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Inspection on 15/07/05 for Prospect House Nursing Home

Also see our care home review for Prospect House Nursing Home for more information

This inspection was carried out on 15th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has an excellent service user`s guide that provides prospective residents with all the information they need to make an informed choice about whether to take up residence in the home. This is supplemented by verbal information provided by the registered manager during the pre-admission assessment. The registered manager and nursing staff ensure that residents` health care needs are addressed as a matter of priority. Residents are treated with respect and all staff are instructed on how to maintain residents` privacy and dignity. The employment of an occupational therapist ensures that residents are able to maintain independence in relation to their activities of daily living and a varied social programme, based on residents` abilities and interests, is made available. Residents are helped to maintain contact with family and friends and exercise choice and control over their lives. They are also provided with a varied, well-balanced diet. The home provides a clean and comfortable environment for residents to live in, with easy access to outside seating areas and local amenities. Residents are protected by the home`s procedures for the recruitment, training and supervision of staff.

What has improved since the last inspection?

Menu holders have been provide for the dining tables, making it easier for residents to see what is on the menu that day. A water cooler has also been provided for the use of relatives and residents. More registered nurse hours and activity hours have been provided to ensure that residents` health and social care needs continue to be met. There is now a central training record that makes it easier to identify staff who require training in specific areas.

What the care home could do better:

Care plans meet regulatory requirements but some minor improvements would aid the care planning process. The home should provide all residents with a copy of the forthcoming activity programme to enable them to plan which activities they wish to participate in.

