CARE HOMES FOR OLDER PEOPLE
Prospect House Nursing Home Blundells Lane Rainhill Merseyside L35 6NB Lead Inspector
Mr Mike Perry Unannounced Inspection 10:00 8 January 2007
th 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.V311826.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.V311826.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 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.V311826.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 25th May 2006 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.V311826.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was the second ‘key’ inspection for the service in the space of 9 months and serves as a follow up to the issues raised on the inspection in May 2006 when the home was assessed as having some major issues to deal with in terms of outcomes for people with dementia and was assessed at that time as ‘poor’. The inspection took place over a period of 10 hours over 2 days. The inspector met with the majority of residents and spoke with visitors [health care professional and occupational therapist] who were visiting at the time. The inspector also spoke with members of care and ancillary staff on a one to one basis and the registered manager. Views from relatives were received from the ‘comment’ cards that were issued prior to the inspection; eight of these were returned and comments are 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. Records were examined and these included three of the resident’s care plans, staff files, and staff training records and health and safety records. The main area of concern had been the organisation of the environment of the home with respect to providing a service for people with dementia and the general maintenance and upkeep of the home. An improvement plan was asked for at the time of the last inspection in May 2006 and was finally received just prior to this inspection date. The plan outlined some improvements that will be made but have not yet been actioned. From the inspection there have been some improvements noted but these are very basic and need to be developed further. Overall there is much work still to do in this area and the managers of the home need to be a lot more responsive and focused in their plans. What the service does well: Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 6 All of the comment cards recieved stated that the information given at the point of admission the home including the issuing of contracts was sufficient and that the management were helpful in providing information. 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 so the home are able to assess whether they can meet care needs. All residents have a care plan and these were generally appropriate in that they covered the needs of the residents. Daily records and diaries are usfull for recording personal care given by the care staff. Records are easily accessible and were tidy and easy to find. 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. A visiting nurse was pleased with the way the home refered residents and felt that staff were diligent in carrying out any instructions. 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. Medication records seen were very clear in their recording. A recommendation was made about PRN [give when necessary medication but standards overall are safe]. All residents seen were presented satisfactorly in terms of dress and personal hygiene and staff were observed to be attending to residents promply in the dining room area where most residents seem to congregate. On the first day of the inspection the staff were involving some residents in an art activity and residents were observed to be benefiting from the social interaction. Resident files were observed to have activity plans and some activities are recorded on the daily diary notes by care staff. The staff should continue to develop activities. Staff were observed to be interacting appropriately and some were skilled and supportative. 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 are appoachable and any issues would be addressed. For 20 residents at the time of the inspection there were 5 care staff on duty including the manager [first day of the inspection]. The duty rota confirms that these minimum care staffing numbers are generally maintained. Relatives reported on the comment cards that staff are supportative. They were described as very approachable and caring. Staff interiewed felt supported by the manager and felt that they could approach her and the deputy for help and assistance.
Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Staff interviewed varied in there understanding of the needs of people with dementia. Needs such as continence management were sometimes veiwed negativly and there remains little evidence in terms of staff enabling residents through modifying the environment to suggest that there is a full understanding of care needs for this specific group. The staff in charge informed the inspector that care plans are signed by relatives and relatives commented that they are kept upto date with the care
Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 8 although there was little evidence of this in the care files and this should be considered. Following requirements from the previous inspections the staff list dates for evaluations of the care plan on a monthly basis. There are still no written records of an evaluation however which should be a record of any progress made set against the objectives of the care plan. Some care needs were not always recorded satisfactorily. One resident in particular had a need for weight to be recorded identified on the care plan but a recording of weight could not be found. The medication policies refer to ‘nursing’ and are somwhat confusing for staff. The medication prolicy needs reviewing so that it is a clear reference tool. The management has not addressed access to the garden, which was a requirement of the last report, and this area remains unsafe for residents. In particular the low level of the fence to the road and subsequent drop on the far side is hazardous and must be addressed before residents access the garden again. Overall the environment 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 manager has produced an ‘improvement plan’ following the last inspection but there is much work still required to bring the home up to minimum standards in this area. A full list of requirements are made at the end of the report and areas of concern are dealt with in detail under the ‘environment’ section of the report. There were two immediate requirements made during the inspection regarding health and saftey issues which were addressed at the time. At the time of the inspection the maintainance person was conducting cleaning duties as well as maintenance duties and this needs addressing so that the home can be properly maintained. Staff training files were inconsistent. For example there was no record of any of the new staff [overseas staff] having manual handling training. some files had no training recorded for over a year so the manager was unable to tell whether certain staff had had training. The current induction package does not meet induction standards set by ‘skills for care’ and the contact web site for further information was left so that this can be reviewed. Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 9 Staff interviewed were not clear about the level of supervision required and there are limited records for formal staff supervision. There is currently 25 of staff trained to NVQ level and this should rise to over 50 to meet standards and to ensure that staff are competent to care for residents in the home. Staff files were reviewed and were deficient in the required checks needed to ensure fitness to look after vulnerable adults in the home. The importance of this was discussed as failure here can put residents at risk. The management team need to address the issues arising from this report. Following the last inspection similar management issues were raised and an improvement plan was asked for in the inspection report and then on two occasions following the inspection. The improvement plan was finally recieved by CSCI on 5.12.06. The managers must be responsive and timely in their efforts to meet rquirments made in inspection reports. Much of the plan has not yet been actioned. There were some hazards noted on the tour of the building and these have been discussed previosly. The monitoring of the environment has not improved since the last inspection. The system of reporting hazards and maintanance issues needs to be reasserted. A more systematic risk assessment process was suggested and this should be recorded monthly with all areas of the home visited. 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.V311826.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.V311826.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 The quality in this outcome area is adequate, based on the available evidence including a site visit. 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 amendments needed to clarify the homes identity. 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. Staff need to continue to develop their understanding of the needs of people with dementia. 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
Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 12 and thier supporters about the home and its staff and facilities. All of the comment cards recieved stated that the information given at the point of admission the home including the issuing of contracts was sufficient and that the management were helpful in providing information. There was some confusion on the last inspection regarding the identity of the home with repect to ‘nursing’. The home provides personal care and not nursing care. The sign outside the home has now been removed and a new one is to be fitted. The stationary and policies /procedures still need reviewing however as they contain references to ‘nursing’ [for example the medication policies]. 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 admitted and include activities assessment, nutrition, falls, moving and handling and pressure sore risk. Staff interviewed varied in there understanding of the needs of people with dementia. Needs such as continence management were sometimes veiwed negativly and there remains little evidence in terms of staff enabling residents through modifying the environment [see enviormental outcomes] to suggest that there is a full understanding of care needs for this specific group. Some work has been completed since the previos visit however and a visiting ocupational therapist has had some input to staff training although this needs to be extended. Prospect House Nursing Home DS0000005467.V311826.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards The quality in this outcome area is adequate, based on the available evidence including the site visit. The home manages the health care needs of residents satisfactorily. care needs are included on care plans and are monitored although improvements can be made in the quality of the evaluation process and the way that relatives are consulted and included in the care planning process. Staff attend to personal care needs and these are met. They are tempered with the environmental improvements needed to maintain dignity EVIDENCE: All residents have a care plan. 3 care plans were reviewed and were generally appropriate in that they covered the needs of the residents. The staff in charge
Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 14 informed the inspector that care plans are signed by relatives and relatives commented that they are kept upto date with the care although there was little evidence of this in the care files. One resident has a relative visiting on a regular basis but had not had any recorded input to the care plan. [Some assessments and care plans were not signed by staff]. There was some discussion as to how this could be improved. The home have a key worker system and a formal system of care reviews have started [last inspection] so that relatives can have more formal input if they wish. Following requirements from the previous inspections the staff list dates for evaluations of the care plan on a monthly basis. There are still no written records of an evaluation 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 referenced on the care plan or evaluation sheet [discussed previosly]. Daily records and diaries are usfull for recording personal care given by the care staff. Records are easily accessible and were tidy and easy to find. 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. two residents were having regular visits from district nurses who were reviewing a dressing. The visiting nurse interviewed was pleased with the way the home refered residents and felt that staff were diligent in carrying out any instructions. Some care needs were not always recorded satisfactorily however. This was the case with the recording of weights for residents in the individulal care files. One resident in particular had this as a need identified on the care plan but a recording of weight could not be found. 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. One resident is on regular pain relief and this should be recorded in the care plan so that there is consistency from staff in administering this medicine as well as providing for regular review. The medication policies refer to ‘nursing’ and are somwhat confusing for staff. The staff interviewed was unclear as the role of the care staff in administering controlled drugs if this was nessarsay. The medication policy needs reviewing so that it is a clear reference tool. Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 15 Most of the residents in the home require quiet high levels of personal care. All residents seen were presented satisfactory in terms of dress and personal hygiene and staff were observed to be attending to residents promply in the dining room area where most residents seem to congregate. Staff were able to discuss the importance of trying to get residents to choose there own daily clothing. There have been locks fitted to toilet and bathroom doors following previos requirments and some environmental cues such as toilet signs although this remains inconsistent and needs to be further developed [see environment] to promote both privacy and dignity for residents. Prospect House Nursing Home DS0000005467.V311826.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. The quality in this outcome area is adequate. This is based on the available evidence including a sight visit. Residents are supported to be involved in activities but these need to be developed further with reference to good practice in dementia care and the removing of 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. 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. On the first day of the inspection the staff were involving some residents in an art activity and residents were observed to be benefiting from the social interaction. Resident files were observed to have activity plans and some activities are recoded on the daily diary notes by care staff. The comment cards received from relatives were fairly consistent in that although staffs efforts are appreciated there could be more done and the
Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 17 regularity of provision of activities for residents was generally described as ‘sometimes’. There is a relaxed feel to the home and relatives reported that generally staff has time to speak although some did comment on the communication difficulties with some of the staff from overseas. Staff were observed to be interacting appropriately and some were very skilled and supportative. 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. These rooms are rarely used however and most residents seem to congregate in the dining room so that this area is particularly important with respect to daily socialisation. Following requirements made in the last report there has been an effort to introduce a more stimulating environment with the introduction of pictures, menu board, clock etc. Some advice has been sought from an occupational therapist. This can be further developed. The management has not addressed access to the garden, which was a requirement of the last report, and this area remains unsafe for residents. In particular the low level of the fence to the road and subsequent drop on the far side is hazardous and should be addressed before residents access the garden again. From the discussion with the manager it is apparent that enabling safe access to green areas is not a priority in terms of quality of life for residents and this needs further thought [see environment]. There is reference in care plans to residents diet and nutrition. There are written menus and residents are asked for choice of meal. Limited setting of tables is encouraged just prior to serving meals. A menu is now displayed. The mealtime observed was relaxed and sociable. Staff were on hand to assist and one staff member was dealing with a resident who was a little agitated in a reassuring manner. Prospect House Nursing Home DS0000005467.V311826.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards The quality in this outcome area is adequate, based on the available evidence including the site visit. 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 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 [ information from comment cards]. Following requirements 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. This has been led by the manager. Some staff interviewed still had a poor awareness of any policies and procedures that are available, however, for the reporting of abuse, but all felt that the manager would act appropiatly. It is important that all staff attend external courses run by, for example, social services and that this training is ongoing. Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 19 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): 19,20,21,23,24,25,26, The quality in this outcome area is poor and is based on current available evidence including the site visit. The home has produced an improvement plan but this has not been fully realised and the issues from the previos inspection remain with reference to maintainance and the need to develop the home so that residents can be safe and experience a better feeling of well being. EVIDENCE: Over all the environment 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,
Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 20 homley surroundings with the right environmental cues available to aid orientation and a feeling of well being. Following requirments previosly made there is now some pictures and orientation aids such as a clock, menu board and orientation board in the dining room and ajioning corridoor. This lends some points of interest and creates a more stimulating surrounding. Locks have also been fitted to toilets to ensure privacy. More should be done however. Much of the recommended improvments to improve the overall ambience of the home still have not been addressed. These include: • 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 fence at the bottom of the garden is low and has a drop of 6 – 8 foot on the other side [drop top the road]. This is a particular hazard and must be addressed before residents can acess this area safley. The internal decor needs to be made bright and homely but less stark. This can be achieved with signs for day areas and tiolets bathrooms. There is some current signage but this is inconsistent. For example one toilet had a sign on it but the bathroom / toilet nearby had the sign missing. Management commented that ‘residents remove these’ but they simply need fixing permanently to the door. Many bedrooms doors have no name or means of orientating residents. Various points of interest for residents such as safe ornaments and rummage boxes and cupboards that residents can safely access. The smell of urine remainds a major concern and continues to be commented on by visitors and relatives. The cleaning rota is poorly managed with no fulltime cleaner available. Currently the maintainance person and a member of staff [on an adhoc basis] share these duties. This is clearly insufficent on two fronts as the cleaning standards are not being maintained and the mantainance person is short of hours to complete all of the mainatinance jobs. There was debris observed on floors in some bedrooms and carpets were not clean [see below as example]. Carpets are clealy impregnated with the smell of urine and the plans for replacment carpets throughout the home must be actioned as discussed [manager gave a date of March for the carpets to be replaced]. Some of the carpets on this inspection remain badly stained. For example one bedroom carpet was stained with feacal material and the odour was particularly offensive.
DS0000005467.V311826.R01.S.doc Version 5.2 Page 21 • • • • • Prospect House Nursing Home • Many bedroooms still need personalising. There has been some attemt at this by the ‘memory box’ project and this should continue. 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. As mentioned the ongoing maintainance issues are still not being addressed. On this inspection the following were observed: • The heating on the first day of the inspection was not operating in the afternoon. Staff did not notice this until pointed out by the inspector. The maintainance person was on hand to attend. Some wall thermometers placed in key areas would benefit staff so that temperatures could be better monitored. There are numerous scuffs and scratches to doors in all areas due to being damaged by wheelchairs. These need repainting and protecting. The bathroom on the first floor was found to have no toilet seat, no toilet paper available, no soap or paper towels. The waste bin had no cover. There were some health and saftey issues that needed immediate attention. The hot water in the bathroom mentioned was very hot to touch. There was no bath thermometer available. An immediate requirment was made and on the second day of the inspection a thermometer was in place and the temperature was satisfactory although a thourough check was scheduled for the following day with a plumber. There is an ongoing need to check water temperatures for all bath and shower outlets to ensure safe temperatures for residents. The light on the corridoor outside the bathroom could be reached by hand [low ceiling in the corridoor] and was unsafe. The light fitting was not covered and the actual fitting was very loose possing a threat of electric shock for residents. An immediate requirmnt was made and the electrician visited on the last day of the inspection. • • • • The above observations were made on a tour of the home by the inspector. There was no note of these deficiencies and following discussion with the maintainance person it would appear that the maintainance book is no longer used to formally record maintainance issues. There is also a need for regular environmental risk assesments carried out at least monthly with the manager so that hazards can be identified and monitored. The maintainace schedule which was shown to the inspector needs reviewing to include the above. Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 22 Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 23 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): All key standards. The quality in this outcome area is poor. Care staff numbers are appropriate to meet service user’s personal care needs but ancillary staff cover is poor so that the home is not being maintained satisfactorily. Recruitment checks are not made appropriately prior to employing staff so that residents are safeguarded. EVIDENCE: For 20 residents at the time of the inspection there were 5 care staff on duty including the manager [first day of the inspection]. The duty rota confirms that these minimum staffing numbers are generally maintained. Relatives reported on the comment cards that staff are supportative. They were described as very approachable and caring. Ancilliary support is in need of review however given the findings under ‘environment’ with respect to maintainance of the home. At the time of the inspection the maintainance person was conducting cleaning duties as well as maintenance duties. Staff confirmed attendance at training courses and this was supported by some reference in staff files. The manager showed the inspector a training plan for the coming months. Staff also reported regular training sessions by the
Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 24 manager and a visiting occupational therapist has had some input into the training. Staff training files were inconsistent however. For example there was no record of any of the new staff [overseas staff] having manual handling training. some files had no training recorded for over a year; for example one file had no training recorded since 2.9.05. this meant that the manager was unable to tell which staff were currently upto date with statutory training. The induction package for the staff was seen and discussed. The current package does not meet induction standards set by ‘skills for care’ and the contact web site for further information was left so that this can be reviewed. Staff interviewed were not clear about the level of supervision required and there are limited records for formal staff supervision. For example one staff file contained 3 dates of supervision sessions since may 2005. This is insufficient particulary given the number of overseas staff and the level of supervision they may require to settle into the home. There is currently 25 of staff trained to NVQ level and this should rise to over 50 to meet standards and to ensure that staff are competent to care for residents in the home. Staff files were reviewed [ 2] of recent recruits to the care team and both were deficient in the required checks needed to ensure fitness to look after vulnerable adults in the home. One had no Criminal Record [CRB] check completed, although this had been applied for,and the Protection of Vulnerable Adult [POVA] check had been completed following employment and not prior to. The importance of this was discussed as failure here can put residents at risk. Prospect House Nursing Home DS0000005467.V311826.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 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 poor based on available evidence including the site visit. The managment team ensure there is basic personal care but there needs to be more structure around Quality Assurance processess which should aim to gradually improve standards and the quality of life for residents and maintain saftey. EVIDENCE: The homes proprioter, 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.V311826.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. The management team need to address the issues arising from this report. Following the last inspection similar management issues were raised and an improvement plan was asked for in the inspection report and then on two occasions following the inspection. The improvement plan was finally recieved by CSCI on 5.12.06. The managers must be responsive and timely in their efforts to meet rquirments made in inspection reports. Much of the plan has not yet been actioned. Quality assurance processess were discussed. As mentioned the managers are guilty of the fact that requirments from previous inspections have not been attended to in full and remain outstanding. There was also evidence of some disorganisation in the running of daily affairs such as the ongoing maintainance issues previosly discussed. The processess for gaining insight and views of residents and relatives is adressed and the manager discussed findings from relative satisfaction surveys. The home has some external auditing from the Blue Cross and investors in people in the past. 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. The fire log book was generally upto date although there is a need to monitor fire extinguishers on a monthly basis. There was no knowledge from the maintainance person of any assessments around legionella risk and this should be actioned and a policy statement drawn up. A recent accident to a resident in the home was discussed. The home have not accessed the current accident recording book [health and saftey issue which is data protection compliant] and this should be actioned. There were some hazards noted on the tour of the building and these have been discussed previosly. The monitoring of the environment has not improved since the last inspection. The system of reporting hazards and maintanance issues needs to be reasserted. A more systamatic risk assessment process was suggested and this should be recorded monthly with all areas of the home visited. Current risk assessments now cover window openings above ground floor as recomendended in the last inspection. Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 27 Prospect House Nursing Home DS0000005467.V311826.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 1 X 1 1 1 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Prospect House Nursing Home DS0000005467.V311826.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(2)(b) Requirement The registered shall keep the service user’s plan under review; Therefore 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 two inspections]. Timescale for action 01/03/07 2 OP7 15 3 OP19 23 13[4] Where appropriate and, unless it 01/03/07 is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; Consequently there must be ongoing evidence that residents [or supporters/relatives] are involved in the drawing up and evaluation of the care on a regular basis. External grounds which are 01/03/07 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
DS0000005467.V311826.R01.S.doc Version 5.2 Page 30 Prospect House Nursing Home 4. OP19 23 The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. Therefore the Registered Manager must assess and review the care environment in the home ensuring that the inspectors comments and observations are taken into account. In particular: • Signs to aid orientation including names on doors. • Damaged and scratched doors to be repainted. • Maintenance book to recommence so that ongoing maintenance issues are recorded. The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. Therefore the bathroom on the first floor must be maintained satisfactorily for residents use. The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. Therefore the heating must be closely monitored so that residents are comfortable in their surroundings. The placement of wall thermometers in key areas would help facilitate this. The Registered Person shall ensure that all parts of the home to which service users have access to are practicably free from hazards to their safety; therefore hot water temperatures in baths and showers must be maintained at all times at a safe level.
