Inspection on 08/07/08 for The Priory

This inspection was carried out on 8th July 2008.

CSCI found this care home to be providing an Poor service.

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 10/02/10

The Priory 02/02/10

The Priory 20/10/09

The Priory 30/06/09

The Priory 02/12/08

The Priory 21/10/08

The Priory 31/07/07

The Priory 02/03/07

The Priory 11/12/06

The Priory 06/10/06

The Priory 08/05/06

The Priory 14/11/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Priory Springhill Wellington Telford Shropshire TF1 3NA Lead Inspector Joy Hoelzel Unannounced Inspection 8th July 2008 10:00 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 DS0000064067.V367970.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. DS0000064067.V367970.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Priory Address Springhill Wellington Telford Shropshire TF1 3NA 01952 242535 01952 641577 thepriory.home@yahoo.com 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) Wellcare Management Ltd Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places DS0000064067.V367970.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Priory Nursing and Residential Home may provide care for a maximum of 37 older people, of whom up to 25 may require low to medium dependency nursing care. Staff involved iin the care of Residents must be suitably qualified, competent and experienced persons who are deployed in such number/skill-mix so as o be minimally in accordance with the Staffing Notice issued by Shropshire Health Authority. 08:00-14:00 1 Qualified Nurse (RGN or EN) 6 Care Staff 14:00-22:00 1 Qualified Nurse (RGN or EN) 4 Care Staff 22:00-08:00 1 Qualified Nurse (RGN or EN) 3 Care Staff 3. NB - additional staff must be on duty when high dependency service users are accommodated - these minimum levels are for direct nursing and personal care only, ie - they do not include ancillary staff. The above numbers may include the Manager when he/she is engaged in direct care provision, but are exclusive of the Manager when he/she is carrying out managerial duties. 31st July 2007 Date of last inspection Brief Description of the Service: The Priory is a privately owned Care Home registered to provide accommodation, personal and nursing care for a maximum of thirty seven older people. Situated on the eastern edge of the Shropshire town of Wellington, with local amenities available a short walk away the home is set in its own grounds, with a car park to the front. The building comprises a large converted town house with a purpose built extension added in recent years. Single and twin bedrooms are available, some benefit from an en suite facility. The home has a selection of sitting and dining areas; all areas within the home are now in need of some redecoration and refurbishment. Information of the home and the provision of the service are available in a service user guide and statement of purpose. Both documents are available on request at the home. The service user guide does not include information on the current level of fees for the service. The reader may wish to obtain more up to date information DS0000064067.V367970.R01.S.doc Version 5.2 Page 5 from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk DS0000064067.V367970.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced inspection took place over seven hours on Tuesday 8th July 2008. Twenty two of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Additionally seven further standards were looked at to gain an overview of the service. Thirty three people are currently living at the home and during the inspection were observed to be in all areas of the home. A new acting manager was in charge of the home, supported by one registered nurse, six care staff and ancillary personnel. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home, observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. What the service does well: An assessment of a person’s care needs are obtained prior to offering a placement at the home, this ensures that staff have the information to meet those needs. People living at the home who were able or wished to comment on how they found the service stated – “I am very satisfied with my room, I have everything and if I do want anything I only have to ask, staff are very good, I’m very happy here, and I have plenty to eat”. DS0000064067.V367970.R01.S.doc Version 5.2 Page 7 People visiting the home stated – ‘Very satisfied with the care they look after Mum very well’. What has improved since the last inspection? What they could do better: The care plans should be in sufficient detail to inform staff of the actions needed to fully meet peoples assessed needs. They should be accurate, concise, comprehensive, person centred and seen as a working document. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. Systems should be in place to ensure that all health care needs are fully met in a consistent and effective way. Systems must be in place to ensure that medications are only administered to the people for whom they were prescribed. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. The dining arrangements are very routine and functional with people given little to no choice. Efforts should be made to ensure that meals and mealtimes are viewed as an opportunity for socialising. A detailed programme for the redecoration/refurbishment of the premises is urgently required with planning for the future developments within the home. All areas now require considerable redecorating and refurbishment to ensure that people have a suitable environment in which to live. Urgent attention is required to the main drive to reduce the risk of accidents to all people living, working and visiting the home. The gardens require attention to ensure they are safe and accessible for people. DS0000064067.V367970.R01.S.doc Version 5.2 Page 8 The home must ensure that there are sufficient bathrooms to meet the needs and requirements of the people living at the home. The national minimum standard requires one bathroom for eight people. Equipment in use at the home, including the baths, must be suitable and capable of meeting the assessed needs of residents. All bedrooms must be provided with a wash hand basin, unless an en –suite and wash hand basin are provided. All rooms should be fitted with windows that conform to recognised standards. All rooms must be centrally heated with radiators that can be easily controlled. The radiator guards must be securely fixed to the walls and in a good state of repair. Improvements must be made to the laundry to ensure that all linen can be adequately dealt with. A hand washbasin is urgently required to ensure that staff are able to follow guidelines for general hygiene and infection control purposes. Automatic sluice disinfectors are needed in all areas to ensure the safe disposal of bodily waste. Staffing levels and skill mix should be determined by the assessed needs of the people living at the home, to ensure that care needs are fully met and that outcomes for people are improved. The home should have achieved a ratio of 50 of trained care staff to ensure that suitably qualified, competent and experienced staff are working at the care home at all times. The home must ensure that people are supported and protected by the homes recruitment policy and practice. All staff must receive training and regular updates in all areas relevant to the service. The acting manager must formally apply for the position of registered manager. This will ensure that the home is run and managed by a competent and experienced person. Effective quality assurance and monitoring of the service will ensure that the home is run in the best interests of the people living at the home. Arrangements should be made to ensure that the health, safety and welfare of people living in, working and visiting the home are promoted and protected. DS0000064067.V367970.R01.S.doc Version 5.2 Page 9 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 be made available in other formats on request. DS0000064067.V367970.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000064067.V367970.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,3,6 Quality in this outcome area is good. Admissions are not made to the home until a full needs assessment has been undertaken. This tells the home all about them, what they hope for and want to achieve, and the support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the service is detailed in the statement of purpose and service user guide and is available upon request at the home. These documents were not inspected in depth but on general observation on this occasion the service user guide does not detail the current level of fees for the service. To comply with the regulations the service user guide must include information about the current level of weekly fees. The new acting manager DS0000064067.V367970.R01.S.doc Version 5.2 Page 12 offered an assurance that the information would be included in the document very shortly. Pre-admission assessments are undertaken prior to people coming to live at the home. This should ensure people’s needs can be met when moving into the home. A member of the homes staff carried out an assessment where the person had been in hospital. A social workers assessment was also in the case file. Other case files looked at included social worker reviews, assessments from Primary Care Trusts and community care services. The statement of purpose and service user guide both explain the preadmission process and what will happen at the point of entering the home. The home does not provide an intermediate care service. DS0000064067.V367970.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this outcome area is adequate. Each individual has a care plan but the practice of involving residents in the development and review of the plan is variable. The plan includes basic information necessary to deliver the person’s care but is not always accurate or reliable and does not consistently reflect the care being delivered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care that is based on the information gained prior to admission. The plan is reviewed at the point of admission to the home and then on a regular basis. There was little evidence in the selection viewed that people or their representatives/relatives are involved in the planning and review process. DS0000064067.V367970.R01.S.doc Version 5.2 Page 14 Four case files were selected for inspection and generally contained the information required to ensure staff have the specific details for successfully meeting a persons needs. However, in the selection viewed there appeared to be omissions of information and some discrepancies and inconsistencies when discussing care needs with individuals and observing staff working practice. For example there was no specific documentation relating to the treatment of pressure ulcers and pressure areas. The core care plan initially stated that a person may need interventions for this but did not go on to specify the exact treatment, the frequency of the interventions or to record the