Inspection on 25/05/06 for Prospect House Care Home

This inspection was carried out on 25th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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 Mr Mike Perry Unannounced Inspection 25th May 2006 09:00 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.V298895.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.V298895.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 0151 4932626 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.V298895.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 20.12.05 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 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 £384 per week. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the entire core Standards the home is expected to achieve. The inspection took place over a period of 10.5 hours over 2 days. The inspector met with the majority of residents and spoke with a number of residents and a number of relatives and visitors [6] by phone or who were visiting the home. The inspector also spoke with members of care staff on a one to one basis [8] and the registered manager. A tour of the premises was carried out and this covered all areas of the home including the resident’s rooms [not all bedrooms were seen]. Records were examined and these included three of the resident’s care plans, staff files, staff training records and health and safety records. What the service does well: The home provides good information for prospective residents and their relatives so that an effective chioce can be made to move into the home. 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. All residents have a care plan and these were appropiate in that they covered the needs of the residents. Relatives interviewed generally felt that they are kept informed of any changes in care. It was clear from the care records that residents have regular access to GP services as well as district nurse and community psychiatry if needed. One resident was having regular visits from district nurses who were reviewing a dressing. The medication process was reviewed and found to be satisfactory. It was clear that residents are reviewed by GPs on a fairly regular basis regarding medication. Records seen were very clear in their recording. Most of the residents in the home require quiet high levels of personal care. All residents seen were presented well in terms of dress and personal hygiene. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 6 Relatives spoken to were able to relate examples of how staff had dealth with some difficult circumstances involving resident care and had been carefull to try and maintain residents dignity and respect. There is an activities cupboard with a collection of various games etc. which staff use to engage residents with. Relatives reported some regular events such as visiting entertainers. The home was described by all of those spoken to as homely and friendly and relaxed. Relatives spoke about staff always having time to speak. They were described as very approachable and like family by more than one relative. Residents and relatives described the food as very good. There is a choice offered and the diet is well balanced. There is a complaints procedure including action for more serious allegations so that residents rights are upheld and people feel that concerns are addressed. Staff interiewed felt supported by the manager and felt that they could approach her and the deputy for help and assistance. It was observed that both managers had a good rapport with residents and visitors and were skilled in reasuring residents in daily interactions. What has improved since the last inspection? Following requirments previosly the staff are more ware of the needs of people with dementia because of the training the home have completed although this still needs to improve further. Following reqiuirment from the previos inspection there has been an increase in the amount of training for staff. Staff interviews confirmed attendance at training courses and this was supported by reference to staff files. The NVQ assesssor was in the home and reported that the managers are keen to support staff training. Staff files were reviewed and evidenced that new staff are recruited with appropiatre checks made. This is following a requirment previosly. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 7 What they could do better: There are some amendaments needed to the information the home puts out to clarify the homes identity as a Care Home rather than a nursing home so that confusion can avioded. There is a need to ensure that all residents and new addmissions recieve terms and conditions of residency. The staff have now listed dates for evaluations of the care plan on a monthly basis. There are no written records of an evauation however which should be a record of any progress made set against the objectives of the care plan. Although staff are aware on a daily care basis, there are improvments needed to the general environment in the home such as locks on toilet doors, personalisation of bedrooms, and environmental cues to promote both privacy and dignity for residents. There are many barriers in the environment that need to be addressed in terms of improving the quality of the social experience in the home. For example residents were observed to be wandering and getting agitated in the dining room and one wanted to get outside to the adjoining garden but was restricted as the garden area has not been made safe. There is a need to develop a more suitable environment for people with dementia so that there is a better chance of encouraging individualised person centred care and improving the quality of life for residents. The home has many positive points; for example the