Inspection on 06/03/06 for The Priory

This inspection was carried out on 6th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 11/07/07

The Priory 18/01/07

The Priory 20/07/06

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 Maria Tucker Unannounced Inspection 6th March 2006 09:30 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 The Priory DS0000039813.V262275.R01.S.doc Version 5.1 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.V262275.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Priory Address Romford Road Pembury Tunbridge Wells Kent TN2 4AY 01892 823018 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 Gillian Daniels 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.V262275.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 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 over 65 years of age; they have 18 places for elderly frail and 14 places for older people suffering from dementia. The home is under new ownership having been purchased 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 on all of the levels, the basement contains the kitchen, managers office and the handy persons room and storage. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 09.30 until 14.30 the inspection was conducted by the lead inspector Mrs M Tucker and Mrs D Sullivan. Time was spent meeting the manager and staff going through various records and documentation. One relative was spoken with. About one hour and a half was spent meeting and observing service users collectively and individually. A partial tour of the premises was made which included service users rooms and communal areas. It is recommended that this report be read in conjunction with the last inspection report to enable the reader to gain a full picture of the home, as some of the standards that were inspected and met during the last inspection were not inspected during this inspection. What the service does well: What has improved since the last inspection? The home has a new registered manager who has successfully completed the fit persons interview process with the CSCI. The environmental health officer has awarded the silver award to the home. A full time activity co-ordinator has been employed. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 6 The home was found to be overall much cleaner and fresher smelling; the cleaning is undertaken daily and more hours have been provided for cleaning. Training for dementia care has begun for staff with 17 staff identified to do the 16 to 20 week course. Staff commented that they had learnt things that had not known before. Following the last inspection and the concerns raised from the findings social services undertook a review of all of the service users in the home over a fiveweek period. Those service users who were not having their needs met in the home are no longer residing at the home. Every relative asked if they wished their relative to remain in the home, stated that they did not want their relative to be moved. Policies and procedures for shared rooms have been devised. A purpose built shower room is now in use. The staff living in the home in a storage cupboard and sharing the service users facilities have moved out. The office has been relocated to the quiet room upstairs and staff are using the old office as a staff room. What they could do better: The staff recruitment must include full POVA and CRB checks prior to commencing employment. All staff that work at the home must have their records kept at the home. All staff must receive a full induction, including staff that change role. All staff must receive the mandatory training required. The furniture and furnishings in the private rooms are tatty and in need of replacing. Two of the baths and one sink have cracks in them and need replacing; another bath is not fit for purpose and another has a hoist that has grime and cannot be thoroughly cleaned. The toilet seats that are not fixed must be fixed for health and safety. Some of the commodes are very old, rusty or wooden and need to be replaced; the wardrobes and other furniture kept in the toilet areas must be reviewed due to infection control. There was a large crack in the wall of a service users bedroom. Those service users who require personal support with meals and personal hygiene must be supported appropriately. Risk assessments must be undertaken and reviewed monthly. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 7 The carpets in the private bedrooms, which have a very bad odour, are in need of replacing or deep cleaning. The passageway carpet is uneven and needs to be level. The doors leading to the passageways and stairs that open inward pose a potential danger, as they do not have glass to enable a clear view if anyone should be the other side of the door. This should be reviewed and discussed with the fire officer if they are fire doors. A review should be made as to the security of the laundry room entrance door that has glass in it. The service users sharing rooms must be reviewed as to the suitability and compatibility of them sharing. The home has a policy and procedure for admitting service users to shared rooms this has not been applied to the current service users. An updated statement of purpose and service user guide must be completed and forwarded to the CSCI. A review should be made as to the accessibility of the garden and the fenced in space provided for service users. All combustible items must be stored appropriately. The care plans to be more comprehensible to provide clear directions as to care and support needs; reviewed monthly; behaviour management guidelines; nutritional screening; day time and leisure choices and activities; preferences and routines. These need to be from a person centred perspective and designed with relevance and good practice for those with dementia. The rota must be accurate and complete. Service users files must be secure and kept in accordance to The Data Protection Act. The home would benefit from the manager being supernumerary and the deputy having some supernumerary hours. 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 Priory DS0000039813.V262275.R01.S.doc Version 5.1 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.V262275.