improvement/deterioration of the area. Assessment of another persons needs identified that full assistance was required in all areas. There was no plan relating to diet, oral hygiene or how to maintain effective communication. However, good information was available for managing pain and specific medical conditions. Staff were able to provide a verbal update of the care of people who use the service and described the individual and diverse care needs. They appeared to have a good idea and knowledge of each persons likes and dislikes. The home operates a twenty eight day prescribing regime for the administration of medication using a monitored dosage system with the additional use of boxes and bottles of medicines. The registered nurses and senior carers administer the medications, the Medication Administration Record (MAR) appears to be fully completed, and no gaps in the recording sheet were seen in the selection viewed. Not all MAR’s had a photograph of the person prescribed the medication to ensure that the risks of giving people the wrong medications are reduced. During the tour of the premises it was evident that many tubs and tubes of external preparations were in use. These medications had not been dated upon opening and the name on the prescribing label did not correspond with the person residing in the room. The care staff were generally observed to be addressing people in an appropriate manner and it appeared that good relationships had been developed. People living at the home in the main commented that the ‘staff were very good’. The people who were unable or did not wish to express comment looked comfortable and relaxed. Curtains are provided between the beds in the shared bedrooms to offer privacy and dignity when a person is being assisted with personal care interventions DS0000064067.V367970.R01.S.doc Version 5.2 Page 15 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): OP 12,13,14,15 Quality in this outcome area is adequate. Generally staff are aware of the need to support residents with the activities of daily living but this process could be improved. Meals and the serving of food are very functional. Menus are not available and residents are not asked what they like or dislike. Individuals have very little choice of what they eat. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a person to organise and facilitate leisure, recreational and social activities, but is currently away from the home. Care staff commented that they are presently arranging activities mostly during the afternoons but were unable to state what had been arranged for that day. People living at the home discussed the forthcoming day trip to Llandudno, with one person stating ‘there’s plenty going on I don’t get bored, lots of chats with staff and visitors’. DS0000064067.V367970.R01.S.doc Version 5.2 Page 16 Some people stayed for the majority of the time in their own bedrooms some because of frail conditions and others because of their preference. One lady stated that she preferred to stay in her room as she was more comfortable and had the television, music, books and magazines to keep her occupied. During the time of this inspection there appeared to be very little structured activity as staff were extremely busy with attending to the personal care needs of people and assisting with their preparations for the day. Some people appeared to be disengaging due to the lack of social stimulus and activities. The service user guide documents in the aims and objectives for the service – ‘To be aware of residents religious needs’. It also includes a section on religion and worship and specifies – ‘We have visiting clergy of many denominations and we encourage you to exercise your spiritual needs’. However, one person stated they would like to have the opportunity to take part in a religious service but was unable to as this is not available within the home. Many people were visiting their relatives and friends and expressed a satisfaction with the visiting arrangements. The main front door is kept locked for security reasons, entry is gained by staff answering the door. On exit a domestic Yale type device can unlock the door. No doors inside the home are kept locked with the exception of a few private bedrooms. Meals are served in the dining or lounge areas, observation of the midday meal in the dining room indicated that it was a very functional occasion with little opportunity for the meal to be a social or pleasing experience. Only four people were at the dining tables for their meal, other people in the lounges had their meals served to them. The pre-plated meal was placed on a small table in front of them. When asked, staff stated that these people preferred not to go to the dining table but we did not hear people being asked their preference. There is no choice in the main course served and people are not asked if the meal is to their liking. Two people commented that – ‘ The meals are very good, no choice, we don’t know what we have until they bring it to you, but we send it back if it something we don’t like’. The new acting manager said that currently there is no choice of menu but – DS0000064067.V367970.R01.S.doc Version 5.2 Page 17 ‘The catering staff are very accommodating and will cook an alternative if required’. The statement of purpose includes a section on mealtimes ‘ We provide well balanced, nutritional home cooked dishes. Residents are consulted as to the foods they like and dislike. Our menu regularly changes and for this we also consult dieticians where needed’. DS0000064067.V367970.