rural setting of the home and the garden areas can be used creativly to ensure a positive experience but these have not been developed so that they can be accessed safely. The day areas are varied and, again, could be better used. There was much discussion with the managers who were receptive to sugestions made. There remain some outstanding requirments which are possibly the result of a current lack of lateral / creative thinking rather that a lack of volition in this area as the managers and staff expressed a wish to provide the best care. An improvement plan has been requested and the management must attend to this as a priority Although some activities have been developed for residents this should be improved further. Access to information [periodicals, courses] on activities was suggested. Most meals are served in the dining room, which is very stark and can be crowded. There was some discussion as how the mealtime experience could be improved. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 8 Quality assurance processess were discussed. The managers are guilty of the fact that requirments from previous inspections have not been attended to in full and remain oustanding. The processess for gaining insight and views of residents and relatives remain fairy informal and could be better developed. There was some discussion around the possible use of a more appropiate external QA system that looks at clinical outcomes and is able to gain resident and relative veiws. A more sytematic risk assessment process in regard to health and saftey was suggested and this should be recorded monthly with all areas of the home visited. Documented risk assessment need to cover window openings above ground floor. 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.V298895.R01.S.doc Version 5.2 Page 9 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.V298895.R01.S.doc Version 5.2 Page 10 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): 1,3, standard 6 not applicable The quality in this outcome area is adequate. The home provides good information for prospective residents and their relatives so that an effective chioce can be made to move into the home. There are some amendaments needed to clarify the homes identity and also a need to ensure all residents and new addmissions recieve terms and conditions of residency 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. Following requirments previosly the staff are more ware of the needs of people with dementia although this still needs to improve. EVIDENCE: There is a written guide to the home [service users guide] together with a philosophy of care and customer charter that aim to tell prospective residents and thier supporters about the home and its staff and facilities. Relatives Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 11 spoken to were happy that they had this information and that the managers had spent some time answering any queries they had during the admission process. The stationary and entrance sign to the home still refer to Prospect House as a nursing home. The home provides for personal care only and this can therefore cause some confusion. Relatives interviewed refered to carers as nurses. Some relatives interviewed said that they had not a contract following addmission. Following discussion it became evident that residents funded by social services should recieve a contract from social services but this did not contain any terms and conditions of residency. All residents have a preadmission assessment completed prior to moving into the home. Care files contain copies of social work assessments and health assessments if needed. Further assessments are carried out in house once addmitted and include activities assessment [ following requirments from the previous inspection], nutrition, falls, moving and handling and pressure sore risk. following requirement from the previos inspection some of the staff have been on training courses in dementia care [ 5-6 staff in total] and were better able to understand [when spoken to] the basics of dementia care alhthough staff were still of the opinion that people with dementia were dificult to do anything with and there remains little evidence in terms of staff enabling residents through modifying the environment [see envinmental outcomes] to suggest that there is a full understanding of care needs for this specific group. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 12 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 quality in this outcome area is adequate. The home manages the health care needs of residents satisfactorily. care needs are included on care plans and are monitored although improvments can be made in the quality of the evaluation process and the way that care plans are accessed on a daily basis. Staff attend to peronal care needs and these are met consistently. They are tempered with the environmental improvments needed to maintain dignity and privacy. EVIDENCE: All residents have a care plan. 3 care plans were reviewed and were appropiate in that they covered the needs of the residents. some care plans were signed by relatives and relatives interviewed generally felt that they are kept informed of any changes in care. The home have a key worker system and a formal system of care reviews have started so that relatives can have more formal input if they wish. Following requirments from the previos inspection the staff have now listed dates for evaluations of the care plan on a monthly basis. There are no written Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 13 records of an evauation however which should be a record of any progress made set against the objectives of the care plan. It was agreed that these would be recorded in the daily records and the date refernced on