Inspection on 11/07/07 for The Priory

This inspection was carried out on 11th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Priory 18/01/07

The Priory 20/07/06

The Priory 06/03/06

The Priory 05/07/05

The Priory 29/09/04

The Priory 27/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Priory Romford Road Pembury Tunbridge Wells Kent TN2 4AY Lead Inspector Mrs Ruth Burnham Key Unannounced Inspection 11 July 2007 9:00 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 The Priory DS0000039813.V339951.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. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Priory Address Romford Road Pembury Tunbridge Wells Kent TN2 4AY 01892 823018 01892 825298 enquiries@thepriorypembury.co.uk 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) The Priory (Pembury) Ltd Mrs Hazel Dawn Stace Care Home 32 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (18) of places The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2007 Brief Description of the Service: The Priory is situated in a rural setting within Pembury near Tunbridge Wells. The Priory offers care for older people with dementia. The current owners purchased the home in September 2003. The home is set in 4 ½ acres of woodland and garden that is mostly laid to grass. The home is an old house that is on four floors; there is lift access to all levels. The day areas are on the ground level; there are comfortable lounge areas and a dining room. The bedrooms are situated on each level; the basement also contains the kitchen, visitor’s room, laundry, the maintenance person’s room and storage. The weekly fees range from £401.00 to £550.00. These figures are based on rooms irrespective of funding arrangements. Extra charges are made for newspapers at cost; hairdressing from £5.20 upward and chiropody £15.60 weekly as required. The home’s last inspection report is available on request at the home. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, the site visit was carried out by one inspector who was in the home from 09:00 to 16:00. Since the last inspection A new manager has been registered for the home. She is a 1st level nurse with post graduate qualification in dementia and many years experience. The registration of the home has been varied to allow all beds to be used for dementia care. This visit was spent talking directly with some service users privately and collectively, care and ancillary staff, the acting manager, provider and an external consultant employed by the home. Due to the nature of the service and cognitive difficulties experienced by some service users, it is difficult to reliably incorporate accurate reflections of the service users in the report. Judgements about quality of life and choices were taken from direct conversation with service users, staff and observation followed by discussion with care staff, and evidencing records held at the home. A tour of part of the premises was undertaken. Information was also gathered through the Annual Quality Assurance Assessment completed by the manager The home currently has 27 people in residence in the home. What the service does well: The Priory has beautiful grounds with plenty of wildlife around for service users to watch, listen to and enjoy. The home is well decorated and furnished. The Priory welcomes relatives and visitors, they are offered refreshments and can visit as often and for as long as they choose. The atmosphere of the home is relaxed and welcoming. The cleanliness of the home is good. Food provided continues to offer choice and variety from fresh produce that is home cooked. People who live in the home benefit from the good care planning system. This involves residents and families and includes good risk management systems. The system provides clear guidance to staff to ensure that people receive a good standard of care in line with their wishes and preferences. The provider consults with relevant professionals to ensure that the environment is suitable for people with dementia. Staff are well supported and provided with relevant training. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 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. The summary of this inspection report can The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1–5 Quality in this outcome area is good. People who are considering moving into the home are given good information to help them decide if the home is suitable and will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who are considering moving into the home are given good information to help them decide if the home is suitable and will meet their needs. The statement of purpose and service users guide have been revised and updated. The manager contacts all enquirers and invites them to visit the home in the first instance to experience what life is like there. The manager who is a Level one nurse, with specialist dementia qualifications and extensive experience and knowledge of the client group, carries out a detailed pre-admission assessment. Where possible the prospective resident is visited in their own home as part of the admission process. An assessment is carried out with the relatives present wherever possible. Additional information is sought from The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 10 relevant others including friends, carers, social and healthcare professionals to ensure that the prospective resident’s needs can be met The information is recorded in the form of a pre admission report which is sent to the appropriate representative for consideration with the prospective resident. Examples were seen where relatives had added additional information at this stage. The prospective resident is invited to visit the home, join in activities and experience what it would be like to live there. The manager said this visit can be repeated as often as necessary for everyone to be comfortable with their eventual decision. As part of the admission procedure every effort is made to ensure that the key worker initially allocated to new residents is on duty on the day of admission to help them settle in. The key worker helps the family and resident to unpack and organise personal possessions. Where possible relatives are encouraged to visit the home before the new resident moves in to personalise the room so that familiar possessions are already in place. Pictorial information is being produced to enhance communication with people who are considering moving into the home. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 11 Quality in this outcome area is good. People who live in the home benefit from the well planned care and the friendly and understanding staff team. Dignity and privacy is respected and health and wellbeing is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are benefiting from the new care planning system is working well to ensure that staff understand and can meet resident’s needs. Care planning is well managed. There are comprehensive individual plans which are regularly updated. The care plan is derived from the initial assessment and includes risk assessments on mobility, nutrition, pressure care, safe environment and medication. A detailed risk assessment on mental well being outlines any known challenging behaviour and triggers. This care plan is stored and maintained in a specialised computer programme, all care staff are trained in the use of this programme. The information provides clear The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 12 guidance for staff to enable them to they carry out individual personal care and promote the wellbeing of residents. Carers use the computer system daily to access information and maintain daily records of care provided, daily events and activities. The Manager or Team Leader in charge reviews all reports at the end of their shift and if satisfactory signs them off. The manager undertakes a review of all care plans in conjunction with the resident and key members of staff and any changes or amendments are then made. During the month changes in care can be recorded at any time to ensure that all information is up to date. Residents and relatives where appropriate are encouraged to be actively involved in the care planning process. People who live in the home are valued and staff provide care in a way which promotes their privacy and dignity. The manager has introduced a key worker system. Each member of care staff is allocated to one or two residents and they have responsibility for inputting into care planning and are involved with any changes in care for that person. This ensures that care plans remain accurate and up to date. They are also responsible for seeing that the residents personal possessions are kept in good order, that wardrobes and drawers are tidy and will alert relatives when new clothing or personal items are required. It was clear throughout the site visit that staff know the residents well and understand their needs. Care and support was given with warmth and good humour. People are able to choose their general practitioner. The health of residents is promoted and access is provided to health care professionals wherever necessary. Opticians are available when required. A six weekly chiropody service is offered with the clinic being held in a private room. Residents are referred to the local hospital where hearing aids are required. There is a referral system to the local dentist who is able to treat residents either at the surgery or, if necessary, in house. District nurses visit daily to provide support and advice as required for all clinical procedures. Access to a community physiotherapist is provided following referral from the GP. When residents attend their hospital appointments a carer is provided for escort duty if the family are unable to accompany them People in the home are protected from harm through the clear medication policy and procedures. The medication policy has recently been reviewed and a monthly audit is carried out to ensure good practice. There were still a few gaps in medication records. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 Quality in this outcome area is excellent. People who live in the home benefit from the calm and relaxing atmosphere. They enjoy the opportunity to take part in a variety of activities. Spiritual and social needs are catered for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The quality of life for residents has been improved through the recruitment of a full time activities co-ordinator who is working with residents on a one to one basis to build a programme of activities taking into consideration their interests and hobbies. Care plans seen contained excellent information about social history which has been gathered in consultation with relatives and residents. There is now a full activities programme with a choice of group activity and one to one interaction. The spiritual needs of residents are catered for through monthly non-denominational services held in the home. Pastoral visitors from a local church provide one to one spiritual and social support at least once or twice a week. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 14 People who live in the home benefit from visiting entertainment providers. Sessions include entertainment for pure pleasure and also mental and physical stimulation such as musical motivation physical exercise classes, quizzes and reminiscing. People also enjoy the resident cat and pet budgie. Relatives and friends are encouraged to accompany the residents on any outings. People who live in the home enjoy the meals and mealtimes. Lunchtime during the site visit was a pleasant and social occasion. Choice is presented in a variety of ways to suit the needs of residents. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 – 18 Quality in this outcome area is good. People who live in the home are protected from abuse through good policies and procedures and appropriate staff training. They are free to offer comment or complaint. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home are protected from abuse through good policies and procedures and appropriate staff training. The home follows the Kent and Medway Multi-agency Adult Protection Policy, Protocols and Guidance which are available in the home. People who live in the home are free to offer comment or complaint. There is a clear and accessible complaints procedure. An example was given where the complaints system has been used as a learning tool. The manager reviewed all staff performance following a complaint which was investigated through the local authority adult protection procedures, additional training was put in place with extra supervision form which some staff changes resulted. It was evident throughout the site visit that outcomes for residents are greatly improved since the last inspection. People who live in the home are protected through sound recruitment procedures. All staff are vetted through the Criminal Records Bureau. Staff records were examined which contained all documentation required under the Care Homes Regulations. All staff including new staff receive training in the Protection of Vulnerable Adults and thereafter receive annual updates. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 – 26 Quality in this outcome area is adequate. People who live in the home are benefiting from the improvements in the environment. Their safety is compromised where suitable furniture is not available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from the beautiful surroundings. The home sits in beautiful grounds with magnificent mature trees. The newly created secure and easily accessible garden has greatly enhanced the quality of life for residents. Major work has been carried out in recent months to improve all areas of the home. The environment is now safe, comfortable, clean and odour free. Many areas of the home have been refurnished and completely redecorated. Residents have enjoyed being involved in choosing fabrics and colours with staff support. Improvements have also been made which are specifically designed to help residents find their way around the home. Each floor is colour coded. The The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 17 expertise of specialists in the environmental needs of people who suffer from dementia was used to ensure that the environment is appropriate for the residents. The lower ground floor has been much improved with the addition of a shower room and small lounge area. Bedrooms are furnished to a comfortable standard and residents are actively encouraged to personalise their rooms. Discussion took place about the suitability of some shared rooms, specifically where rooms are long and narrow which means that the privacy of one of the occupants of these rooms is compromised as staff and the other resident need to use their area for access. Also one of the occupants in these rooms has no access to the windows. The management agreed to review the suitability of these rooms for sharing. People who live in the home benefit from the well equipped laundry and kitchen. Service areas have been improved through organising the layout more effectively. The home is to be congratulated on achieving the Gold Standard Award from the local Environmental Health department. An occupational therapist has recently visited the home to review suitability following the changes. The summary of their report states, ‘There has been real progress with the environmental provision for the service users with an increase in the safety and orientation being a strength of the home.’ The lack of side tables in communal areas is compromising the safety of People who live in the home. There is nowhere for people to put their hot drinks and residents were seen trying to balance a plate and a hot drink on their laps. The manager said that additional tables have been ordered. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People who live in the home benefit from the support and care provided by the well trained and competent staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live in the home benefit from sympathetic care provided by permanent staff who get to know them well. The manager does not use agency staff. An independent auditor concluded, ‘All staff roles met or were highly rated above the mean for all homes surveyed. The home achieved exceptional scores for the manager and care staff. Interaction between staff and residents throughout the site visit was warm, supportive and respectful. People are protected from harm through sound recruitment procedures. Appropriate checks are carried out on all staff prior to appointment. New staff have appropriate induction training. Peoples’ lives are enhanced by the support of an appropriately skilled staff team. There are sufficient staff on duty to ensure that the needs of residents are met. Staff are clear about their roles and responsibilities. There are team leaders on each shift who have a Level 3 National Vocational Qualification. The majority of care staff are qualified to at least Level 2. The activities coordinator is currently undertaking a specialist course in activities for people with dementia. The manager provides additional in house training to update and supplement existing knowledge. The organisation of training has greatly improved and all staff receive training in dementia. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People who live in the home are benefiting from the skills and competence of the management team. Improvements in all aspects of the running of the home have ensured that the health, safety and welfare of people who live in the home is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The quality of life for people who live in the home has been enhanced by the changes and improvements the owner and manager have made in all areas of the home. The new registered manager is experienced and well qualified to sustain these improvements with the support of the owner. There is a clear commitment to providing the best possible care for residents. A monthly management meeting is held at which time all areas of operation in the home are discussed and any concerns can be raised. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 20 The wellbeing of people is promoted through clear policies and procedures, which have all been reviewed. An external company is used to carry out service user surveys as part of the quality assurance process. The safety and welfare of people who live in the home is promoted through the good management and development of the staff team. The atmosphere in the home throughout the site visit was calm and relaxed. The manager operates an open door policy and it was good to see the freedom both staff and residents enjoy to come in and out of the managers office, sometimes with a question and sometimes just for a chat. Record keeping in the home has greatly improved in recent months through reorganisation and the introduction of more effective systems. The health and safety of people who live and work in the home is promoted through safe working practices. Staff receive appropriate training to maintain and improve safety in the home. An independent auditor carried out a recent Health & Safety inspection. Their report stated, There has been real progress with the environmental provision for the service users with an increase in safety and orientation being a strength of the home. There is an up to date fire risk assessment and regular fire drills are carried out. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 21 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 2 3 3 2 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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. 2. Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 31/07/07 arrangements for the recording, handling, safe keeping, safe administration and disposal of medication received into the care home. In that record of medication given must be completed accurately – there should be no gaps in medication records. This is carried over from the last inspection. This requirement remains ongoing with progress having been made since the last visit. 2 OP20 13(4) (a)(c) The registered person shall ensure that unnecessary risks to health and safety of service users are identified and so far as possible eliminated. In that adequate furniture must be provided in communal areas to ensure that residents do not have to balance hot drinks on their laps. DS0000039813.V339951.R01.S.doc Requirement 31/07/07 The Priory Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP23 OP24 Good Practice Recommendations It is strongly recommended that the use of shared rooms where one occupant has insufficient private space which is fit for purpose shall be reviewed. It is strongly recommended that the use of shared rooms where one occupant has no direct access to a window shall be reviewed. The Priory DS0000039813.V339951.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 - 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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