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this outcome area is adequate. The service has a complaints procedure that meets the national minimum standards and regulations and is displayed on a notice board in the home. There have been a number of complaints that have been addressed in a timely way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide include detail of how to make a complaint, a copy of the complaints procedure is displayed at the entrance to the home. The statement of purpose has the incorrect address for contacting the commission should a person wish to do so. The acting manager stated that the document would be amended shortly. The home has received two complaints recently in June and July both have been fully documented in the complaints log. The acting manager discussed the concerns raised and the action she is currently taking to come to a satisfactory conclusion. The service has not made any referrals to the Safeguarding multi agency team. DS0000064067.V367970.R01.S.doc Version 5.2 Page 19 We, the commission, have received one anonymous concern regarding staffing levels and registered nurse cover. We phoned the home and spoke with the acting manager regarding this. The acting manager confirmed that there had been difficulties with arranging cover from the current staff. The acting manager had contacted the agencies for additional staff but was told they were unable to help, as ‘they hadn’t got anyone’. The Telford and Wrekin Safeguarding procedures are available for staff reference if they suspect any wrong doings. Care staff were able to explain the actions they would take if they had any suspicions or worries in this area. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this are maintained and fully receipted. Each person’s money is separately held in the homes safe. DS0000064067.V367970.R01.S.doc Version 5.2 Page 20 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): OP 19,20,21,22,24,25,26. Quality in this outcome area is poor The home does not have an on-going maintenance programme. Maintenance is only done when a problem has already arisen. Many of the fixtures and fittings need replacing and most of the décor requires upgrading. There are insufficient bathrooms, the heating is not up to standard, the laundry is inadequate and the home is not always clean and tidy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Priory is situated on the eastern edge of Wellington and is a short walk away to the local amenities. The property is a large house, which has been extended and has had alterations throughout the years to provide the DS0000064067.V367970.R01.S.doc Version 5.2 Page 21 accommodation for a social care home. The Priory is now in need of considerable redecoration and replacement and renewal of the fabric and fittings. The gardens to the side of the property require attention to ensure that they are safe and are accessible to people. The main drive is in urgent need of attention as there are many potholes. Some remedial work has been carried out but a more permanent fix is now urgently required. One visitor stated that she would like to take her relative out more often but is unable to do so as the main drive is too dangerous. They felt the wheelchairs became too unstable with the unevenness of the drive to ensure their relatives safety. The new acting manager discussed the improvements made since April 2008 with 5 of the 39 bedrooms being redecorated, with 2 being fitted with new carpets. The remaining bedrooms are in need of attention. During the tour of the premises all bedrooms were looked at, there was variety of bedroom furniture that has been provided by the home, some of which is in a poor state and in need of replacement. The decor also varies greatly. The carpets in the main corridor between the residential and nursing units have been placed over manhole covers, this has the potential for people to trip and sustain injury. The carpets in all corridors are dirty and soiled and in need of a thorough clean and/or replacement. The small lounge is currently being redecorated and is out of use. The acting manager is hopeful that it will be back in use shortly. There is insufficient seating available in the dining area in the residential unit should all people wish to have their meals at the dining tables. It is incorporated in the sitting area and is very crowded. This area would benefit considerably by redecoration and refurbishment. The home has only 2 bathrooms in use for 37 people; both are situated on the ground floor. There is no bathroom for the people residing on the first floor if they wish to have bath they have to come down stairs. Two residents stated that they had not had a bath for a considerable period (September 2007), the reasons being that the facilities were unsuitable. A selection of communal toiletries was observed to be in the bathrooms, it was obvious that the practice of sharing toiletries continues and as such compromises a person’s choice and personal preferences. A good practice recommendation was made following the key inspection in July 2007 that repairs and refurbishments of the bathrooms and shower room are completed without delay. Not all bedrooms doors have been fitted with an appropriate locking facility and not all toilet and bathroom doors have a lock or ‘in use’ indicator. The lack of these has the potential of compromising a person’s privacy and dignity. Some bedrooms have been supplied with a commode for use when a person cannot get to the toilet. The two automatic sluice disinfectors are both out of