Inspection on 04/12/07 for The Priory Home

This inspection was carried out on 4th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 11 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 29/05/08

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 09/07/2008.

CARE HOME ADULTS 18-65 The Priory Home 26-28 Priory Avenue Hastings East Sussex TN34 1UG Lead Inspector Jason Denny Key Unannounced Inspection 4th December 2007 10:30 The Priory Home DS0000067494.V352740.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.V352740.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.V352740.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.V352740.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. 19TH May 2006 key inspection [ previous service no 2159] Random Inspection 10th November 2006 under Date of last inspection 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 mainly single rooms, and has one double room (all with wash hand basin) located on the ground, first and second floors. The building is undergoing ongoing refurbishment work, which is required. 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 suitable for those with mobility problems. Fees charged by the service range from £460.00 - £560.00 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 organisation 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 for the home remain unchanged as result of this switch to becoming a company. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 10.30am and 4.00pm on December 4th, 2007. A random inspection took place on November 10th 2006 to follow up on a number of concerns from the last key inspection of May 19, 2006. The random visit was the first inspection since the home became a registered company in June of 2006. It is important to note that although the home now has a new service number and changed name from the Priory residential home to the Priory home, the current owner and manager remains unchanged for over twenty years across successive inspections. This inspection focused on assessing whether the progress evidenced in the short random inspection of November 10th 2006 had continued. The visit also looked at whether the home was building upon adequate outcomes in order to improve quality and involve residents more in the running of the home and the meeting of their individual needs. The visit included an inspection of Care records for three residents, medication needs, lifestyle opportunities and activities. The inspector toured some communal areas of the home with meal arrangements examined A record of complaints was inspected. Staffing was looked at in detail along with how quality is maintained and improved upon. The inspector spoke in detail with eight of the current sixteen residents whilst observing others. The inspector spoke on the phone with three relatives and some social services professionals connected with the home during and following the visit. The home sent back to the Commission a completed Annual Quality Assurance Assessment before the visit, which informed the inspection and the report. Of eight-outcome areas four are judged to be adequate and in need of improvement to ensure good outcomes and four are judged to be poor and need urgent improvement. What the service does well: The Residents all praised the manager of the home with typical comments such as “the manager is fair”. “ The manager is helpful”. Residents benefit from the experienced manager who has owned the home since it opened over twenty years. The service has given some stability to residents who have had unstable lives or multiple homes. There have been no new residents for over three years and only one person has moved out in this period due to serious health issues. Residents enjoy the food in the home. There has been no turnover of The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 6 staff over the last year. The home tends to admit people who are likely to be reasonably compatible with one another. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 7 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.V352740.R01.S.doc Version 5.2 Page 8 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. People who use this service experience Adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which knows their basic needs but they would benefit further if the home carried out a comprehensive written assessment prior to them moving in to inform 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 summary. Care plans did not show that this had been fully integrated into the care programme approach. Resident files showed that the home does not carry out their own written assessment prior to admission and rely on information received. The Registered Manager/owner confirmed that there have been no new admissions in over three years and would in future carry out a written assessment. The manager also confirmed that there is 28-day trial period to assess resident capability. That pre- assessment information which exists is incomplete and does not include all necessary information such as interests and what the resident can do for themselves. It is therefore not possible to evidence whether resident needs are being fully met based on those records inspected. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 9 The inspector spoke with Social Services professionals connected with the home and who are able to comment on the care of those case tracked. Responses were mixed with visiting professionals confirming that basic needs are met but the holistic needs of each individual need to be further established in order to get these needs met. 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, which they try to obtain on the NHS. It was recommended to the manager that room numbers and arrangements around additional charges are confirmed along with explaining why some residents are charged higher fees. These minor shortfalls were not found to be affecting outcomes with all current residents now fully funded by social services. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 10 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. People who use this service experience Poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst residents can have some confidence that basic care needs are recorded they can be less confident that all their individual needs are recorded and addressed. Residents do not benefit from care-plans and other information such as risk assessments which are regularly updated and which show changing needs. EVIDENCE: The inspector attempted to sample three care-plans relating to those residents case tracked. Information was found to be organised into three different files, which makes accessibility difficult. Whilst the manager was able to make some links due to having inputted the information the current format is not accessible to staff or residents. There was no evidence of any resident involvement in the care-plans and no reference to them was observed during the Inspection. Some professionals connected with the home have indicated The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 11 that the home lacks an individualised approach to care planning, which would help residents to reach their potential. Information in care plans is limited and affected in turn by the lack of written assessment by the home on admission. Care plans lack regular review and repeat the same basic information every one to two years. The plans identify a limited range of needs but are not specific on how these will be met. Behaviour management guidelines are particularly vague and open to misinterpretation. The plans do not identify resident strengths and weaknesses making it difficult to see what each person can do for themselves and what specific help they require. No goals and aspirations for each individual are recorded. Reviews which do take place do not indicate what progress is being made or why the plan is being repeated. Plans do not record people’s interests such as activities. Some information such as medication being taken was found to be out of date when compared with current medication being dispensed. Some residents made comments about the service and expressed ideas which were not found to be recorded but which the manager showed some knowledge of. Residents put an emphasis on the manager in meeting their needs. The manager is also the owner of the home and is recommended to protect everyone’s interests in that independent advocacy is explored especially as many residents lack any family involvement and which will give them a voice outside the home. The manager confirmed that advocacy has been used in the past. Risk assessments were found to lack detail, scope, and need review, which should take place within the care planning process. It was evident from talking with residents and Social Services that the manager deals fairly with incidents between residents and that there is commitment to create a safe home. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 12 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. People who use this service experience Poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from regular or planned activities and opportunities for mental stimulation are limited due to resources and lack of consultation. The home is unable to show the extent to which young adults are reaching their potential or achieving any goals or aspirations. Residents benefit from freedoms and flexible routines although it is not clear if this is their choice, and generally enjoy the food. EVIDENCE: Most of the residents in the home have been in the home for a very long time from three to twenty-one years and the registered manager advised that the The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 13 there is only one resident that is interested in activities and that she is well stimulated, she plans her holidays, outings, shopping and goes on leave with her sister. A repeated feature across successive inspections of the service has been the lack of programme of activities or records of resident’s interests and aspirations. Nothing was found to be planned on the day of the Inspection and the last entry on the resident notice board, which relates to afternoon staff on duty and activities on an afternoon five months prior to the Inspection visit. The sixteen Residents lacked staff engagement throughout the inspection and were observed occupying themselves. Residents and the manager confirmed that several years ago an activities organiser used to visit in the evenings and provided a range of activities which residents where free to choose from. Whilst there are some difficulties with the resident group in relation to motivation towards stimulating activities the service has not demonstrated it has attempted to record wishes and put resources in towards improving peoples lifestyles. The manager agreed to explore appointing an activity specialist to provide group or 1:1 opportunities. Some residents do access the community independently. Those who need staff assistance or prefer it are restricted due to staff shortages. 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. Residents praised the fact that the manager allows them freedoms and they choose when to get up. Due to the lack of recording of planed activities and staffing it was not clear the extent to which residents routines and choice are set by the home or the extent to which residents choose them. 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 as seen in the Inspection when one resident choose a different meal. A cooked meal is available midday and in the evening. Alternatives that are given to residents are recorded. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 14 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. People who use this service experience Adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from having their basic health needs met although gaps in care planning and lack of regular reviews affect full meeting of these needs. Medication arrangements are adequate but would benefit from consistent information and evidence of regular reviews. 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 all medication administered had been signed for appropriately. Some residents had medication being dispensed, which did not tally up with the care-plans. Some care managers from Social Services spoken with were not aware of medication changes. It is recommended that a more transparent system is established to The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 15 show when medication is reviewed and that the care plans are updated with this information. Whilst basic care needs appear to be met; based on records and discussions it was not possible to evidence if health needs are fully met due to a shortfall in care-planning. The manager confirmed that residents were registered with a dentist but they chose whether to try and access other specialist treatments such as chiropody. Some community psychiatric nurses are regular visitors to the home and have good knowledge of the service as confirmed in phone calls with the inspector. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 16 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. People who use this service experience Poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a complaints and concerns recording system although it would be better if outcomes were recorded or agreed. Whilst the home manages aggression and incidents it need to be more transparent about how this occurs to protect the best interests of residents. EVIDENCE: The home has received one complaint from a resident since the last key inspection according to the complaints book inspected. This complaint concerned the behaviour of a peer and whilst it is positive that it was recorded no investigation or outcome has been recorded along with the residents view. All residents spoken with described the manager as fair and approachable. It is not clear where else residents can go if they are unhappy with the manager but they are made aware of the Commissions contact details according to the home. The Commission has not received any complaints or concerns about the home since the last Inspection. Relatives and Social Services spoken with indicated they there are no current issues in the home. 