the care plan or evaluation sheet. Daily records are recorded by care staff but there seems to be little reference to the care plan. The care plan is not obviosly located in the care file and should be made more prominent so that it can be used on a daily basis. It was clear from the care records that residents have regular access to GP services as well as district nurse and community psychiatry if needed. One resident was having regular visits from district nurses who were reviewing a dressing. The medication process was reviewed and found to be satisfactory. There are no residents self medicating due to their mental state. It was clear that residents are reviewed by GPs on a fairly regular basis regarding medication. Medication records seen were very clear in their recording. There was some discussion around the prescribing of infrequently given medication [PRN] and the understanding of staff as to when this should be given. Clarification should be agreed with the GP and guidence should be given in the care plan so that all staff are aware. Currently the suplying pharmacist does not carry out routine auditing of the medicine policy in the home and this is indicated as a quality assurance initiative. Most of the residents in the home require quiet high levels of personal care. All residents seen were presented well in terms of dress and personal hygiene. Staff were able to discuss the importance of trying to get residents to choose there own daily cothing. Relatives spoken to were able to relate examples of how staff had dealth with some difficult circumstances involving resident care and had been carefull to try and maintain residents dignity and respect. There are, however, improvments needed to the general environment in the home such as locks on toilet doors, personalisation of bedrooms, and environmental cues to promote both privacy and dignity for residents [ see environment]. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 14 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 quality in this outcome area is adequate. Residents are supported to be involved in activities but these need to be more varied and perhaps centred on the use of environmental cues and a removing barriers so that residents make use of the facilities in the home. A choice of good quality home cooked food is provided to the residents. There is a need to work at improving the mealtime experience in terms of the surroundings so that meals can be more relaxed. EVIDENCE: Staff interviewed stated that there are activities for residents in the home. There is an activities cupboard with a collection of various games etc. which staff use to engage residents with. Relatives reported some regular events such as visiting entertainers. Relatives also enjoyed the rural surroundings and occasionally escorted their relative on a walk in the grounds. The home was described by all of those spoken to as homely and friendly and relaxed. Relatives spoke about staff always having time to speak. One relative described how the home had ensured he could enjoy Christmas dinner with his wife and was very pleased with the effort the home had gone to. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 15 Some of the home offers a therapeutic environment in terms of socialisation; for example the corridor area is useful for exercise and the small TV lounge is relaxing and well appointed with appropriate furnishings. The Rose room at the front of the home offers some privacy for visitors. There are many barriers in the environment however that need to be addressed in terms of improving the quality of the social experience in the home. For example residents were observed to be wandering and getting agitated in the dining room and one wanted to get outside to the adjoining garden but was restricted as the garden area has not been made safe [see environment]. Staff were keen to develop ideas for activities on a daily basis but felt that it was difficult to do anything with people with dementia. Access to information [periodicals, courses] on activities was suggested. There is reference in care plans to residents diet and nutrition. There are written menus and residents are asked for choice of meal. Residents and relatives described the food as very good. Most meals are served in the dining room, which is very stark and can be crowded. Limited setting of tables is encouraged just prior to serving meals. There was some discussion as how the mealtime experience could be improved [displaying of menus, brighter décor in the dining room, greater use of other day areas to serve meals]. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 16 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): 16,18 The quality in this outcome area is adequate. There is a complaints procedure including action for more serious allegations so that residents rights are upheld and people feel that concerns are addressed. The issue of formal training for abuse awareness for staff still needs to be addressed. EVIDENCE: The home have a complaints procedure and this is in the information available in the home. A recent and ongoing complaint was discussed and the process of investigating this by the managers would seem to be appropiate. Staff intrviewed were aware of the complaints procedure and relatives felt that the managers were appoachable and any issues would be addressed. Following a requirment in the last report there has been some inhouse training around awarness of abuse and poor practice and how this relates to local policy in reporting abuse. It is important that all staff attend external courses run by, for example, social services. During the inspection one resident was being supported by social service finance officers who reported that the home are very clear in their understanding of the residents rights in this area and proactive in ensuring the correct representation. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 17 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): 19,26 The quality in this outcome area is poor and is based on current available evidence. The home need to develop an improvment plan that removes the current barriers to appropiate dementia care so that residents can experience a better feeling of well being. EVIDENCE: Over all the envirenment is the main outcome group of standards that the home need to work on and develop. There is a need to develop a more suitable environment for people with dementia so that there is a better chance of encouraging individualised person centred care and improving the quality of life for residents. This group of residents, more than any other, rely on bright, homley surroundings with the right environmental cues available to aid orientation and a feeling of well being. The home has many positive points in this area. For example the rural setting of the home and the garden areas can be used creativly to ensure a positive experience but these have not been developed so that they can be accessed safely. The day areas are varied and, Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 18 again, could be better used. There was much discussion with the managers who were receptive to sugestions made. There remain some outstanding requirments which are possibly the result of a current lack of lateral / creative thinking rather that a lack of volition in this area as the mangers and staff expressed a wish to provide the best care. The following are some observations and suggestions for improvments. The requirment is for the managers and staff to develop an improvment plan with time scales to meet the standards. * The garden needs to be made safe and accessible for residents so that this can be an extension of the dining room and residents can experience more space. Fencing needs to be provided and trip hazards reduced as much as possible. * The internal decor needs to be made bright and homley but less stark. This can be achieved with signs for day areas and tiolets bathrooms, pictures [reminiscence themes] and orientation boards including menu board in the dining room. [One resident was observed coming out of his bedroom and was looking for toilet but could not find it without escort] * Varios points of interest for residents such as safe ornaments and rummage boxes and cupboards that residents can safley access. * The smell of urine can be quiet strong at times and, although very pleased with the general care, this was commented on by relatives. The cleaning rota can perhaps be reviewed although the problem is possibly one of poor ventilation and carpets which have become impregnated with the odour. The ventilation system needs reviewing with the extractor in the bathroom upgraded [currently not working at all] and liason with the fire authorities to get fire doors along corridoors wired into the alarm system so that they can remain open creating both free movment of air as well as removing a barrier for residents who may wander to other day areas in the home instead of feeling restricted to the dining room. More appropiate fllooring for areas of greater traffic need to be considered. * There must be appropiate locks fited to all toilets an bathrooms to ensure privacy for residents. * Bedrooms need personalising. Some rooms are very poorly furnished and very stark in appearance. Relatives support is needed to create a more homely environment. Residents names / photos etc can be put on the outside of doors [ the idea of memory boxes were discussed.] * One room discussed must have the carpet replaced. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 19 These are some ideas. There is usfull guidence available [ Web, periodicals such as dementia care magazine, recent NICE - SCIE draft guidance suporting people with dementia should be consulted] Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 20 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 quality in this outcome area is good. Staff numbers are appropriate and service user’s needs are being met. Some members of the staff team are being provided with training in dementia care thus enabling them to understand and meet the needs of the residents more effectively Staff are recruited appropriately so that residents are protected. EVIDENCE: For 23 residents at the time of the inspection there were 4 care staff on duty including th manager. The duty rota confirms that these minimum staffing numbers are generally maintained. There was some sickness on the first day of the inspection but this was covered by another staff member. Staff reported that there is enough staff to maintain a standard of care. relatives reported that staff were very able and suportative. They were described as very approachable and like family by more than one relative. Following reqiuirment from the previos inspection there has been an increase in the amount of training for staff. Staff interviews confirmed attendance at training courses and this was supported by reference to staff files. There is Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 21 currently 25 of staff trained to NVQ level and this should rise to over 50 to meet standards. The NVQ assesssor was in the home and reported that the managers are keen to support staff training. Staff files were reviewed [ 4] and evidenced that new staff are recruited with appropiatre checks made [ CRBs were difficult to locate and need filing more appropiatlly]. This is following a requirment previosly. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 22 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 quality of this outcome area is adequate based on available evidence. The managment team ensure there is good basic personal care and that the home is maintained safely. There needs to be more structure around Quality Assurance processess which should aim to gradually improve standards and the quality of life for residents. EVIDENCE: The homes proprioter, Mrs Maureen Bramlow, is the registered manager. She has many years experience of the home and also has a general nursing qualification [RN]. The deputy manager also plays an important role in the running of the home and is currently undertaking the Registered Managers Award [NVQ 4]. Mr Malkandi, also provider, assists in an administration role. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 23 Staff interiewed felt suported by the manager and felt that they could approach her and the deputy for help and assistance. Some reported that formal supervision has started and staff felt suported by this. It was observed that both managers had a good rapport with residents and visitors and were skilled in reasuring residents in daily interactions. The feedback from a social service worker [ finance officer] visiting the home was that the manager is always professional in her approach.The finances of the one resident assessed in this context was appropiate. Quality assurance processess were discussed. The managers are guilty of the fact that requirments from previous inspections have not been attended to in full and remain oustanding. There was also evidence of some disorganisation in the running of daily affairs such as poor filing of CRB certificates, and lack of promptness in completing paperwork for inspection purposes. The processess for gaining insight and views of residents and relatives remain fairy informal and could be better developed. For example resident surveys have not been sent out for over a year an there is little in the way of relative meetings. The home has some external auditing from the Blue Cross and investors in people although have not been audited since 2004. Internal quality audits are infrequent. There was some discussion around the possible use of a more appropiate external QA system that looks at clinical outcomes and is able to gain resident and relative veiws. The deputy manager is the Health and Saftey co ordinator and has attended a recent training course. Saftey certificates seen were upto date and staff reported some awarness training in fire saftey and health and saftey. There were some hazards noted on the tour of the building [ panel side of bath brocken and sharp edged] althouth generally the home has a system of reporting any repairs to the handiman. A more sytematic risk assessment process was suggested and this should be recorded monthly with all areas of the home visited. Documented risk assessment need to cover window openings above ground floor. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 25 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(2)(b) Requirement The manager must ensure that all care plans are reviewed appropriately in that a record is made of the evaluation as discussed set against current individual objectives. [Outstanding from last inspection]. All toilets and bathrooms must have appropriate locks fitted to ensure privacy for residents. The Registered Manager must assess and review the care environment in the home ensuring that the inspectors comments and observations are taken into account and produce an improvement plan with time scales to improve the environment in the home with respect to dementia care. The manager must ensure that the home is maintained free of offensive odours. Proposals to deal with this must be included in the overall improvement plan. [Outstanding from the last DS0000005467.V298895.R01.S.doc Timescale for action 09/07/06 2. 3. OP10 OP19 12 23 09/07/06 15/08/06 4. OP26 13(3) 15/08/06 Prospect House Nursing Home Version 5.2 Page 26 inspection]. 5. OP33 24 The manager must establish a quality monitoring system and annual development plan in accordance with the standard. The quality assurance system in the home should ensure that residents / relatives views are integral. An external QA system is recommended. The health and safety risk assessments carried out monthly must be documented and include reference to window openings above GF level. The registered Person must review all documentation and omit the ‘nursing’ description, which is false under the homes current registration. [This would include the main entrance sign to the home]. 17/07/06 6. OP38 13 09/07/06 7. *RQN CSA Sec 26 17/07/06 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. 4. 5. Refer to Standard OP2 OP4 OP7 OP9 OP9 Good Practice Recommendations All residents [including those who are social service funding] should have a copy of the homes Terms and Conditions of Residency supplied on admission. Extend training in dementia care to all staff. Arrange care files so that the care plan is easier to locate and more prominent [as discussed] Ensure that all PRN medication I referenced in the care plan so that care staff are aware and consistent in their administration of the medication. It is recommended that the supplying pharmacist completes a regular audit of stock and medicines in the DS0000005467.V298895.R01.S.doc Version 5.2 Page 27 Prospect House Nursing Home 6. 7. OP18 OP28 home. All staff should attend external training in local adult protection procedures [check with social services]. The home should have 50 care staff trained to NVQ level to meet this standard. Prospect House Nursing Home DS0000005467.V298895.R01.S.doc Version 5.2 Page 28 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.V298895.R01.S.doc Version 5.2 Page 29 - 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. 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