DS0000064067.V367970.R01.S.doc Version 5.2 Page 22 use and have been so for a considerable period of time. The acting manager confirmed that the contractors have been contacted and have stated that due to the machines age they cannot be repaired. The current practice of the disposal of bodily waste has the potential of contamination and splash back accidents for staff and effective control of the spread of infection is being compromised. A good practice recommendation was made following the key inspection in July 2007 that the sluice machines be repaired and/or replaced. Not all rooms (private or communal) have been supplied with heating that can easily be controlled. There are some electric storage heaters that require to be turned on overnight to ensure they have sufficient heat for the next day. Most of these electric heaters have been turned off, some areas around the home appeared cold. There are no thermometers to record the air temperature to ensure that all parts of the home are maintained at ambient level. The acting manager was unsure of whether all these electric heaters were in working order. Most of the radiators have been supplied with a wire guard to reduce the risk of accidents on the hot surfaces. However, most of the guards are in a poor state of repair, the paint peeling off, some are rusty and some have not been fixed to the walls. The double glazed units at the front of the building are permanently misted, with the seal between the two pieces of glass broken down. This results in air getting between the glass and gives rise to the condensation. To ensure that people living in the room can have a view of the outside world the units should be repaired and/or replaced. One bedroom on the first floor is not supplied with a wash hand basin or toilet facilities. A statutory requirement was made following the key inspection in July 2007 that this room should be provided with one; the requirement therefore has not been complied with. The acting manager stated that this person either uses the wash hand basin situated in a small toilet across the corridor or staff take hot water in a bowl to the bedroom. The service user guide states ‘The Nursing Unit – there are nineteen single rooms; all have wash hand basins with toilet facilities. The Bottom Unit – there are eighteen single rooms and two double rooms all have wash hand basins with toilet facilities’. The service user guide is incorrect as not all bedrooms have either a wash hand basin or toilet facilities. DS0000064067.V367970.R01.S.doc Version 5.2 Page 23 The laundry is situated in a very small area with space for only one washer and one dryer. There are no hand wash facilities in the laundry. There have been plans for the laundry to be re-sited but there appears to have been delays in obtaining planning and building permissions. During this inspection the registered provider telephoned the home and spoke with the acting manager and confirmed the plans for the laundry have been submitted to the appropriate departments. The communal areas vary in appearance and standard of cleanliness and are in need of improvement and attention. Many items left lying about gave the home a messy and uncared appearance in places. DS0000064067.V367970.R01.S.doc Version 5.2 Page 24 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): OP 27, 28,29,30, Quality in this outcome area is poor. The level of staffing is restricting the ability of the service to deliver person centred support, staff only have time to offer basic care. The service had a poor recruitment procedure with staff appointed and starting work without references or other important documentation being received. The acting manager is aware of this and has plans to deal with it. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. One registered nurse is on the premises over the twenty four hour period. On the day of the inspection there were thirty three people in residence of which twenty six had been assessed as requiring nursing care. The staff complement for the morning of this inspection consisted of the acting manager (in a supernumery role), one registered nurse, six care staff (including one new care staff on an induction day), three catering staff, two domestics and the maintenance person. DS0000064067.V367970.R01.S.doc Version 5.2 Page 25 All care staff appeared extremely busy attending to the needs and personal requirements of the residents. One member of staff commented that they were always ‘very busy as there are lots of dependent people’. From general observations of the working practices and discussions with people it appears that staff are able to provide the basic care but have little time available for anything else. The acting manager discussed the recent difficulties with maintaining adequate staffing levels when additional cover is needed for annual leave and sickness of the permanent staff. Staffing agencies have been contacted to assist with supplying experienced care staff. This has not always been possible with the agencies at times unable to help. The acting manager went on to say that the service has successfully recruited an additional three people for the care staff team and is now hopeful that the situation will improve. Staff spoken with stated that in their opinion they all worked together as a team and did their best to care for the people at the home. They spoke of their reluctance to assist with working additional shifts and stated ‘very often asked to do overtime only to be not paid for it’. Observations of the cleanliness and general hygiene of the premises