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. Some unreported incidents of physical aggression by residents against peers were found in records. These incidents were not reported at the time to Social The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 17 Services or were recorded in a separate format. Of particular concern was the use of phrases, which indicated restraint such as staff holding someone “by their chin”. It was not clear what these descriptions meant and they were not specifically covered in the care plan. Although the manager showed a general policy on this area of control it has not been individualised for appropriate residents or agreed. The Inspector recommended that any approach is fully explained and known to staff along with being agreed with relevant people. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 18 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. People who use this service experience Adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have benefited from some improvements to the homes environment although further work is needed in relation to safety measures. Some communal areas are homely and popular with residents whilst others need improvement. EVIDENCE: Over the last year refurbishment has continued in the home, which has included bathrooms and flooring. Further double rooms have been extended and made into singles. The lounge and kitchen has also been redecorated and a new carpet fitted in the lounge. Residents have particularly enjoyed receiving four new leather sofas in the lounge, which can seat everyone. A new outside smoking area has been created to cater for residents now that smoking is banned within the home. This outside area is currently not popular with residents with some observed preferring to smoke outside in the drizzle. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 19 Residents have requested windows on the outside building or a move to different area attached to the back of the home. The laundry room facilities were found to be problematic with the home advised to take appropriate advice. The drying facilities are outside the main building home in an open area, which has inappropriate flooring. The home now ensures that liquid soap and paper towels and pedal bins are situated in all communal bathrooms and toilets. The kitchen bin was found to be full and had no lid with the home advised to address this. In addition the manager was advised that fire doors should not be wedged open with chairs and should be kept closed or auto closures fitted. This door was eventually closed during the afternoon of the Inspection. The registered manager explained that the fire door was wedged open while cleaning was taking place and that all fire doors are normally kept closed. It has previously been recommended that consideration be given to fitting residents’ bedrooms with a television aerial point, as this is a resident wish. The manager again explained that residents have portable aerials and that he wants to avoid the possibility of residents spending too much time in their rooms and becoming isolated. Some of the dining room furniture and its cleanliness was found to need attention with this expected to be addressed by the homes rolling programme of renewal. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 20 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. People who use this service experience Poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are reliable, meet basic needs and complete tasks. Residents would benefit more fully if there were enough staff at all times to meet needs which would support relationship building and provide more attention and activities. Residents would benefit from staff having regular written supervisions and clear aims to help them achieve their potential. EVIDENCE: On the day of the inspection there was one carer, a cleaner and cook on duty for the sixteen residents. The manager was also present but was involved in meeting with Social Services in the home for part of the visit. The manager was due to work as carer with the other care support worker. It was explained that other than Monday and Tuesdays there are two carers on shift with the manager helping where necessary and that most staff do not like working on these days. There has been no turnover of staff since the last Inspection according to the homes Annual Quality Assurance Assessment so it is confusing The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 21 why this shortfall has not been addressed to ensure that assessed needs are met at all times. The manager confirmed that additional staff are being recruited. It is also evident from the amount of administration that needs updating that more management hours are needed. Observations throughout the Inspection indicated that due to the low staffing levels that opportunities for engaging with residents were limited with the focus on completing tasks such as cleaning, cooking, making drinks and answering questions. Social Services confirmed to the inspector that staff are valued by residents and that relationships with staff could be further built upon. The manager and records 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 manager confirmed that four current staff without the National Vocational Qualification in Care level 2 are commencing this course in the month following the Inspection. The registered manager has obtained the Skills for Care specification with regard to the induction training offered in the home. The manager confirmed that this has been competed for relevant staff including a one-day course along with the workbook training. At the time of the inspection the manager was unable to locate the induction evidence. The manager now carries out fresh Police CRB disclosures when discrepancies appear on original checks or when new information comes to light. The manager was again advised of the usefulness of a written statement to confirm why someone with items on these checks is employed. Fresh checks revealed that no staff are currently on a protection of vulnerable adults register. All newer staff since the last inspection were found to have appropriate checks carried out prior to them starting work in the home. All staff employed in March 2005 received written supervision on the same day. No further supervision has taken place since that time. The format of this supervision is useful to the care of residents and the manager is required to ensure that there is regular written evidence to show how staff are being monitored and supported to both understand the aims of the home and fulfil them. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 22 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 People who use this service experience Adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. 