Inspection on 19/08/05 for The Old Prebendal House

This inspection was carried out on 19th August 2005.

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

The Old Prebendal House 29/05/07

The Old Prebendal House 04/01/06

The Old Prebendal House 15/03/05

The Old Prebendal House 28/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Old Prebendal House Station Road Shipton-under-Wychwood Oxfordshire OX7 6BQ Lead Inspector Philippa MacMahon Unannounced 19 August 2005 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. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Old Prebendal House Address Station Road, Shipton-under-Wychwood, Oxfordshire, OX7 6BQ 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) 01993 831888 01993 831800 dora@oldprebendalhouse.com The Old Prebendal House Limited Mrs Dora W Gurnett Care Home with Nursing 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: On admission persons should be aged 60 years and over. Date of last inspection 15 March 2005 Brief Description of the Service: The Old Prebendal House is an elegant Cotswold stone historic building set in extensive grounds in the village of Shipton-under-Wychwood in the west of Oxfordshire. It is close to the Cotswold towns of Stow-on-the-Wold and Burford. The home offers comfortable accommodation to a very high standard for 45 persons, with the maximum of 21 places for persons requiring nursing care. The communal areas include a library, drawing room, and a large, spacious dining room that has been created in a beautiful barn conversion. The service users are offered choice in every aspect of their daily lives, from the large and varied choice of well-prepared meals to the range of activities available. The care provided is tailored to the individual needs, and preferences. The emphasis within the home is very much one of enabling the service users to live their lives as they wish, and to do so with dignity. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection between the hours of 09.45 and 14.45. The registered manager was not on duty and her deputy was the nurse in charge at the time of the inspection. The inspector examined care plans and records, toured the building, and spent a large amount of time talking to residents, staff, and visitors to obtain their views. What the service does well: What has improved since the last inspection? Nothing was noted at this inspection and the last inspection did not include any requirements or recommendations. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 6 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. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 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 The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 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) 3. All people admitted to the home do so only after having had a thorough assessment of their care needs, and knowledge that the home can meet those needs. EVIDENCE: The inspector examined a sample of care plans and found that pre-admission assessments are undertaken on all residents, and the registered manager carried these out. These assessments covered all aspects of the person’s care and gave a clear picture of their care needs. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 9 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. Each resident has a care plan in which their assessed care needs are identified and the action required to meet those needs. In one instance the inspector found care plans from another home mixed up with the home’s. This is not good practice and it is recommended that the previous home’s notes should be archived separately, and the home develop its own care plan and documents using the pre-admission assessment as the base line for developing the care plans. It is a requirement that all staff are made aware that all people admitted to the home whether it is on a long or short stay basis, must have a care plan in which their care needs are identified and how these will be met. The home does not appear to have a policy and procedure in place in respect of a resident administering their own medicine. It is recommended that the registered manager should look at the home’s policy and procedure in respect of self-medication and ensure that it is implemented. The nutritional assessment tool “MUST” has been implemented but there is little knowledge or understanding of its purpose and function. It is recommended that all the staff are made aware of the purpose of the tool and how it works. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 10 EVIDENCE: The inspector examined a sample of the residents’ care plans and overall found that they reflected the residents’ care needs and how these would be met. Regular reviews are carried out and documented. One of the care plans examined contained care plans and documentation from the previous care home the person had transferred from, some time ago, and these were still being added to alongside the home’s plans. A person who had recently been admitted to the home had a pre-admission assessment, and a daily record, but no care plan had been commenced. The staff spoken to were unclear as to whether this person was admitted on a short or long stay basis. Two of the care plans seen referred to the resident as “self-medicating” within the body of the plans. There was no care plan in respect of the person giving their own medicine, how this would be monitored, how the staff would ensure that the person had a sufficient supply of medicine, and that it is safely stored. There was no risk assessment in relation to “self-medicating” in either case. The inspector noted that the MUST nutritional assessment tool scores were being added to the care plans with no supporting calculations, or rationale. Talking to the staff it appeared that only one member of staff carried out this assessment and the rest of the staff did not understand how the tool worked. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 11 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) The inspector did not make a judgement about this outcome as none of the outcomes were inspected. EVIDENCE: None of these standards were assessed on this occasion. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 12 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) The inspector did not make a judgement about this outcome as none of the outcomes were inspected. EVIDENCE: None of these standards were assessed on this occasion. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 13 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) 19,20,21,22,23,24,25,26. This is a most gracious, comfortable and homely environment, and the standards of cleanliness and maintenance of the home are impeccable. The charging of batteries above a seating area is not good practice and could be a risk to the health and safety of the residents. It is a requirement that a more suitable power point is found from which to charge power batteries in a safe manner. The staff need to be more aware of the importance of maintaining all areas of the home for the residents’ benefit, including appropriate storage of equipment, and means of communication between staff. EVIDENCE: The inspector made a tour of the home and found all areas to be maintained, and cleaned to a very high standard. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 14 The décor and furnishings are immaculate, and a number of residents spoken to are most appreciative of the high standards maintained, and of the ability to choose between a number of communal spaces in which they can sit, and of the lovely grounds. The residents’ private rooms are very individual and have been personalised by the addition of their own possessions. The bathrooms and lavatories were found to be clean and in good order. The inspector noted that the downstairs bathroom was cluttered with bags of new incontinence pads. The senior nurse in charge arranged for these to be placed in a more appropriate store. The inspector noted a battery for the hoist in the bathroom on the 1st floor being charged at a power point on a ledge above a seating area in the corridor that is frequently used by residents. A free standing cupboard on one of the corridors was found to have a quantity of packages and disposable kidney dishes placed on top that looked unsightly and the senior nurse in charge arranged for these to be removed. A number of paper notices for staff were placed on the walls in the corridors. The senior nurse on duty removed these at the time of the inspection. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 15 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) The inspector did not make a judgement about this outcome as none of the outcomes were inspected. EVIDENCE: None of these standards were assessed on this occasion. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 16 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) 35,38. During past inspections the inspector has been told of plans to improve the laundry, and nothing has materialised so far. It is not a pleasant area for the staff to work in and the staff who work in this area do very well to maintain the high standards of workmanship in such poor conditions. It is a requirement that the registered manager must find a more effective way of removing the emissions from the tumble dryers and ensuring that the laundry door is kept closed at all times. There are good systems in place for the protection of the residents, and the record keeping is in good order. However there need to be additional checks made by the staff using the facilities such as using a bath thermometer and not relying on a mechanical valve to always provide the correct temperature control of the hot water. A further statutory requirement is listed in the appropriate section of this report. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 17 EVIDENCE: The inspector examined the system for keeping residents’ money on their behalf, and found that all records and checks were in place. Examination of the fire log and hot water temperature monitoring records show that regular checks are being made as required by regulation. The inspector randomly checked hot water outlets during the course of the inspection and found the upstairs bath to have a recording of 63oC. There was no bath thermometer in the room. This could pose a risk of scalding and an immediate requirement was issued that all staff must be made aware of the hazard, and a means of controlling the temperature of the hot water at around 43oC must be found. The registered manager must also provide a bath thermometer to be used on each occasion of drawing a bath for a resident. The inspector found the laundry door to be held open and unattended. The two large dryers were working and the room was very hot, and the emissions from the machines could be detected in the corridors adjacent to the laundry. There is no extractor fan in the laundry only a vented window, and a large electric fan that blows the hot air round the room. A resident’s room is immediately opposite the laundry and the noise from the dryers made it difficult to converse with the resident, as well as having the smell of the drying clothes. The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 18 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 3 x 3 2 The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 19 N/A 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 7 Regulation 15(1) Requirement It is a requirement that all staff are made aware that all people admitted to the home whether it is on a long or short stay basis, must have a care plan in which their care needs are identified and how these will be met. It is a requirement that a more suitable power point is found from which to charge power batteries in a safe manner. It is a requirement that the registered manager must find a more effective way of removing the emissions from the tumble dryers and ensuring that the laundry door is kept closed at all times. It is a requirement that all staff must be made aware of the hazard of risk of scalding, and a means of controlling the temperature of the hot water at around 43 degrees centigrade must be found. The registered manager must also provide a bath thermometer to be used on each occasion of drawing a bath for a resident. Timescale for action 26.08.05 2. 19 13(4) 26.08.05 3. 38 13(4)(a) 30.09.05 4. 38 Immediate The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 20 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. Refer to Standard 7 Good Practice Recommendations It is recommended that the previous homes notes should be archived separately, and the home develop its own care plan and documents using the pre-admission assessment as the base line for developing the care plans. It is recommended that the registered manager should look at the homes policy and procedure in respect of selfmedication and ensure that it is implemented. It is recommended that all the staff are made aware of the MUST nutritional assessment tool its purpose and how it works. 2. 3. 9 8 The Old Prebendal House H57-H08 S27180 The Old Prebendal V244146 190805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Burgner House, 4630 Kingsgate, Cascade Way, Oxford Business Park South, Cowley, Oxford. OX4 2SU 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. 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