suggest that there are insufficient domestic staff to ensure the home is maintained in a clean, hygienic state free from dirt and clutter. It was not possible on this occasion to accurately establish how many of the staff have been accredited with a National Vocational Qualification in care at levels 2 or 3. Without this there is no guarantee that people are being cared for by competent and well-informed staff. Three staff personnel files were selected for inspection. Two were long term employees, with one recently appointed. Only the file of the most recent employee contained references, protection of vulnerable adults first check, application for criminal record bureau disclosures and confirmation of identity. The other two were lacking this information. Without this information there is no guarantee for ensuring the protection of service users. All files contained some certificates of training most were dated for 2007. The acting manager is currently auditing all staff files to gain an accurate picture of the qualifications held by staff and what their training needs are. She went on to explain the difficulties being encountered with accessing some training agencies to facilitate the courses. Staff discussed the recent training in the safe handling of medications and the control of substances hazardous to health. One person was going through the induction programme, and stated that she was enjoying the work and was ‘learning very quickly’. It was not possible to establish if the induction programme was to the Skills for Care specifications. DS0000064067.V367970.R01.S.doc Version 5.2 Page 26 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): OP 31,33,34,35,38 Quality in this outcome area is poor. The new acting manager is qualified and has the necessary experience to run the home. However, the registered provider is not sufficiently involved in the control and direction of the business and there is no evidence of long term or strategic planning. Resources have been cut to an unacceptable level and the home is struggling to deliver a good quality service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: DS0000064067.V367970.R01.S.doc Version 5.2 Page 27 Since the last key inspection in July 2007 the registered manager has left the service and in April 2008 another person was recruited as the acting manager. Ms Lyn Honey is a registered nurse and has had previous experience of managing a social care home. Ms Honey has yet to make a formal application for the position of registered manager. People living in, working and visiting the home offered positive comments and stated that Ms Honey had ‘ made a good start’ and was ‘easy to talk with’. Ms Honey offered a clear understanding of the key principles and focus of the service and discussed the plans for improvement. She openly discussed the problem areas and the barriers being encountered for improving the service. The registered provider is reluctant to release sufficient funds for household expenditure, with the manager having to obtain authorisation for any items required. A very small limited amount is available as petty cash. Good practice recommendations were made following the last inspection for the main drive to be repaired, alterations to the laundry, installation of automatic sluice disinfectors, and repairs and refurbishment of the bath and shower rooms. Little to no attention has been paid to these recommendations with the lack of investment and actions contributing to the poor outcomes that people are experiencing. Limited quality assurance and monitoring of the service continues with general satisfaction surveys being distributed to people living at the home and their representatives. The acting manager states these will be analysed in due course. The service currently does not have an annual development plan and the registered provider and/or representative does not visit the home each month as required by regulation. A review of the policies and procedures relevant to the service is on the acting managers ‘to do list’. The acting manager was requested to obtain a copy of the financial statements for the company to demonstrate the financial viability and effective management of the business. The registered provider was contacted during this inspection and requested to forward a copy. The provider stated that the accounts would be ready in 10 days time and it was agreed that they would be forwarded to the commissions West Midlands regional office by the 18th July 2008. Following this inspection the acting manager was contacted and informed us that there was a delay in sending the accounts to us. A letter of request for the accounts was sent to the Company’s Secretary with a date of the 28th July for the information to be sent to us. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this are maintained and fully receipted. Each person’s money is separately held in the homes safe. Records are maintained for the weekly, monthly and annual health and safety checks and these appeared to be up to date. DS0000064067.V367970.R01.S.doc Version 5.2 Page 28 The records for checking the temperature of the hot water were lacking information of the vicinity of the outlet of the test and the acting manager was unable to verify if the thermometer was in working order. For the comfort and safety of people the water temperature should be maintained at around 43 degrees Celsius. The acting manager stated that currently an audit is being completed for the use of bedrails to ensure that they are compatible with the bed, fitted correctly and safe. DS0000064067.V367970.R01.S.doc Version 5.2 Page 29 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 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 1 1 2 X 1 1 1 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 2 3 X X 2 DS0000064067.V367970.R01.S.doc Version 5.2 Page 30 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. 