Inspection on 29/05/08 for The Priory Home

This inspection was carried out on 29th May 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Priory Home 07/11/08

The Priory Home 04/12/07

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 The Priory Home 26-28 Priory Avenue Hastings East Sussex TN34 1UG Lead Inspector Alexis Reilly Unannounced Inspection 29th May 2008 09:30 The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 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 Home DS0000067494.V364470.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 Adults 18-65. 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 Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Priory Home Address 26-28 Priory Avenue Hastings East Sussex TN34 1UG 01424 436792 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) bmsaumtally@hotmail.co.uk The Priory Residential Ltd Mr Bhaye Saumtally Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is seventeen (17). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users will have a past or present mental illness. Date of last inspection 4th December 2007 Brief Description of the Service: The Priory is registered to provide accommodation for up to 17 people suffering from mental health issues and admits people with medium to high dependency needs. The premise was originally two detached properties, is situated in Hastings, and has only single rooms, (all with wash hand basin) these are located on the ground, first and second floors. The building has undergoing refurbishment work. Residents have the use of a large lounge on the ground floor, a smoking area and three dining areas. There is a large rear garden with lawn areas for residents to enjoy. The home is in a residential part of Hastings within easy walking distance of the town centre. Short stay car parking is available in the street outside. The Priory is not registered or suitable for those with mobility problems. Fees charged by the service range from £355 - £500 per week. Inspection reports and other information such as Statement of Purpose are made available by the service on request. In June 2006 the home became a company following a successful registration process. This resulted in change of service number and change of name from the Priory residential home to the Priory home. The manager who is also the owner of the home remains unchanged. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 5 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 was an unannounced key Inspection, which included a visit to the home which took place between 9.30am and 2pm on the 29th May 2008, the inspection was carried out by two Regulation Inspectors. This inspection focused on assessing whether the home was building upon adequate outcomes, in order to improve quality of life for the residents placed in the home and meet their individual needs. The service became a registered company in June 2006, although this has lead to the home having a new service number and name which has changed from the Priory Residential Home to the Priory Home, the current owner and manager remains unchanged for over 20 years. The service had a Random Inspection on the 10th November 2006 to follow up concerns from a key inspection on 19th May 2006. During the Random Inspection of 10th November 2006 a recommendation was made to ensure issues found on staff CRB disclosures were explored with the staff concerned, and risk assessed by the Registered Manager to ensure the safety of the residents placed in the home. During the Key inspection on 4th December 2007 a number of requirements were made. During this current inspection it is evident that those in relation to the following standards YA 2,6,23,39 and 42 have still not been met, and the timescales have elapsed. These were in relation to YA2, the home must ensure its pre assessment document is comprehensive and forms the base of the care plan, the timescale given for this to be completed was 4/1/2008. YA 6 that care plans are comprehensive and based on individual aspirations, YA23 that the policy on restraint is clarified and any incidents are fully and clearly documented, YA 39 that a annual development plan covering all aspects of the home is developed, the timescale for these standards to be met were the 4/3/2008, and YA 42 significant incidents are reported promptly to Social services and CSCI the timescale for this was 4/12/2008. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 6 The current inspection on the 29th May 2008 included an inspection of care records for three residents. The following documents were also examined on the day of the inspection, the activities record in the home, the accident book and the way incidents are recorded, the list of staff on duty, daily log, medication records, menus, and the recruitment files of new members of staff. A full environmental tour was also carried out. The inspectors spoke with three residents and interviewed two members of staff. Further residents and staff were observed interacting in the home. The Registered manager was not present at the inspection however the Regulation Inspector has spoken with him in detail to clarify issues prior to writing the report. The inspector spoke on the phone with two mental health professionals, one of which had carried out a comprehensive review of two of the residents placed in the home prior to the inspection. The home sent back to the Commission a completed Annual Quality Assurance Assessment before the visit, which informed the inspection on the 4th December and this current inspection. However this Annual Quality Assurance Assessment was only partially completed. Of eight-outcome areas one is judged to be good, four are judged to be adequate and in need of improvement to ensure good outcomes and three are judged to be poor and need urgent improvement. What the service does well: The Registered Manager who is also the owner has managed the home for twenty-five years and is clearly valued by residents. The manager is well qualified including being a registered mental health nurse. In discussion with staff and residents it is obvious he is well liked and respected within the home. Most of the residents in the home have been in the home for a very long time from three to twenty-one years. The staff and the Registered Manager know the residents well and interactions between staff and residents are positive. Staff informed the inspectors what the residents enjoyed doing, who looked after the plants in the home, who enjoys cooking and what roles they take within the home. As part of the inspection the Inspector spoke with mental health professionals to gain their views about the home, the following comments were received ‘providing excellent standard of care, the family are very happy with the home’. ‘No particular worries expressed about the home. The person is not unhappy’. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Residents have care plans in place which record their basic care needs. However residents do not have comprehensive care plans and risk assessments which are up to date and are regularly reviewed. The Registered Manager must ensure that care plans are comprehensive and are based on individual aspirations, and interests and activities are recorded. Care plans must contain information as to preferences and include strengths and weaknesses. The plans must be regularly reviewed and updated to indicate changing needs. This requirement is now being considered for inclusion in the Statutory Notices. The Manager must ensure all risk assessments are in place and that the health and safety measures identified are dealt with to ensure residents are protected. Residents must have comprehensive risk assessments and these must be reviewed. These should include personal risks as well as environmental risks. This is now being considered for inclusion in the Statutory Notices. Whilst the home manages aggression and incidents it needs to be more transparent about how these occur to protect the best interests of residents. The Registered Manager must ensure that all Regulation 37 incidents are reported without delay. That fire risk assessments are updated and regularly reviewed to cover the risk of residents smoking in the home. That environmental risk assessments are up to date and ensure the safety of residents placed within the home. That window restrictors are fitted and used correctly. This is now being considered for inclusion in the Statutory Notices The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 8 The procedure for administering some of the medication was found to be confusing and incorrectly recorded. A referral has been made to the Pharmacy Inspector to follow up the concerns found at the inspection. Residents are not protected by the homes recruitment procedures. The Registered Manager must ensure recruitment procedures within the service are robust and promote the safety of the residents placed. That Recruitment files must include a statement made by the owner to confirm their satisfaction that any issues raised on a employees Criminal Records Bureau Check have been discussed and explored and that the owner is satisfied that the employee posses no risk to the residents placed in the home. This is now being considered for inclusion in the Statutory Notices Residents would benefit from a Manager who formally evaluates the service and has a plan in place to move the service forward. 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. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, & 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service experience Adequate outcomes in this area. Residents live in a home, which has a good knowledge of their basic needs. Prospective residents would benefit further if the home carried out a comprehensive written assessment which gave consideration to the individual needs of the resident, this in turn would inform and provide a good base for the development of their care plan. EVIDENCE: The three resident files examined evidenced that a competent person (the mental health team) had assessed their needs prior to admission and that the home had obtained a copy of the documents. Resident files showed that historically the home does not carry out their own written assessment prior to admission and use the information gathered from the placing mental health professional. Some of this information is historical and does not cover sufficient areas to provide the basis for a full assessment. During a telephone conversation the Registered Manager confirmed that there have been no new admissions in over three years and that in future they would carry out a written assessment. The Registered Manager informed the The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 11 inspector he plans to use the new care plan assessment as a pre admission assessment. The Registered Manager must ensure that this allows for a comprehensive assessment to be completed. The manager also confirmed that there is 28-day trial period to assess resident capability. Written records showed how the home has updated individual’s terms and conditions to indicate that these now include the fees charged. The range of fees is between £460.00 - £560.00 per week. These contracts were signed by the resident and the manager. The manager confirmed that no extras are charged for and that residents organise their own additional medical treatments such as chiropody. All the residents placed are now fully funded by social services. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, & 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service experience poor outcomes in this area. Residents have care plans in place which record their basic care needs. However residents do not have comprehensive care plan and risk assessments which are up to date and are regularly reviewed. Routines at the home are not person led. Residents would benefit from having more control of their own life and by having the opportunity to make their own choices and decisions, by being treated as an individual and being involved in the development of their care plan. Contact with advocacy services is not promoted. EVIDENCE: Most of the residents in the home have been in the home for a very long time from three to twenty-one years. The staff and the Registered Manager know The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 13 the residents well and interactions between staff and residents are positive. Staff informed the inspectors what the residents enjoyed doing, who looked after the plants in the home, who enjoys cooking and what roles they take within the home. However this information is not recorded in care plans, and risk assessments for activities such as mowing and cooking are not in place. Care plans were a mix of old and new formats, there were paperwork which was historical in detail and the inspectors found them confusing to access. Risk assessments were not up to date and not reviewed on a regular basis. The new Assessment is in a 4 column format, this is divided into strength, weaknesses, likes and dislikes. Under each of these headings there are areas for discussion and assessment; shopping, money, outings, leave, family, friends, advocacy, CPN/district nurse, day centre, social skills, mental health, physical health, verbal aggression, physically