CARE HOMES FOR OLDER PEOPLE Prospect House Nursing Home High Street Malpas Cheshire SY14 8NR Lead Inspector Gill Matthewson Announced 15 July 2005 09.30 th 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 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 F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Prospect House Nursing Home Address High Street Malpas Cheshire SY14 8NR 01948 860011 01948 860006 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Prospect House (Malpas) Ltd Mrs Anne Leslie Care Home with Nursing 44 Category(ies) of Terminally ill (1) registration, with number Old age, not falling within any other category of places (44) Physical disability (4) Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users must not exceed 44 2. 44 service users aged 65 years and above in the category OP may be accommodated 3. 1 service user aged 40 years and above in category TI may be accommodated 4. 4 service users aged 40 years and above in the category PD may be accommodated Date of last inspection 11 November 2004 Brief Description of the Service: Prospect House is a large detached house situated in a village location The majority of the accommodation is provided in a purpose built extension to the home. The home is located on the village high street and is in close proximity to all the local services, public amenities and local transport.Within the home a passenger lift and staircase provides access to bedroom accommodation situated on the ground and first floor. The second floor is used for administration.Bedrooms are mainly single rooms and there are several larger rooms available to accommodate married couples or those who wish to share. The majority of bedrooms have en suite toilet facilities and all have a nurse call system and TV point.Day space consists of six lounges/ sitting areas and a dining room.There are front and rear gardens. Access to the service is located to the side of the building and is accessible to those with mobility difficulties. Service users have direct access to the rear enclosed garden and paved courtyard.The home is registered to care for persons whose primary care needs are due to physical frailty and infirmity. This service is also registered to provide care for one person who is terminally ill and can provide intermediate care for 1 resident. Nursing care is provided and in accordance with the statutory requirements there are registered general nurses on duty at all times. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The lead inspector spent two hours planning the inspection by reviewing previous inspection reports and the service history over the last twelve months. The inspection took place over six hours and include a tour of the building, inspection of records and discussion with seven residents, three relatives, the registered provider, registered manager and three staff. Comment cards were received from three social workers. Feedback was given to the registered provider and registered manager immediately following the inspection. Overall, the home provided a high standard of care. What the service does well: The home has an excellent service user’s guide that provides prospective residents with all the information they need to make an informed choice about whether to take up residence in the home. This is supplemented by verbal information provided by the registered manager during the pre-admission assessment. The registered manager and nursing staff ensure that residents’ health care needs are addressed as a matter of priority. Residents are treated with respect and all staff are instructed on how to maintain residents’ privacy and dignity. The employment of an occupational therapist ensures that residents are able to maintain independence in relation to their activities of daily living and a varied social programme, based on residents’ abilities and interests, is made available. Residents are helped to maintain contact with family and friends and exercise choice and control over their lives. They are also provided with a varied, well-balanced diet. The home provides a clean and comfortable environment for residents to live in, with easy access to outside seating areas and local amenities. Residents are protected by the home’s procedures for the recruitment, training and supervision of staff. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2&3 The home provides comprehensive information to prospective residents in order to help them make an informed choice about where to live. The preadmission assessment procedures give prospective residents confidence that the home will be able to meet their needs. Both the resident’s and care provider’s responsibilities are clearly set out in a written contact. EVIDENCE: The home has an excellent service user’s guide, which includes the home’s statement of purpose. This document contains all the information a resident would need to understand how the home operates, the facilities and services that are provided and how to raise any concerns. It is detailed, clearly written and a good reference guide. Residents spoken with confirmed that they or their relatives had been provided with this information. Residents were provided with a written statement of terms and conditions of residency. Those who were privately funded were provided with a written contract that included the fees payable and what is included in the fees, any additional charges, rights and obligations of both parties and period of notice. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 9 Residents spoken with confirmed that the registered manager visited them prior to their admission to the home to assess their needs and explain how the home could meet those needs. Assessment documents were completed and held in residents’ care files. In addition, residents were also assessed by an NHS registered nurse to determine the level of funding to be provided by the NHS. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 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 standard(s) 7,8&10 A plan of care is drawn up with each resident to ensure that all their health, personal and social care needs are met. Residents are treated with respect and their privacy and dignity are maintained. EVIDENCE: Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 11 During this inspection the case files of four residents were examined. One was for a resident admitted for short term intermediate care, one for a resident of low dependency and two for residents with greater nursing needs. In all cases there was a care plan in place that set out the action that needed to be taken by nursing and care staff to ensure that all aspects of the residents’ needs were met Care plans were reviewed on a monthly basis. Residents and their representatives were invited to an evaluation meeting every 11 weeks to review whether the care provided continued to meet their needs. In some cases, residents’ needs had changed and additional nursing instructions had been added to the care plan. However, the previous instructions had not been crossed out. It was possible to determine the current care needed by reading through all the monthly reviews, but a discontinuation of the previous instruction or rewriting of the care plan would have made the plan clearer. Also, not all care plans identified the expected outcome the nurse was hoping to achieve by implementing a plan of care. The identification of an expected outcome would assist nurses reviewing the plan of care to determine whether it was being achieved. See Recommendation 1. Discussion with residents and staff confirmed that care staff supported residents to maintain their personal hygiene. Residents were assessed for risk of pressure sores and appropriate intervention and equipment were provided. One resident had been admitted to the home with extensive pressure ulcers. The nursing staff had obtained specialist advice and implemented a plan of care that had resulted in the pressure ulcers being almost healed at the time of the inspection. Residents were also assessed and reviewed in relation to their continence and nutritional needs. All residents were registered with a GP and had access to other health care personnel if required, for example, chiropodist, dentist, optician, tissue viability nurse specialist, continence adviser, physiotherapist. The home had link nurses for palliative care, infection control and tissue viability. These nurses had links with nurse specialists from the Primary Care Trust and were responsible for keeping themselves up to date and disseminating good practice in these areas to other staff in the home. It was evident from discussion with residents, relatives, the registered provider and nursing staff that the home’s philosophy is that their primary responsibility is to ensure that residents’ health is promoted and maintained as far as possible. The service users’ guide, staff booklet and policy documents all emphasised the importance of maintaining residents’ privacy and dignity. Arrangements for privacy within the service included private rooms and secluded sitting areas. Cordless telephones were available and a number of residents had their own telephone line. Residents received their mail unopened. Conversations with residents confirmed that any personal or nursing care was provided within their own rooms or in bathrooms and that staff were very respectful of their privacy and dignity. Screens were available for privacy in shared rooms. Staff were observed to be courteous and caring towards the residents. