CARE HOMES FOR OLDER PEOPLE
Prospect House Nursing Home Blundells Lane Rainhill Merseyside L35 6NB Lead Inspector
Mrs Trish Thomas Unannounced Inspection 20th December 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.V274691.R01.S.doc Version 5.1 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.V274691.R01.S.doc Version 5.1 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.V274691.R01.S.doc Version 5.1 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. 01/09/05 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.V274691.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection concentrated on quality of life for residents and on checking requirements from the last inspection. Discussion took place with the manager and two members of staff, time was spent with residents in the dining room and the home’s records relating to care, staffing and health & safety were read. Five residents made brief comment and due to their levels of confusion and capacity, primary evidence of their experiences in the home, was gained through observation and reading care files. What the service does well: What has improved since the last inspection?
The manager said that a replacement freezer was on order. A faulty lamp had been removed from a resident’s bedroom and a headboard had been replaced in another bedroom. The dining room had been decorated and decoration on upper floors, following repairs to the roof, had been carried out. An improvement was noted regarding the problem with offensive odours in some areas of the home. Staffing levels were being maintained in accordance with resident numbers and dependency. First Aid training had been arranged and some training updates had been undertaken. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 6 What they could do better:
The manager must ensure that all care plans are reviewed and that the reviews are ongoing within a twenty-eight day period (maximum period). The manager must arrange for residents’ social preferences to be fully addressed in their care plans, and acted upon. In meeting these requirements the manager will ensure that care plans fully reflect residents’ health, personal care and social needs. The manager must assess the use communal areas/ facilities in the home and arrange for them to be used in a way, which promotes a comfortable and stimulating environment for residents. Written confirmation of the outcomes to be provided to CSCI by the date stated. In meeting the requirement the manager will ensure that the environment is comfortable and stimulating for residents and provides areas for activities which meet the preferences recorded on care plans. The manager must arrange for all care staff to undertake dementia training. In meeting this standard, the manager will ensure that the service is meeting the residents’ needs, and home’s registered category, aims and objectives. The manager must arrange for the repair/replacement, (where worn) of the kitchen floor covering. The manager must ensure that staff have completed training in Infection Control. In meeting the requirements the manager will avoid a future tripping/infection hazard and ensure that staff are aware of the means of preventing infection. The manager must ensure that all staff have undertaken training in Protection of Vulnerable Adults. The manager must not employ staff without having obtained the information required in Schedule 2(1-7) Care Home Regulations 2001. In meeting the requirements the manager will ensure that residents are protected through the home’s training and recruitment policies. The manager must arrange for fire drills and instruction to be accurately recorded in the fire book and must ensure that fire system tests are carried out weekly. In meeting this requirement the manager will ensure that residents are protected from the risk of fire in the home and give evidence of staff competence in case of fire. To ensure that arranged training is carried out, it is recommended that the manager arranges updated medication instruction with the pharmacist and that staff undertake updated First Aid Training. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 7 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.V274691.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 The home was not meeting standard 4 as all care staff had not received training in dementia care. The home does not provide intermediate care and will not be measured against standard 6. EVIDENCE: In discussion with the manager, Mrs. Bromley, she said that staff had not received dementia training and that this had been arranged for January 06. From direct observation of an incident with one resident in the dining room, it was evident that staff skills and abilities vary, with regards to managing challenging behaviour. The home was measured against standard 3 during the last inspection and was meeting the standard. Residents care files contained professional assessments on admission to Prospect House. There was evidence of ongoing assessment post admission by home’s staff.
Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 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. The home was not meeting standard 7. All residents have a care plan but shortfalls were noted regarding care plan review periods and planning for residents’ social needs. The home was meeting standards 8 and 9, regarding residents’ access to health and paramedical services and management of residents’ prescribed medication. EVIDENCE: A sample of four care plans was read. One of the care plans seen, had last been reviewed on 5/10/05. A requirement from the last inspection is repeated with extended time limits given. There is provision in the care planning process, to address the individual’s personal care, social and mental health needs. In one instance the activities care plan had not been completed for the resident and a requirement is given. 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.
Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 11 The manager said that from January 06, to avoid a conflict of interests, alternative arrangements would be in place for G.P. cover for the home. There was evidence in care plans that residents have access to a G.P. and paramedical services, district nursing services, and continence advisers. The home has a procedure in place for the management of residents’ medication and records and storage were satisfactory at this time. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 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): 12,13,14,15 The home was not meeting standards 12 as to lifestyle in the home. The home was meeting standards 13,14 and 15 regarding residents’ contacts and representation and their meals. EVIDENCE: Standards 12. The home is providing a residential service for 24 people with dementia. There is a range of games and crafts in the home, which are aimed at engaging residents’ skills and interests. The manager said that activities take place after 10.30am to lunch, after lunch to teatime and in the evening. At the time of inspection, there were not enough easy chairs on the ground floor (dining/lounge areas) to accommodate 24 residents, and some were spending much of the time seated on dining chairs at the dining tables, with little stimulation. There is a corridor leading from the dining room to the entrance, which provides internal space for residents to exercise. There is level access to the garden from the dining room. There is a lounge near the front of the building but this room was either not occupied, or used for staff breaks, during the inspection. A member of staff said that residents are brought into this lounge in the evening. There is an additional room at the front, where a resident was seen seated in her wheelchair, entertaining visitors.
Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 13 This room has low wicker furniture, which may not be suitable for residents who have poor mobility. Through reading care plans and observing the environment and home’s routines, there was evidence of these shortfalls relating to the standard. There was also positive evidence of friendships between residents and of support for residents’ religious observances. A number of social events had been planned for Christmas, including a pantomime and supper, visiting entertainer, prize bingo, religious service and a visit from Father Christmas. There was evidence of representation for residents, and access to advocacy on care plans and of regular visits from family and friends to the home. There was reference in care plans to residents’ diet and nutrition. The manager said there had been a recent review of the content of meals served in the home. There are written menus and a residents’ meal list, where their daily preferences are recorded. The home was catering for two residents on diabetic diets. There were good food stocks and menus for Christmas had been planned. The dining area has been decorated since the last inspection. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 14 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): 18 The home has Adult Protection and “Whistle Blowing” policies, but was not meeting standard 18 with regards to related training. Standard 16 was assessed as satisfactory during the last inspection. EVIDENCE: Standard 18. Reference was made to staff files and a member of staff commented. There was no evidence that all staff have completed training in Protection of Vulnerable Adults and a requirement is given. Standard 16. There has been one complaint to CSCI relating to Prospect House since the last inspection and a provider investigation was in progress. The manager said that she had looked into the concerns, which had been expressed by the complainant, and would respond to CSCI in due course. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 15 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 standard 19 as some requirements from the last inspection have not been met. There are not sufficient easy chairs on the ground floor for the registered number of residents, and a requirement is made that these be provided. The home was meeting standard 25 with regards to kitchen ventilation. The home was not meeting standard 26 regarding training in infection control and an outstanding requirement from the last inspection. EVIDENCE: Standard 19. Requirements from the last inspection were discussed with the manager. Mrs. Bromley said that the faulty lamp had been removed from a resident’s bedroom (as required) and the headboard in another bedroom had been replaced (as recommended). Outstanding requirements relating to replacing the freezer and kitchen flooring are repeated in this report with extended time limits given.
Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 16 Standard 25. The manager said that in response to a recommendation under 25.2 (as to ventilation), she had contacted the Environmental Health officer. The advice given was that, as the kitchen has an air exchange system, a fly screen is not necessary, as the window may remain closed. Standard 26. The home looked clean and tidy in the areas visited. The home was not completely odour free but an improvement was noted since the last inspection. The requirement from the last inspection is repeated with extended time limit given. The home employs a full time domestic and a laundry assistant. A member of staff spoken with had not received training in infection control and a requirement is made that this training be completed by staff who have not done so. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 17 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): 27,28,29,30 The home was meeting standards 27 and 28 regarding staff numbers and NVQ training. The home was not meeting standards 29 and 30 as there were shortfalls noted in staff vetting and training. EVIDENCE: Standards 27 and 28. Reference was made to staff rosters and staffing levels were being satisfactorily maintained. Mrs. Bromley said that the home was meeting the over 50 ratio in NVQ training. Standards 29 and 30. A requirement from the last inspection relating to vetting of a member of staff remains outstanding with an extended time limit given. A recommendation relating First Aid training is repeated in this report. The manager said that this training had been arranged but had not yet been completed by staff. The manager said that staff who administer medication have received ongoing medication training but the last session was cancelled by the trainer. A recommendation is given that medication training be rearranged. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 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): 31,33,35,38. The home was meeting standards 31 and 35. The home was not meeting standards 33 and 38. EVIDENCE: Standard 31. The home’s proprietor, Mrs. Maureen Bromley, is the registered manager. She has many years experience in the management of the home and holds a nursing qualification. Areas of management are delegated to the deputy manager, who also provides hands-on care. Staff said they felt supported by the manager and that she is approachable. Mrs. Bromley could discuss residents’ needs in depth and residents were seen entering the office to speak with her. Standard 33. There was no evidence of in depth quality monitoring systems and of an annual development plan, (including the stages of planning, action and review), in accordance with the home’s aims and objectives and outcomes to residents. A recommendation is made in this report.
Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 19 Standard 35. Mrs. Bromley confirmed that finances are not managed on behalf of residents and that their representatives are billed for extras. Relating records were seen. Standard 38. Maintenance certification was up to date. Reference was made to fire safety records and shortfalls were noted with regards to regularity of fire systems test in the home (the last recorded being 5/12/05). These tests are required to be carried out weekly. A requirement from the last inspection is repeated. The last recorded fire instruction in the fire book was 25/2/05. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 20 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 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X 3 2 STAFFING Standard No Score 27 3 28 3 29 2 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.V274691.R01.S.doc Version 5.1 Page 21 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 16 (2)(m) (n) Requirement Timescale for action 20/03/06 2. OP7 15(2)(b) The manager must ensure that residents/representatives are consulted as to their preferred social interests, that these are included in the care plan and acted upon. The manager must ensure that 20/03/06 all care plans are reviewed and that reviews are ongoing within a twenty-eight day period (maximum). Outstanding from last inspection, extended time limit given. The manager must ensure that 20/03/06 all staff have undertaken training in dementia care/challenging behaviour. The manager must assess the use communal areas/ facilities in the home and arrange for them to be used in a way, which promotes a comfortable and stimulating environment for residents. Written confirmation of the outcomes to be provided to CSCI by the date stated. The manager must ensure that
DS0000005467.V274691.R01.S.doc 3. OP4 19(5)(b) 4. OP12 16(2)(c) 20/03/06 5. OP18 13 (6) 20/03/06
Page 22 Prospect House Nursing Home Version 5.1 6. OP19 23(2)(b) 7. 8. OP19 OP19 23 (2) (h) 23(2)(c) all staff have undertaken training in Protection of Vulnerable Adults. The manager must arrange for 20/03/06 the worn floor covering in the kitchen to be repaired/replaced. Outstanding from the last inspection, extended time limit given. The manager must provide an 30/01/06 easy chair in the lounges on the ground floor for each resident. The manager must arrange for 20/03/06 the damaged freezer to be replaced. Outstanding from last inspection, extended time limit given. The manager must ensure that staff have completed training in Infection Control. The manager must ensure that the home is maintained free of offensive odours. Outstanding from the last inspection, extended time limit given. The manager must ensure that the information required in Schedule 2(1-7) is obtained for all staff and made available for inspection by CSCI. Outstanding from the last inspection, extended time limit given. 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. Outstanding from the last inspection, extended time limit given. 20/03/06 25/01/06 9. 10. OP26 OP26 13(3) 13(3) 11. OP29 19 20/03/06 12. OP38 23(4) 20/01/06 Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 23 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 OP30 OP30 OP33 Good Practice Recommendations The manager should contact the pharmacist to arrange updated instruction in medication administration for staff. The manager should ensure that staff receive First Aid training and mandatory updates where these are out of date. The manager should establish a quality monitoring system and annual development plan in accordance with the standard. Prospect House Nursing Home DS0000005467.V274691.R01.S.doc Version 5.1 Page 24 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.V274691.R01.S.doc Version 5.1 Page 25 - 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!