1 Standard OP8 Regulation 12(1)(a) (b) Requirement The service must make proper provision for the health and welfare of people who live at The Priory to ensure that they receive the nursing, personal care and monitoring that their conditions require. The service must make proper provision for people to live in a safe well-maintained environment. The service must make proper provision for people to have access to safe and comfortable indoor and outdoor facilities. The service must have sufficient bathrooms to meet the requirements of the people living at the home The service must provide suitable bathing facilities to meet persons preferences and needs. The service must provide suitable heating to ensure that the home is maintained at an ambient temperature for the comfort of the people living at the home. Alterations must be made to the DS0000064067.V367970.R01.S.doc Timescale for action 31/07/08 2 OP19 23(1)(a) 31/07/08 3 OP20 23(2)(n) (o) 23(2)(j) 31/07/08 4 OP21 31/08/08 5 6 OP22 OP25 16(2)(c) 23(2)(p) 31/08/08 31/08/08 7 OP26 13(3) 31/08/08 Page 31 Version 5.2 8 OP27 18(1)(a) 9 OP29 19 10 OP30 18(1)(a) 11 OP34 25(1)(2) laundry facilities to ensure that there is sufficient capacity to deal with the laundry of the people living at the home. Sufficient numbers of staff must be on the premises at all times to ensure that the care needs and requirements of all people living at the home are fully met. The recruitment procedures must be sufficiently robust to ensure that service users are being cared for by people suitable to work with vulnerable adults. All staff must have the opportunity for training and regular updates in the core and specialist topic areas that are relevant for the service. A copy of the audited accounts for the service must be submitted to verify the financial viability and effective management of the business. 31/07/08 31/07/08 31/07/08 28/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP7 OP9 Good Practice Recommendations The service user guide should include information on the current level of fees. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative For ease of identification and to reduce the risk of administering medications to the wrong person each Medication Administration Record should have a photograph of the person. The external medications should be dated upon opening DS0000064067.V367970.R01.S.doc Version 5.2 Page 32 4 OP9 5 6 7 8 9 10 11 12 13 OP12 OP15 OP16 OP19 OP24 OP24 OP24 OP25 OP25 14 15 16 OP25 OP26 OP28 17 18 19 OP30 OP31 OP32 with tubs discarded after one month of opening and tubes after 3 months of opening. This will reduce the risk of using out of date preparations. All people should be offered opportunities to engage in leisure and recreational activities to suit their personal preferences People must be offered a choice of food and when and where they wish to eat The service user guide should be amended to include the current details of the commission. The gardens to the side of the property should receive attention to ensure that they are safe and are accessible to people Toilet and bathrooms doors should be fitted with a suitable locking facility/’in use’ indicator to ensure that privacy and dignity are upheld. Each resident’s room should have a wash-hand basin Doors to service users private accommodation should be fitted with locks suited to individuals capabilities to ensure that privacy and dignity is upheld. Thermometers should be available in all areas of the home to monitor the temperature of the home to ensure that an ambient and comfortable temperature is maintained. The rusted and chipped guards surrounding the radiators should be replaced to a more suitable type. They should be securely fixed to the wall to prevent anyone coming into contact with hot surfaces. The double glazed window units that are permanently misted should be replaced, so that people in the room can see outside. The premises should be kept clean and hygienic with systems in place to control the spread of infection. The home should by now have achieved a ratio of 50 of trained care staff to ensure that suitably qualified, competent and experienced staff are working at the care home at all times The homes induction programme for new employees should be to the Skills for Care specifications. The acting manager should make a formal application for the position of registered manager of the service. The home should develop and implement an effective quality assurance and monitoring system for the service to ensure that the home offers the service that it states it does. The registered provider or a representative of the company should visit the home at regular monthly intervals as part of the ongoing monitoring of the service. DS0000064067.V367970.R01.S.doc Version 5.2 Page 33 20 OP33 21 OP38 A report should be prepared following these visits and be available for inspection upon request. For the safety and comfort of people the hot water should be maintained at a temperature of around 43 degrees Celsius. DS0000064067.V367970.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000064067.V367970.R01.S.doc Version 5.2 Page 35 - 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. 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