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Service users and their representative do not have accurate information to base the decision to move to the home. Service users who share rooms cannot expect an accurate assessment as to their suitability or best interest. EVIDENCE: The Statement of Purpose and service users guide have not been updated since the changes that took place following the last inspection. . An accurate completed version of the statement of purpose and service user guide has not been available and has been identified as required in the inspections conducted on 29/09/05; 27/04/04. An updated version of a service users contract was inspected. It has not been amended or changed as identified during the last inspection. A service users file contained an inventory. The admission format has been revised. An assessment for shared room occupancy to be conducted as part of the pre admission contained a section stating that the costs for moving to a single room would be the responsibility of the service user. It is recommended that this be reviewed as it is no longer legal to have a ‘top up’ of fees paid direct by the service user. Also to include evidence from a professional The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 10 assessment that a shared room is of benefit to the service user, currently comments only are made. It is also recommended that the policy and procedures for shared rooms, include shared rooms to be shared by either service users who both have a diagnosis of dementia or both fall into the category of old age. The home does not provide intermediate care. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Service users cannot expect to be treated with dignity or respect or to have their assessed or changing needs met. Service users who have dementia are not cared for with best practice i.e. a person centred approach. The homes’ medication procedures do not sufficiently protect service users. EVIDENCE: The care plans were basic and did not contain enough information for the needs of the service users to be fully met or give the staff enough guidance to support these needs. Items assessed were not followed through into a care plan. Presenting difficult behaviours had no guidelines as to how to manage and support these. Risk assessments were not comprehensive or completed for some service users. The care plans were not reviewed monthly or had a change in need that had been noted for some months generated a review of the care plan to be updated. There was no evidence that service users are involved in their care plans. Some service users were observed to be in need of support with feeding in that they spilt most of their porridge down their tops; could not reach their food or tea; were not eating; eating in an undignified way i.e. with fingers; had no over tables for drinks. A toothbrush was seen to be caked in dried toothpaste indicating that support is required but not given. A service user was wearing socks that were far too tight, staff spoke of how they became aggressive if approached so they did not address The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 12 this until requested to do so. Some service users had holes in their tights or no stockings or tights on. The cloths were creased a relative stated that their “Only beef was the laundry”. Staff spoken with were unfamiliar on how to devise a care plan for service users with dementia, based on a person centred perspective through dementia care mapping. A staff member was standing up to feed a service user. The general practitioner is called when needed and staff monitor any deterioration in health and act quickly if they feel the GP is required further. The compatibility of the shared rooms had not been reviewed or considered thoroughly. One care plan assessed that the service user had nocturnal disturbances; they were given sedatives that made them drowsy. Another service user shared room had faeces smeared in it, staff were aware that the service users does this. This was identified during the last inspection as not acceptable for service users who share. The manager stated that staff administering medication had received medication training, a member of staff administering the lunchtime medication round confirmed that they had been trained to do so. Medication is stored in a dedicated room; senior staff are in charge of the keys and the medication trolley is tethered in the room when not in use. The room was poorly lit and items that were not related to the use of the room were stored in it. Various homely remedies such as travel sickness medication and throat pastilles were kept in one cupboard; the use of these had not been recorded on care plans. MAR sheets contained photographs of service users; those inspected had been correctly completed with the exception of entries in respect of creams and sprays, where only a tick had been entered rather than a signature. A washbasin had recently been fitted in the room although there were no hand towels or soap. The member of staff in charge of the round was observed to leave the medication trolley open and unlocked whilst administering to a service user in the lounge, and at breakfast time medication was seen to have been left with service users on the tables with no staff monitoring that it was taken. The security of the medication trolley; arrangements of the clinical room and a procedure for the administration and recording of nonprescription homely remedies were identified by the CSCI pharmacist during the last inspection. A response by the responsible individual on 2/8/05 stated all requirements raised by the CSCI Pharmacy inspector are being addressed. There is not a trained first aider on each shift, during the course of the inspection a service user who had been unwell and drowsy was given a cup of tea that they were unable to hold and consequently spilt, due to the risk of scalding first aid was required but staff on duty did not respond to do this. The manager was questioned as to if the service user had nursing needs and if an assessment from a health professional had been requested or conducted. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 13 Neither had been done. The service user was in bed when the inspectors arrived and had been got up by staff. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users have variety and choice and wholesome food. They do not have choice or are the routines and support provided adequate to meet there needs or in their best interest. EVIDENCE: The activity co-ordinator was busy in the dinning area assisting four service users with artwork. Care plans recorded activities that had taken place. One service user was in their room listening to the radio with their relative. The large lounge had music on that was quite loud and obtrusive and the television on at the same time. A service user sitting by the television in a quieter area was distressed at having the television on and asked repeatedly for this to be turned off. The remote control is kept by staff. The manager acknowledged that it was difficult to please everyone. Most of the service users were sat around with nothing to do and no stimulation. Many were sleeping on and off. The manager confirmed that tea is taken in the dinning area and no longer on service users laps. The routines of the meal times was discussed again as service users were seated up to 1 hour before the meals was served. The breakfast and lunch was appetising and there was plenty available. It was noted that service users were not supported with meals or drinks appropriately and food was on tables going cold. It is very strongly again recommended that The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 15 consideration be made as to two sittings so that staff can concentrate of supporting service users individually and service users have meals in the dinning room instead of the lounges. One relative spoke of how their relative enjoyed walking and that they took them out when they visited. The manager stated that staff have also taken them out for a walk. There is no room identified where service users can meet visitors in private. The manager stated that the dinning room or the office would be used for this. There was no evidence that service users had any choice over the routines of the day i.e. when to get up or where to spend the day. It is acknowledged that preferences and choice details were not recorded in the care plans and that the layout of the home would make it very difficult to support service users who choose to spend their time in their room. There was no evidence that relatives /appropriate others or service users were consulted or informed before changes were made to the home i.e. moving of the office to the visitors room / quiet lounge although it is acknowledged that this is preferable to the previous arrangement for the staff office. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users cannot expect to be protected from harm or have first aid administered in the event of an injury. EVIDENCE: No complaints had been made since the last inspection. A relative mentioned that their only “Beef was the laundry”. The manager stated that she was aware of this and was actively dealing with it. There was duty times when no staff with a certificate in first aid was on shift. During the inspection first aid was required and staff did not take the appropriate action. A record of unexplained bruising was made in a service users file. This had not been followed through or had the social services or CSCI been notified. A staff member has been employed without the home receiving the CRB or POVA checks. The manager explained that they were not providing personal care and were supervised. This staff member was supporting service users with feeding on their own in the service users room. The CSCI has received Regulation 26 notifications following incidents of falls and injuries when service users have been taken to A&E. There have been no adult protection alerts raised since the last inspection. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Service users do not live in a comfortable environment that is well maintained and suitable for their needs. EVIDENCE: There have been some new over chair tables purchased for service users to use. Some new mattresses have been provided. Room 18 has had a window put in it. The action plan received stated that 7 bedrooms have had new carpets fitted; 1 wardrobe and chest of draws purchased; 2 commodes; 4 bed bases and 2 bed-heads. The garden area remains not suitable for service users and the fenced area is not utilised by service users, as it is not fit for purpose. Much of the furniture and equipment in individual rooms were mainly of a poor standard i.e. not matching, old, in a poor condition and soft furnishings that could not be properly cleaned. Some of the service users private bathrooms and toilets were used as storage facilities with wardrobes and other items. One wicker stand next to a toilet The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 18 had dried faeces on it. The manager explained that every day an inspection took place of all the rooms to ensure they were clean and tidy. All of the service users beds had been made and had clean bed linen. The laundry floor remains impermeable and easy to clean. The laundry is limited for space with no identified areas for sorting clean laundry. The walls are not easily cleaned. One bathroom is unsuitable for use, so service users in the basement have not got access to bathing facilities on that level; one bathroom has a very long bath and is difficult for service users to negotiate around if they have a Zimmer frame; two of the bathrooms have assisted baths. There was a large crack in the wall of a service users bedroom. The small private lounge area has been made into an office. There is no identified area available for service users to receive visitors in private. The manger explained that the dinning area or office would be available if needed. The responsible individual stated in the action plan from the last inspection that ‘as far as practicable the recommendations made by the occupational therapist on 13/08/04 have been implemented. Report to follow’. No report has to date been received or made available. There was no evidence that the service users had made a positive choice to share the rooms. One shared room had faeces smeared in it. A service user who was sharing another room had recorded in their care plan that they had nocturnal disturbances. Some radiators remained unguarded. Some of the service users rooms did not have all the items as listed in standard 24. The shared rooms were small and it is acknowledged that fitting in everything may not be possible. It should be considered that for the shared rooms that can only fit the basic furniture in should be reviewed as to fit for purpose i.e. the shared room that has wardrobes in the bathroom as there is not enough space in the bedroom; the shared room that is very cluttered with lots of personal effects and very limited space. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The service users cannot be assured that the staffing provided is able to meet their needs. EVIDENCE: The manager works supernumerary for 2 shifts a week. The deputy has no identified hours as supernumerary. The staffing levels comprise of 4 staff am shift and 3 staff pm shift. There is 2 waking night staff. There are extra staffing for activities; cooking; cleaning and laundry. The duty rota was not complete. As mentioned earlier in this report service users did not receive the support or assistance they require with personal support and assistance at peek times i.e. meal times. The manager confirmed that 50 of staff has the NVQ level 2 qualification. Staff were seen and heard to be respectful and courteous with genuine concern for the service users. A staff member’s file did not contain any evidence that they had a CRB or POVA check prior to commencing employment. There was no evidence of verifying references. A temporary managers details of employment and records were not available in the home. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 20 Not all of the staff had completed the mandatory training. There were shifts of the rota when no first aid trained staff member was on duty. Staff at the home undertook a range of roles and responsibilities. The manager was supportive towards staff needs and circumstances and changed hours or roles accordingly. It was noted that many of the staff worked in various positions i.e. caring and catering. It was discussed that when changing roles staff would need an induction into the new role. A staff file did not evidence that the homes policies and procedures for recruitment had been followed through. It is acknowledged that this is difficult with oversees staff and staff are recruited through an agency. It remains the responsibility of the manager to ensure that equal opportunities in terms of recruitment are followed and discussed that the home need to firm up and follow their policies and procedures for recruitment for all staff. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 21 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, 32, 33, 35, 36, 37, 38 The service users live in a home where the senior management are failing to provide them with a quality service. EVIDENCE: The manager has successfully completed the process of becoming registered manager with the CSCI. There is a deputy manager and external support by the clinical director of care. The home does not manage service users finances. Staff have been provided with a staff room. Staff spoken with confirmed that they received supervision. The care plans for service users are recorded on the computer service users do not have access to this. Service users old files were kept in the staff room unlocked and not made secure. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 22 A quality assurance questionnaire was sent out to relatives and representatives prior to the last inspection. These findings have not been made available or were there any evidence that the information has been collated or has been incorporated to form part of the quality assurance and quality monitoring system. The action plan and agreed timescales to implement the requirements made at the last inspection have not been progressed within a reasonable timescale. Two of the baths and one sink have cracks in them and need replacing; another bath is not fit for purpose and another has a hoist that has grime and cannot be thoroughly cleaned. The toilet seats that are not fixed must be fixed for health and safety. Some of the commodes are very old, rusty or wooden and need to be replaced; the wardrobes and other furniture kept in the toilet areas must be reviewed due to infection control. The carpets in the private bedrooms, which have a very bad odour, are in need of replacing or deep cleaning. The passageway carpet is uneven and needs to be level. The doors leading to the passageways and stairs that open inward pose a potential danger, as they do not have glass to enable a clear view if anyone should be the other side of the door. This should be reviewed and discussed with the fire officer if they are fire doors. A review should be made as to the security of the laundry room entrance door that has glass in it. All combustible items must be stored appropriately The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 2 1 The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 24 Yes 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 OP1 Regulation 6(a)(b) Requirement Timescale for action 17/04/06 2 OP7 15(1) 3 OP7 13(4)(c) 4 OP7 15(2)(b) (c) The registered person shall keep the statement of purpose and service users guide under review and, where appropriate, revise the statement of purpose and service users guide and notify the Commission and service users of any such revision within 28 days. Unless it is impracticable to carry 17/04/06 out such consultation, the registered person shall after consultation with the service user, or a representative of his prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. The registered person shall 17/04/06 ensure that unnecessary risks to health and safety of service users are identified and so far as possible eliminated. The registered person shall keep 17/04/06 the service users plan under review; where appropriate and unless it is impracticable to carry out such consultation, after consultation with the service DS0000039813.V262275.R01.S.doc Version 5.1 The Priory Page 25 5 OP8 12(1)13 (1)(b) 6 OP8OP 8.9 17(1)(a) 7 OP9 13(2) 8 OP12 12(3) 9 OP14 12(2) 10 OP18 12(b) 11 OP21 23(2)(j) user or a representative of his, revise the service users plan. The registered person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users; to make proper provision for the care and where appropriate, treatment and supervision of service users. Records to be kept: details of any plan relating to the service user in respect of medication, nursing, specialist health care or nutrition. Schedule 3 (o) The registered person shall make arrangements for the recording, handling, safe keeping, safe administration and disposal of medication received into the care home. In that the actions are followed as per the pharmacist letter following their inspection. The registered person shall for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as it is practicable ascertain and take into account their wishes and feelings. The registered person shall so far as it is practicable enable service users to make decisions with respect to the care they receive and their health and welfare. The registered person shall ensure that the care home is conducted so as to make proper provision for the care and where appropriate treatment of service users. The registered person shall having regard to the number and needs of the service users ensure that there are provided at appropriate places sufficient DS0000039813.V262275.R01.S.doc 17/04/06 17/04/06 17/04/06 17/04/06 17/04/06 17/04/06 17/04/06 The Priory Version 5.1 Page 26 12 OP22 16(2)(c) 23(2)(n) 13 OP25 13(4)(a) (c) 14 OP27 17(2) 15 OP27 18(1)(a) 16 The Priory OP29 19 numbers of baths and showers. The registered person shall having regard to the size of the care home and the number of needs of the service users provide in rooms occupied by service users equipment suitable for the to the needs of the service users and ensure that suitable adaptations equipment and facilities are provided. In that recommendations of the occupational therapy assessment on 13/08/04 be implemented. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated in that the radiators must be guarded or operated at low surface temperatures. The action plan following the last inspection stated that covers had been ordered for the two remaining radiators. The home shall keep and maintain a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked. Schedule 4 7 This remains not met from the last inspection and the inspections conducted on 29/9/04 and 27/7/04 The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall not DS0000039813.V262275.R01.S.doc 17/04/06 17/04/06 17/04/06 17/04/06 17/04/06 Page 27 Version 5.1 17 OP30 18(1)(c) (i)4(c) 18 OP33 24(1)(a) (b)(2) 19 OP37 17(1)(a) (b)(2)(3) 20 OP38 12(1)4(a) 13(3) employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraph 8 of schedule 2. That he is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of schedule 2 Regulation 2 (8) 19 1 (c) in respect of that person. The registered person shall, ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they perform. In that mandatory training and induction training is completed for all staff. And shall make suitable arrangements for the training of staff in first aid. The registered person shall establish and maintain a system for reviewing at appropriate intervals; and improving the quality of care provided at the care home. The registered person shall supply to the commission a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available to service users. The registered person shall ensure that records referred to in paragraphs (1) and (2) are kept up to date. That the Data Protection Act is followed in respect of the records of service users not kept secure in the staff room. Regulation 15 (1) (2) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service DS0000039813.V262275.R01.S.doc 17/04/06 17/04/06 17/04/06 17/04/06 The Priory Version 5.1 Page 28 users; in that the items identified in the text are addressed. Most of the items in the text in relation to the environment continue to be made a requirement. Regulation 16 (2) (j) 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 OP2 Good Practice Recommendations It is recommended that the shared room assessment format be reviewed as it is no longer legal to have a ‘top up’ of fees paid direct by the service user. Also to include evidence from a professional assessment that a shared room is of benefit to the service user. That the policy and procedures for shared rooms, includes shared rooms to be shared by either service users who both have a diagnosis of dementia or both fall into the category of old age. It continues to be strongly recommended that the service user contract specify if the room is a single or double, include the fees payable and by whom and specify the category of service user as being either old age or dementia. This has been carried over from the last inspection and identified in the inspection conducted on 29/09/04. It is recommended that special attention is made to provide and maintain the dignity and respect of service users. This was raised during the last inspection. It is recommended that special attention is made to provide and maintain the dignity and respect of service users. This was raised during the last inspection. It is very strongly recommended that a suitable room be identified for service users to meet relatives and appropriate others in private. It is yet again very strongly recommended that a review be made of the meal times routine in that service users are not seated for an unacceptable period of time before lunch is service. That service users are supported to eat meals in the dinning area and not in the lounges. DS0000039813.V262275.R01.S.doc Version 5.1 Page 29 2 OP2 3 4 5 6 OP8 OP10 OP13 OP15 The Priory 7 OP19 8 OP19 9 10 OP20 OP23 11 OP24 12 13 14 OP26 OP27 OP29 15 OP33 It is very strongly recommended that a planned replacement of the furniture and furnishings that are old tatty and in need of replacing as identified in the text be made and a reasonable time period is made in which to complete this. It is very strongly recommended that a review be made as to the fenced in area provided for service users to access the garden. That suitable provision is made for service users to enjoy being outside. It is strongly recommended that a visitor’s room be made available. It is again very strongly recommended that service users who currently share a room have the opportunity not to share. That the policy and procedures for admitting service users to shared rooms apply to those already sharing. It is recommended that, where practicable, service users bedrooms be furnished as identified in standard 24. That a review be made of the space available with shared rooms. There was again no evidence that this had been considered or service users assessed or consulted as to their choices, preferences or needs and of this being recorded. It remains recommended that the laundry floor be made impermeable. It is very strongly recommended that the manager and the deputy have more time working as supernumerary for office and management tasks. It is very strongly recommended that the records of all staff working at the home be kept at the home i.e. temporary managers, additional workers from other homes. It is very strongly recommended that the action plan and agreed timescales to implement the requirements made at the inspections be progressed within a reasonable timescale. The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Priory DS0000039813.V262275.R01.S.doc Version 5.1 Page 31 - 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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