outcome is therefore clearly recorded. On the other hand an entry made on the same plan says ‘socialisation impossible due to advanced dementia’. There is a later evaluation dated 14.7.07 which indicates that the resident gets out occasionally [‘walk if weather is fine’] but there is no further evaluation of this so that thee is no indication as to the progress [or not] made against this need. On another care plan the moving and handling assessment was included on the plan and had last been updated on 27.11.07 and states that two care staff can move and transfer the resident. Staff interviews indicated that the hoist is used for some of the time however and the observations by the inspector and relative comments clearly indicate that the resident cannot bear his own weight. The same resident had a dressing on his arm but there was no record of why or the need for this. It is a requirement that this residents care plan be updated accordingly. It was observed that relatives have signed the care plans as evidence of their input. Evaluations of the care are sporadic however and there is no real indication that relatives are included in this on an ongoing basis. Relatives interviewed were clearly satisfied with the care however and spoke well of the staff’s attention and general attitude: ‘I’m very happy with care. My relative is always clean and tidy. The food is good and he eats well.’ ‘We are always informed what’s going on. 12 months ago x had a bad infection and staff were very quick to get the doctor and get reviewed. Always clean and tidy and clothes are always fresh’. A social care professional was also consulted and felt hat the home had overall given good care to one resident reviewed although comments were made about some of the detail in the care records. Care is also recorded on a daily basis by the staff in the daily diary and daily record sheet. Ongoing evaluations remain inconsistent however as evidenced above. These could be in more depth. There was [again] some discussion as to the need to make written observations with reference to the care plan and for the monthly evaluation to be a record of the progress the resident has made against the aims and objectives of the care plan. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 15 The health care of residents is met with consistency in terms of appropriate referral to health care professionals. The district nurse team are regular visitors and input is recorded in care files. The social care professional spoken with said that the home had been proactive in reporting changes in the behaviour of one resident and a referral for review had been appropriately made. Residents reviewed were receiving their medications safely. The records seen were up to date and the training of the staff that administers medicines is appropriate. Staff reported that they are ‘shadowed’ by the senior staff to ensure competence. It is recommended that a competency assessment be signed off by the managers and kept as part of the training record. The deputy manager carries out regular checks and audits so of the system and it is recommended that this should include a stock check of selected medicines. Other audit details need to be recorded more accurately [i.e. what was checked and found] rather than just ticking the box. One resident has a cream applied daily and the staff who applies this does not record anywhere. This was discussed and the record will be included on the daily diary record. The personal care carried out by staff was observed and residents were treated with patience and respect. The meal time period for example evidenced some residents requiring sustained assistance by staff with feeding and this was carried out with much patience and preserved the dignity of the residents concerned. Residents were seen being assisted to the toilet and those staff interviewed were aware of the need to maintain privacy. One the first day of the inspection the residents were observed directly in terms of their dress and personal hygiene. Some residents were not as appropriately dressed as others. For example one residents with very creased trousers and others who looked a little dishevelled. This did not maintain his or their dignity. some residents needed a shave. Some of the female residents had unkempt hair. This was discussed and it was noted that the home was short of care staff on that particular morning and the general good standard as evidenced by comments from relatives had not been maintained. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to be involved in activities and the daily social life is relaxed but there needs to be further development with reference to good practice in dementia care and the removing of barriers so that residents make use of the facilities in the home. EVIDENCE: The home has a relaxed atmosphere and staff are friendly and welcoming. The social life of the home is organised around the dining room mainly but on this visit it was observed that the lounge / day area was in use with six or seven residents socialising. Social interaction were observed and the general interactions of staff were positive. Staff were supportive to residents and there was a relaxed pace to the care with staff acknowledging residents feelings. Some residents were observed to be displaying a high level of wellbeing and engagement/ Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 17 involvement in terms of reacting to events around them. This was particularly so in the lounge where residents chatted to the inspector. Over the dinner time period there was a good staff presence and residents were offered plenty of support so that those residents who had difficulty were enabled to take their diet. There was some good social interaction. The meal was well presented and a choice was offered. The menu board displayed the days meal but this could not be read due to the board being a dark colour. Residents enjoyed the meal and one commented ‘we always get plenty of food here’. It was observed that the vegetables served were cooked from frozen. The inspector was informed by the manager that the home does not order any fresh vegetables. This needs to be reviewed in terms of offering choice and quality. Staff offered residents an art based activity [colouring] but residents seemed disinterested and some were asleep. There is a general lack of planned activity day to day although staff one to one interactions were good. In the care records seen there was good reference to each individuals life history. There remains a lack of orientation aids available despite the introduction of some signage to assist residents. There should be much more in terms of brightening up the environment and providing visual [and auditory – radio for example] cues and prompts so that residents who are disorientated can be enabled to both find their way around and to be more aware of their surroundings. There is a lack of newspapers, magazines although staff reported that they ‘sometimes bring some in’. Access to the garden area has only partially been addressed with the introduction of some fencing. This area needs to be assessed for risk and an action plan made so that the garden can be made more accessible to residents and therefore improves their quality of life. Information from relatives is that the home has an open policy of visiting and that staff are always welcoming. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure including action for more serious allegations so that residents rights are upheld and people feel that concerns are addressed. EVIDENCE: The home have a complaints procedure and this is in the information guides available in the home. Staff interviewed were aware of the complaints procedure and relatives feel that the managers were appoachable and any issues would be addressed. The complaints proceedure is not actually displayed any where in the home and tis is recommended. There is a complaints file used to monitor any complaints. There have been no complaints since the last inspection and the manager asserts that this is an indicator of how the home has progressed. The last recorded comlaints were about lighting at the front of the home and the lack of a door bell and these have been addressed. Complaints prior to this have been noted to be investigated by the manager and reported appropriately. Staff reported some trainign around awarness of abuse and poor practice and how this relates to local policy in reporting abuse although not all staff said that they have had this. Staff spoken to were able to understand the process Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 19 of reporting abuse or mistreatment. The inspector asked for training records to show that all staff have undergone such training and these could not be produced. It is important that records evidence this so that staff can be continully monitored and updated as needed. From discussion with the manager it is apparent that there is a good understanding of the rights of people with dementia in the area of autonomy and decision-making: ‘The home adopts the view that the service users although assessed by professionals as not being competant to make decisions about advanced directives or about major issues of personal safety are capable of choosing what they would like to eat and when and if they wish to join an activity or not: and that their capacity in this type of decision may vary from day to day.’ Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the environment of the home and the management/provider are continuing the process of upgrading so that residents live in comfortable surroundings. EVIDENCE: The general internal environment of the home has considerably been upgraded over the past two inspections and now presents as more homely. This has included the upgrading of flooring in much of the home including some of the bedrooms. There has been some décor completed. The new shower room on the ground floor has been a big improvement and the pervasive odour that was evident in the home is no longer present. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 21 The home was generally clean although the staff hours for domestic duties have been dramatically reduced recently due to the staff shortages in the home and the need for staff to ‘double up’ on various jobs. Similarly there is a currently no maintenance person and this role was being interviewed for at the time of the inspection. All bathrooms and toilets seen were now functional and maintained for residents use. There are some areas still needing attention [such as the carpet in the dining room which is worn and stained and retains an unpleasant odour] but following discussion it is clear that the provider / manager intend to carry on the work [although this was mentioned on the previous visit]. The external gardens have been commented on previously and are still inaccessible for residents without staff escort. The requirements to develop safe access to the garden remain. In terms of quality there is still a need to develop some orientation aids and this has been discussed earlier under ‘daily life and social activities’. The dining area is the main area to now concentrate on internally in terms of making it more homely. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are inconsistencies in the training and retention of staff in the home which can reflect in the quality of care at times and is a major barrier to the general progression of care standards. EVIDENCE: The last inspection carried out in October 2007 evidenced improved staffing in the home throughout and the subsequent effect on the care in the home and the general management was positive. On this inspection it was very noticeable that the staffing in the home is again an issue. On the first day of the visit, which was unannounced, the care staff on duty consisted of three in total for 21 residents in the morning. The staff in charge pointed out that a member of staff had rung in sick. The ability of the home to cover staff sickness at short notice is poor as the pool of current staff is limited. The manager came in at approximately 10am and had arranged interviews for maintenance person [short of a maintenance person for some time] and cook. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 23 Currently the person who normally takes on the domestic role is covering all of these posts. There was some discussion with the manager around the issue of staffing as this seems to be the main barrier to any continued progress in the home and is cited by the manager in the AQAA return as such. Staffing inconsistency has also been an issue on previous inspections. As a result [for example] the manager’s time over the two days of the visit was wholly engaged in staff recruitment as opposed to any developmental or quality planning. The manager was able to show some evidence from staff files of the ongoing training in the home. A training schedule has been drawn up for various external and internal training over the next few months. Staff spoken to had already undertaken some of this training and feel that the manager does try and ensure regular training. There was also evidence that staff are given appropriate supervision so that they can be supported in the work that they do. It was difficult for the manager to evidence some of the ‘statutory’ training such as fire safety and manual handling that all staff should receive and the compilation of a training matrix, which can be continually, updated was discussed and is recommended for monitoring purposes. Similarly the induction programme for staff was evidenced from staff interviews but these were inconsistent and there was a lack of further evidence from any staff records. One identified staff member had worked for 6 months but there was no record of induction training. This was discussed on the last inspection and it remains a requirement that accurate training records are maintained. NVQ training is offered to staff but presently there are only 30 that have at least at level 2 in this qualification. This should be developed further over the next 6 – 12 months so that a higher percentage of the staff are trained to care for the people in the home. The staff files evidenced appropriate recruitment checks had been made prior to employing staff in the home. Staff files were complete in the detail required and this is an improvement on the previous inspection. Some recommendations however, are that references are clearly signed and dated and there is a place on the form to identify who the referee is. This was not clear on some of the references seen. The feedback from relatives was positive and staff are seen as caring and interested in their work. Observed care [see previous comments] was also positive. Staff interviewed were clearly interested in their work and generally felt supported by the managers despite the difficulties. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 24 Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is evidence of some internal quality systems developing but they inconsistent and patchy and further organisation is required so that the home can better act in the interests of the residents. EVIDENCE: The homes proprieter, Mrs Maureen Bromley, is the registered manager. She has many years experience in the home and also has a general nursing qualification [RN]. The deputy manager also plays an important role in the running of the home. Mr Malkandi, also provider, assists in an administration role. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 26 Staff interiewed felt supported by the manager and felt that they could approach her and the deputy for help and assistance. On the previous inspection the management where able to evidence improvement against the requirements listed on inspection reports and had improved the staffing. On this inspection there has been a lack of progress in key areas although the homes environment has been addressed satisfactorily. The maintenance of a consistent staff team is a priority if any progress is to be made. This inconsistency affects all parts of the running of the home. It is to the staffs credit that a degree of consistency in the general care has been maintained. There is a general lack of any further development in terms of quality assurance systems in the home. The manager tends to rely on informal feedback through discussion with relatives and visitors rather than any formal processes – internally or externally - in the form of quality audits. The manager has previously stated: ‘Our RNHA Blue Cross Mark of Exellence ISO 900 is in the process of updating and we are working toward recognition. We have Purchased the RBS Monitor System to modernise our Conract Law and Personel Systems and their Health and Safety systems to modernise all our health and safety issues and risk assesments. These are in place since July2007 and I am working with consultants on the new hand books’.[AQAA] The manager was not able to evidence any progress on the above however. The development of further quality assurance processes and internal auditing can serve to both monitor and provide feedback for further improvements. The manager has started to audit medication and care planning for example although these were discussed and the tools used need to include the evidence available when carrying out the audit so that better feedback can be obtained. The management of resident’s monies was not assessed on this visit. The home includes smaller items such as toiletries and small outings in the fees of the home. More substantial purchases such as clothing is billed to families through the homes finance officer. Staff do not handle residents money and the practice is for relatives to manage all monies. This has been evidenced on the previous inspection. There were no issues raised by relatives around the management of monies. The health and safety records were seen. The fire records still need to be tightened up with respect to regular recorded checks on a monthly basis for Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 27 fire extinguishers and the recording of fire safety training. The records could not be produced on this inspection. A regular environmental risk assessment has been recorded so that any environmental risks can be picked up and appropriate action taken. Overall the management systems and documentation are patchy and need organising. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement The care plans must be regularly updated and include all care needs. Evaluations must be recorded regularly and all care needs updated and reviewed clearly so that the care can be monitored and applied consistently. The care plan of the resident discussed in terms of moving and handling must be reviewed and updated to include the use of the hoist so that staff approach is consistent. External grounds which are suitable for, and safe for use, service users are provided and appropriately maintained; therefore the garden area must be made accessible and safe for residents with particular [Last requirement date 01/03/08 not met] 4 OP27 18(1)a The registered person must ensure that at all times there is suitable staff employed to meet service user needs. This includes DS0000005467.V361858.R01.S.doc Timescale for action 01/07/08 2 OP7 15 01/05/08 3 OP19 23134 01/07/08 01/06/08 Prospect House Nursing Home Version 5.2 Page 30 both care and ancillary staff so that there is enough staff employed to ensure consistent standards in the home. 5 OP30 18(1) c Persons employed in the care home must receive training appropriate to their work. Therefore training records must evidence training completed for all staff. Induction programmes must be updated to meet skills for care standards. This ensures that staff have received appropriate training to meet the needs of the residents. [Last requirement date 01/03/08 not met] 6 OP38 23(4) All fire records must be maintained up to date so that all fire safety systems can be monitored satisfactorily and safety ensured. 01/05/08 01/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP9 Good Practice Recommendations There should be a readily available copy of the service user guide available for any visitor to access. The medication audit should include a routine stock check A competency assessment of staff giving medicines should be signed of by the management and retained on the staff file. A record of any cream being applied should be made so it is clear which staff have administered. Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 31 3 4 OP12 OP15 Activities should continue to be developed with reference to good practice in dementia care. The menu should be reviewed and the introduction of fresh vegetables actioned. The menu board should be changed to a more suitable type that can be more easily seen by residents. It is recommended that the complaints procedure be displayed in the home. Staff training records need to indicate up to date training for staff around safeguarding issues and the reporting of abuse. The dining area is the part of the home internally that should now receive some upgrading in terms of good practice guidance for dementia care and making it more homely. The carpet is badly stained and needs replacing. The home should have 50 care staff trained to NVQ level to meet this standard. References need to be signed and dated. There should be room on the form to include details of the identity of the referee. The induction of staff should be recorded fully and this should take place over a 6-8 week time frame rather than the current 5-6 month average. The quality assurance systems in the home should be developed so that the home can assess and evidence continued progress. Monthly checks on fire extinguishers [see schedules] should be recorded. 5 6 7 OP16 OP18 OP19 8 9 10 11 12 OP28 OP29 OP30 OP33 OP38 Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Prospect House Nursing Home DS0000005467.V361858.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!