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 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 standard(s) 12,13,14&15. Residents have control over their lives and can maintain contact with their family and friends. The activity programme provides daily variation and interest for people living in the home and residents are offered a well balanced diet. EVIDENCE: Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 13 On the morning of the inspection the activity coordinator was assisting residents to make lavender boxes. Other artefacts that had been made by residents were displayed in the home. Observations, interviews, care plans, policies and procedures demonstrated a high level of commitment towards residents’ social fulfilment. Activities and outings were arranged on an ongoing basis by an occupational therapist to ensure that a full programme of events was maintained. These included coffee mornings for which service users make cakes and refreshments. In addition there were regular visits from a musical therapist. Musical movement, exercise, reminiscence and games were encouraged. The activities programme was displayed in the entrance hall with information on current and future events and special occasions. Observations made around the home and interviews confirmed that residents were encouraged on a daily basis to participate as far as their capabilities would allow and according to their choice. However, those residents who chose to stay in their rooms did not have access to the programme. One resident said that if she knew what was coming up she may plan to participate in some activities. See Recommendation 2. The service user’s guide, residents and relatives all confirmed that residents could receive visitors in private whenever they wished. The home had links with both local primary and secondary schools. There were displays of art work from both schools in the home, and two pupils from the secondary school had work placements in the home one day a week whilst working towards a GNVQ in Customer Care. The home also had links with local churches. The contract identifies that the home is conducted to maximise the individual’s autonomy and choice. This was confirmed by residents. The home provides three meals a day and snacks and drinks are available at all times. On the afternoon of the inspection the cook was asking residents what they would like to eat the following day. Two choices were offered for each meal, but residents could ask for something else if they didn’t like the choices on offer. Lunch on the day of inspection was fish and chips or Irish stew, followed by fruit jelly or apple crumble. The tables in the dining room were nicely set with a centrepiece of a vase containing a fresh flower. The food was well presented and staff offered assistance in a discreet manner, ensuring that everyone had plenty to drink and enough to eat. All residents spoken with said that the food was very good. One resident said that his appetite was poor and he chose to eat in his room. He had not wanted any of the choices on offer, but the cook had made him some mushroom soup and a milk pudding. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 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 standard(s) 16 The promotion of the home’s complaints procedure gives residents confidence that any complaints will be addressed. EVIDENCE: The home had a satisfactory complaints procedure, which was displayed on the notice board and in the service user’s guide. Residents spoken with said they would know who to complain to if they were not happy with any aspect of the service. There had been no complaints since 2003. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 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 standard(s) 19&26. The home provides residents a pleasant, comfortable and well-maintained environment in which to live. EVIDENCE: The location of this service is within a small rural town on the main street and in close proximity to all local services, amenities and public transport. The house was maintained to a high standard and a maintenance schedule was available and audited weekly. The internal dimensions of the house and the use of space created several areas for residents to spend time in company or alone throughout the day. The grounds were tidy and safe and allowed access for residents and visitors. A tour of the premises that included communal areas and some bedrooms confirmed a high standard of cleanliness and hygiene throughout the home. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29&30 Robust recruitment procedures provide protection for residents. Staff numbers and training ensure that residents’ needs can be met by competent staff. EVIDENCE: There were 43 residents at the time of the inspection. The registered manager was supernumerary. The home provided two registered nurses and six care staff from 7am to 2pm plus an additional three hours care to help those residents who required assistance with feeding, one registered nurse and five care assistants from 1.30pm to 8.30pm, and one registered nurse and three care assistants from 8pm to 7am plus an additional carer up to 10pm to assist residents to bed. There were also catering, laundry, domestic and administrative staff in addition to these numbers. The home had employed three staff since the last inspection, including two from overseas. Their files were examined and all contained the required information and documentation set out in Schedule 2 of the Care homes Regulations 2001. Staff training files were reviewed and discussed with the Deputy Matron responsible for training within the home. All new staff received induction training that met Skills for Care training targets. Induction was carried out over a six week period. Staff were given a staff handbook that included the General Social Care Council Code of Conduct and Practice and an excellent booklet on communication. All care staff were encouraged to undertake an NVQ Level 2 in Care. All staff received an annual appraisal, which include the identification of any training needs. Training plans were reviewed on an Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 17 ongoing basis. The home subscribed to the Primary Care Trust Nursing Home Training Group. Four of the registered nurses had completed palliative care foundation training. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff supervision ensures that residents receive consistent, quality care. EVIDENCE: Supervision reports demonstrated that care staff were supervised by registered nurses. Supervision covered aspects of practice, philosophy of care and training needs. All other staff were supervised by the registered manager as part of the normal management process. The registered manager said she was looking into ways of providing clinical supervision for the registered nurses. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 4 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 x 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x 3 x x Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 20 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 Regulation None Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP12 Good Practice Recommendations Care plans should identify the expected outcome of the care to be provided and rewritten if instructions have significantly changed. A copy of the activity programme should be distributed to all residents. Prospect House Nursing Home F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LJ 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 F51 F01 S18815 Prospect House V227305 150705 Stage 4.doc Version 1.30 Page 22 - 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. 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