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 more open and inclusive management approach, which supports them as individuals within a properly evaluated service on the basis of improving quality and moving the service forward. Some health and safety measures need attention to protect residents. 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 The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 23 qualified including being a registered mental health nurse and is positive about the role. It was agreed by all those spoken with that the service meets basic needs and is liked by current residents. Some residents indicated how they liked the way in which the home treats them as normal, that there is no sign outside the home and that staff do not wear uniforms. It was also evident from the same discussions which also included the manager and Social Services professionals and the lack of quality assurance measures, that the home has not kept up to date with changes in social care and the move towards creating more person- centred and responsive services. The manager also demonstrated that he lacks knowledge of what constitutes good care planning. The manager completed an Annual Quality Assurance Assessment prior to the Inspection, although most sections lacked information, evidence of consultation with residents, or an evaluation of where the service could improve. There was no clear indication in the Annual Quality Assurance Assessment of evidence to indicate a good service. The last survey of residents took place in 2005 and the questionnaires examined did not lend themselves to full consideration of aspects important to residents or around the service as a whole. In light of the poor quality of the Annual Quality Assurance Assessment submitted and lack of recent consultation with residents the manager was required to conduct a full survey of residents and their representatives views and produce an action plan based on this information and incorporate into an annual development plan for 2008. The manager indicated that meetings with residents and staff occur periodically but indicated that this has not been recorded for several years. 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 was 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’s Annual Quality Assurance Assessment confirmed that all necessary health and safety checks on equipment are regularly carried out. Hot water is now better controlled. Overall practices need more attention as evidenced on a tour of the home where for example fire doors and bins were found open. The home accommodates young and vulnerable adults where a number of visitors come and go. The home is therefore advised to maintain 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. Such reports were found in the home and will benefit from greater clarity. The manager confirmed that social services are sent such information on an annual basis or when they conduct reviews. The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 24 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 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 1 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 2 1 X X 1 X The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A [new service number. existing service] 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 04/01/08 2 YA6 3 YA12 4 YA23 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. 15(1) That the Registered person must 04/03/08 ensure that care plans are comprehensive and are based on individual aspirations and interests such as activities and contain information as to preferences and include strengths and weaknesses. That these plans are regularly reviewed and updated to indicate changing needs. 16[m]&[n] That the Registered person must 04/03/08 ensure that residents are consulted as to their activity interests and that this is recorded with resources put in place to ensure that residents have regular opportunities for mental stimulation. 13[7] That the Registered person must 04/03/08 DS0000067494.V352740.R01.S.doc Version 5.2 The Priory Home Page 26 5 YA30 13[4] 6 YA30 13[3] 7 YA33 18[1][a] 8 YA36 18[2] 9 YA39 24 10 YA42 37[1][g] 11 YA42 17[2] schedule ensure that it clarifies its overall policy on restraint and develops individually based guidance for those residents where approval and agreement has been reached. That incidents of restraint are fully and clearly documented. That the Registered person must ensure that appropriate bins are used in the home and that they have lids such as the bin in the kitchen. That the Registered person must ensure that advice is sought from the local environmental health department in relation to current laundry facilities. 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 ensure that there is written evidence to show that staff are being regularly supervised and fulfil the aims of the home That the Registered person must improve measures to evaluate and improve quality for the benefit of residents. That a survey of residents is carried out using appropriate questionnaires and an annual development plan covering all aspects of the home is developed from this survey. That this plan is sent to the Commission by the date shown. That the Registered person must ensure that all Regulation 37 notifiable incidents are reported without delay. An immediate requirement made on the day of the inspection. That the Registered person must ensure that an accurate and DS0000067494.V352740.R01.S.doc 04/01/08 04/03/08 04/03/08 04/03/08 04/03/08 04/12/07 04/01/08 The Priory Home Version 5.2 Page 27 4.17 appropriate record is kept of all visitors to the home. 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 4 4 6 6 7 8 9 Refer to Standard YA5 YA7 YA9 YA12 YA14 YA22 YA18 YA20 YA20 YA34 Good Practice Recommendations That Contracts [terms and conditions] fully reflect the information required. That the service explore independent advocacy so that resident have someone outside the home to speak with. That risk assessments are updated. That resident’s goals and aspirations are recorded. That a survey of leisure interests is carried out. That complaints by residents show evidence of investigation and closure. That residents’ full range of health needs are recorded. That over the counter medications are labelled. That prescribed medication matches the list in the careplan. That Recruitment files 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. That evidence of appropriate staff induction is accessible in the home. That the manager takes advice on person centred care planning and user involvement in service development. That the service look at introducing regular meetings or forums for recording residents views and wishes. 10 11 12 YA35 YA37 YA38 The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Priory Home DS0000067494.V352740.R01.S.doc Version 5.2 Page 29 - 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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