aggression, bad tempered, shouting, smoking, meals, table manners, bedtime, relationship, contact, getting up, personal hygiene, getting dressed, shaving, and bathing. In addition of some concern were that restrictions had been included in residents care plans, an example of this was a resident being refused entry to the kitchen if they had not done what was expected of them previously. The Registered provider must ensure that all restrictions in care plans are discussed with the resident, their placing social worker or CPN and are signed by both, and reviewed regularly. One of the care plans examined by the Inspectors identified the resident’s individual needs. This was an older style care plan which was used by the home previously. The plan focused on identified needs, issues around nutrition, interfering, lack of motivation, fire risk, alcohol abuse, manipulative behaviour, and obsessive behaviour. This care plan also included aims how to get to the desired goal, and an area for a progress update. However the care plan was not signed, and there was no evidence of review. There was no action plan to deal with issues around eating, or alcohol intake. The Inspector also looked at the homes daily log and incident book, and saw use of inappropriate language. The Registered Provider must ensure staff record appropriately and use correct terminology within the home. As part of the inspection the Inspector spoke with mental health professionals to gain their views about the home. The following comments were received ‘providing excellent standard of care, the family are very happy with the home’. ‘No particular worries expressed about the home the person is not unhappy.’ The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service experience Adequate outcomes in this area. Residents do benefit from regular and planned activities. Residents benefit from freedoms and flexible routines, and generally enjoy the food. Residents are consulted and listened to regarding the choice of daily activity, but this process could be improved. Further work on exploring and promoting a greater variety of activities both within the home and the community should be explored as should educational, and where appropriate, employment opportunities. EVIDENCE: Most of the residents in the home have been in the home for a very long time from three to twenty-one years The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 15 The inspector viewed the menus, which are planned day to day and showed variety. The menus do not offer choice although alternatives are made where the resident does not like what is being cooked the menu is displayed on the board in the dining room. A cooked meal is available midday and in the evening. Alternatives that are given to residents are recorded. Staff are aware of the general need to support residents to develop their skills, including social, emotional, communication, and independent living skills. Residents are consulted regarding the choice of daily activity, but this process could be improved. Residents in the home do have the opportunity to use the community resources however more could be done to gather information on community-based events and try to make individual arrangements for people to attend. A survey of leisure interests was carried out on the quality assurance questioner. The level of staffing severely restricts the ability of the service to deliver person centred support. Educational, and where appropriate, employment opportunities should be explored with the people using the service. During the afternoon of the inspection one resident was playing the piano, this could be heard around the house. From the activities book it was evident that resident’s birthdays are also celebrated. On the 26th May the home had a party for a resident’s birthday. The signing in book showed that the last visitor to the home was on the 18th May 2008. The majority of the people placed at the home have little family involvement. However if family relationships are helpful they are encouraged. One resident goes home for the weekend and a further resident has their mother visit regularly. Residents appear settled within the home and manage to stay in the home without numerous hospital admissions. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service experience Adequate outcomes in this area. Residents benefit from having their basic health needs met although gaps in care planning and lack of regular reviews could affect the full meeting of these needs. The procedure for administering some of the medication was found to be confusing and incorrectly recorded which could in turn place residents at risk. A referral has been made to the Pharmacy Inspector to follow up the concerns found at the inspection. EVIDENCE: The service has good links with health care professionals who are used for support, advice and guidance. Medication is supplied in blister packs and the local pharmacy carries out regular audits of the home’s medication. The registered manager also confirmed that a local pharmacist comes to the home to monitor the dispensing of medication. The sheets which record the administration of medicines were viewed and showed that some medication The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 17 was not being administered as the guidelines stated and that this was not being recorded correctly. No sample staff signatures were in place and there were no photographs of the residents or a list of any allergies. . A sticker was in place to cover the dates on the Medicine Administration Record sheets and the senior carer stated they had come with the wrong dates from the pharmacy. The services BNF was dated 2001, a new updated version needs to be purchased. No medication risk assessments were in place and there was no evidence of medication review. The administration of medication that is given on a ‘ as required’ prescription must be clearly documented on the administration chart with times administered. Medication was stored appropriately however the Registered Manager must ensure that this is secured to the wall. Advice regarding the storage of medicines can be accessed on the CSCI website. The manager confirmed that residents were registered with a dentist but they chose whether to try and access other specialist treatments such as chiropody. Care plans of residents who had particular health needs were inspected and the relevant information was found to be in place. There was a record in the incident book of a bruise on a residents face this had not been recorded and followed through onto an accident form, however in discussion with the senior carer they stated that the carer who had recorded this event should know to fill out a accident form as they have all been told to do this. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, & 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service experience poor outcomes in this area. The service has a complaints and concerns recording system. However there are no records of complaints kept at the home. There is no evidence of the service valuing complaints or improving outcomes for people as a result of complaints. Whilst the home manages aggression and incidents it needs to be more transparent about how these occur and report them promptly to protect the best interests of residents. Residents are not protected by the homes recruitment procedures. EVIDENCE: The Commission has not received any complaints or concerns about the home since the last Inspection. Professionals from the Mental Health team and Social services were spoken with and no complaint or Adult Protection issues have been raised. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 19 The service has an Adult Protection Procedure in place and staff are aware of the procedure to follow in the event of an allegation of abuse. The service has a Policy on Restraint in the service. However this needs review as it clearly states that restraint is not allowed within the home. Due to the complex needs of the service users placed this needs to be reviewed, to include ways of deescalating any conflict and ways the staff may need to protect themselves from incidents of aggression, whether that is physical or verbal incidents. The Inspectors found that poor recruitment procedures in the home undermined the safety of the residents placed. The service has a poor recruitment procedure with shortfalls in recording and judgements being evident. A member of staff had stated they had no criminal record on the job application form however the check from the Criminal Records Bureau showed significant issues with regard to a criminal record. In discussion with the Registered Manager they confirmed that the initial Protection of Vulnerable Adults first check had been clear and only on receipt of a full CRB check the offences had became apparent. There was no written information to show that the issues identified in the CRB had been explored and risk assessed by the owner, to ensure the safety of the residents placed. The Registered Provider confirmed that the CRB had been received in January 2008 five months prior to the current inspection. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service experience good outcomes in this area. Residents have benefited from improvements to the homes environment, and now live in a bright and clean home with an accessible garden. However the Registered Manager must ensure environmental risk assessments are in place and all window restrictors are used and in working order. EVIDENCE: A full environmental tour was carried out during the inspection, two bedrooms were not inspected as one resident had locked there door and another was in their room and preferred not to be disturbed. The inspection found that room 3 had a broken tap. There were some exposed pipes on the shower room floor. The hall on the second landing had a window which was open, and this The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 21 was also the case in room no 9. Radiators were uncovered and the Registered manager must ensure there are risk assessments in place to cover this and that also the exposed pipes are risk assessed or covered to ensure the safety of the residents. Overall the house was well decorated, bright with spacious bedrooms and new flooring in the bedrooms. The home was clean with no unpleasant smells. However there was smell of cigarettes in one of the upstairs shower rooms. The Registered Manager must ensure that up to date fire risk assessments are in place to ensure the safety of the residents placed. Included in this risk assessment must be reference to the fact that bins are not used in the bathrooms of the building as the Registered Manager is concerned the residents may by accident set fire to them. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, & 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service experience Adequate outcomes in this area. Staff are reliable, friendly interact well with residents and meet basic needs and complete tasks. Residents would benefit more fully if there were more staff to enable relationship building and provide a person centred approach to the delivery of care. Increasing the staff time would also enable a greater emphasis to be put on person centred care. EVIDENCE: The Registered Manager confirmed that at least half the current staff team are trained to NVQ level 2 or above, and three staff are first level registered nurses. Most staff hold a current first aid certificate. Staff are also trained in areas relevant to the needs of residents such as mental health related subjects including dealing with depression, obsessive compulsive disorders, schizophrenia and psychotropic medication. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 23 The Registered Manager and senior career confirmed in separate conversations that the training programme is due to commence again shortly. The Registered Manager is currently in the process of recruiting more staff to ensure there are four staff in the morning, two employed for care, one for domestic duties and one for cooking in addition to the Registered Manager and that there would be two staff on duty in the afternoon. The Registered Manager has obtained the Skills for Care specification with regard to the induction training offered in the home. On the day of the inspection this was not seen by the Inspectors, however the Manager confirmed that this has been completed for relevant staff and included a oneday course along with the workbook training. The Registered Manager provided the Regulation Inspector with dates of formal supervision which had taken place on all staff since January 2008. The service has a poor recruitment procedure with shortfalls in recording and processes being evident. The Registered Manager is required to have a more comprehensive application form for employment, which clearly shows last employers and employment history, this will ensure that the correct references are called for, and a comprehensive picture of the person’s employment history is obtained. If a CRB has issues recorded on it the Registered Manager must ensure that these have been explored and risk assessed by the Registered Manager, and that there is written confirmation that this procedure has taken place. Recruitment procedures must be robust within the service to ensure positive outcomes for the residents placed, and ensure their safety at all times. During the inspection the Regulation Inspector saw evidence of a friendly staff team which interacts well with the residents placed, and also knew a lot about the individual residents and their likes and dislikes. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service experience poor outcomes in this area. Residents benefit from a long serving Manager they trust and who is very experienced and qualified albeit lacking knowledge of current best practice. Residents would benefit from a Manager who formally evaluates the service and has a plan in place to move the service forward. The Manager must ensure all risk assessments are in place and that the health and safety measures identified are dealt with to ensure residents are protected. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Registered Manager who is also the owner has managed the home for twenty-five years and is clearly valued by residents. The manager is well qualified including having a management qualification in public and social studies. They are a Registered Mental Nurse, State Enrolled Nurse, and have completed the AQAA course and the Mental Capacity Act 2005 training. In discussion with staff and residents it is obvious he is well liked and respected within the home. However there is limited or no understanding of person centred thinking in the service. With regard to formal process within the home the Annual Quality Assurance Assessment which was requested prior to the Inspection, lacked information, it was brief and gave very little information about the service. The Registered Manager has demonstrated he has a lack of understanding of the purpose of the AQAA. The questions relating to the views of residents and to equality and diversity are particularly poorly completed. Areas of the data section are left blank. The AQAA did not provide the Regulation Inspector with a reliable picture of the service. Care plans are unorganised and risk assessments are not in place. recruitment procedures within the home raise serious concern. The Quality assurance monitoring is not regarded or implemented as a core management tool. The service has a range of general policies and procedures in place such as, values of privacy, dignity, choice, fulfilment, rights and independence. The manager is advised to look at some of these policies in relation to individual variations for some residents such as in relation to restraint practices. The home now maintains a visitor’s record book. The home deals with incidents of aggression and protects resident’s welfare. However the way in which this is done needs more timely reporting. The home is required to report any occurrence covered under regulation 37 and not just incidences where residents are badly hurt. These need to include incidents of residents assaulting peers. The manager confirmed that social services are sent such information on an annual basis or when they conduct reviews. During a telephone conversation with the Registered Manager they confirmed that the gas boiler and appliances are regularly serviced and that electrical appliances within the home were last tested on the 23/04/2008. The service has a safe wiring electrical certificate in place dated May 2005, the Registered The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 26 Manager is advised to confirm that this certificate is valid for 5 years from the date of issue. Fire extinguishers were last inspected in May 2008. The service fire risk assessment was updated in November 2007. The Registered Manager must ensure the policy with regard residents smoking in the home is up to date and that residents remain safe. The Registered Manager informed the inspector that the water temperatures within the home are checked weekly as are fire alarms, emergency lighting is checked monthly and the last fire drill within the service was dated 1st May 2008. The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 30 2 2 X 1 X X 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 STAFFING Standard No Score 31 X 32 3 33 2 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000067494.V364470.R01.S.doc 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Priory Home Score 3 3 1 X 3 1 2 X X 2 X Version 5.2 Page 28 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 YA2 Regulation 14[1]&[2] Requirement Timescale for action 01/08/08 2 YA7 12(2) 3 YA20 13(2) That the Registered person must ensure that the home carries out its own written assessment before admitting anyone. That the home confirms in writing that it can meet assessed needs prior to admittance. That this assessment is comprehensive and forms the basis of the care-plan. That the policy and assessment guidelines in place reflect the service admission procedures and that the assessment process is comprehensive. That the Registered person 10/07/08 ensures any restrictions in residents care plans are recorded and agreed by the resident and placing professional and are regularly reviewed. That the service explore independent advocacy so that resident have someone outside the home to speak with. That medication is 10/07/08 administered and recorded correctly, and that residents DS0000067494.V364470.R01.S.doc Version 5.2 The Priory Home Page 29 4 YA23 13[7] 5 YA33 18[1][a] 6 YA39 24 (1)(2)(3) photographs are in place and that there is a sample list of staff signatures. That the Registered person must ensure that it clarifies its overall policy on restraint. Due to significant incidents in the home, there needs to be a comprehensive policy on restraint. Incidents of restraint must be fully and clearly documented. That the Registered person must ensure that a review is carried out of current staffing levels to ensure that all times staff are deployed in sufficient numbers to meet assessed needs. That the Registered person must improve measures to evaluate and improve quality for the benefit of residents. That an annual development plan covering all aspects of the home is developed. That this plan is sent to the Commission by the date shown. 01/08/08 01/09/08 01/08/08 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 Refer to Standard YA20 YA37 Good Practice Recommendations That the Manager refers to a recent BNF for medication administration. That the manager takes advice on person centred care planning and user involvement in service development The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Priory Home DS0000067494.V364470.R01.S.doc Version 5.2 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. 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