DS0000005467.V311826.R01.S.doc 01/03/07 5 OP21 23 01/02/07 6 OP25 23 01/02/07 7 OP25 23 13[4] 10/01/07 Prospect House Nursing Home Version 5.2 Page 31 8 OP26 13(2) [Immediate requirement given and actioned]. All parts of the care home must be kept clean; therefore the manager must ensure that the home is maintained free of offensive odours [Outstanding from the last inspection]. Cleaning must be carried out daily and a cleaning rota must be actioned that ensures cleanliness of the home is maintained. The registered person must ensure that at all times there is suitable staff employed to meet service user needs. Ancillary staff hours must be reviewed so that there is enough staff employed to ensure standards around maintenance and cleanliness are addressed. The registered person shall not employ staff unless the person is fit to work in the care home. Therefore all staff must not start work in the home until adequate checks are made prior to employment. 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. The registered person must establish and maintain a system for reviewing and improving the quality of care in the home therefore; The manager must establish a quality monitoring system and annual development plan in accordance with the standard. Requirements made in CSCI 01/04/07 9 OP27 18(1)a 01/02/07 10 OP29 19(1) a 01/02/07 11 OP30 18(1) c 01/03/07 12 OP33 24(1) a 01/03/07 Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 32 inspection reports must be met with consistency and the home must display ongoing improvement based on service user and statutory body feedback. 13. OP38 13 The Registered Person shall ensure that all parts of the home to which service users have access to are practicably free from hazards to their safety; therefore the health and safety risk assessments carried out monthly must continue to be documented. A general risk assessment of all areas must be conducted to identify hazards and risks to residents and appropriate action recorded. The immediate requirement to replace the hazardous light fitting was actioned. 14 *RQN CSA Sec 26 The registered Person must review all documentation and omit the ‘nursing’ description, which is false under the homes current registration. 01/04/07 01/03/07 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 OP4 OP7 OP7 Good Practice Recommendations Extend training in dementia care to all staff. The staff making the record should sign all care notes. All residents should have their weight clearly recorded in the care notes particularly if this a need identified on the
DS0000005467.V311826.R01.S.doc Version 5.2 Page 33 Prospect House Nursing Home 4 OP9 care plan. 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. The medication policy should be reviewed with reference to comments made in the report. The environmental upgrading required [see environment] is needed to help promote residents dignity. Activities should continue to be develo0ped with reference to good practice in dementia care. 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. Current level of formal staff supervision needs to be increased to meet standards of 6 per year. Monthly checks on fire extinguishers [see schedules] should be recorded. Risk assessments covering legionella should be addressed and a policy statement drawn up. A new accident-recording book should be accessed which complies with data protection. 5 6 7 8 9 10 11 OP9 OP10 OP12 OP18 OP28 OP36 OP38 Prospect House Nursing Home DS0000005467.V311826.R01.S.doc Version 5.2 Page 34 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
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