Care Home: Prestbury Court Residential Home

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What the care home does well People said of the home: • • “I am very satisfied with the care that my mother receives from Prestbury court. Its cleanliness and atmosphere. She is well cared for.” “Always available to discuss things and very helpful. My mother seems very well looked after.”Prestbury Court Residential HomeDS0000033222.V378244.R01.S.docVersion 5.2• • •“The staff are always pleasant and smiley and unstressed normally and generally kind to the patients.” “They are excellent at looking after my mother’s needs.” “The home has a good, caring attitude; pleasant, helpful staff. Lots of activity. Always someone around. New gardening project to engage residents, which is brilliant. Excellent manager.” “The home is very caring and welcoming.”•People receive an assessment of their needs prior to admission and their care is planned so that staff know how to support and care for them. Staff treat people with respect and dignity and support their individuality. The standard of personal care provided is very high and health care needs are met with the support of local health care services. A district nurse described the standard of care as good. People are supported to lead fulfilled lives within their capability. The food provided is nutritious, well presented, tasty, in sufficient quantity and, for the most part, to people’s taste. People are protected through the ‘open door’ policy of the manager, complaints arrangements and staff knowledge of safeguarding from abuse. The home environment is homely in appearance, well maintained, warm, and clean and appears to be pleasant. The home is well equipped. Staff are provided in sufficient numbers and are skilled and knowledgeable in their work. They are very happy with the standard of training provided and are well supported and supervised. The quality of service provided is under regular review. The manager is experienced. She aims for continual improvement at the home. The provider organisation invests in the business and supports the management. What has improved since the last inspection? Care plans are now regularly updated and daily records completed to ensure that they accurately reflect the care required by each person living in the home. The actual dose of a medicine administered is now accurately recorded where the dose to be given can be variable. The statement of purpose and service user guide has been updated to provide accurate information. Activity records are now detailed. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Sills at all exits are now made safe to ensure there is no possibility of people tripping and to make them easier to use with wheelchairs. The quality monitoring system has now been extended. There has been much investment in equipment, especially to reduce the possibility of pressure damage. What the care home could do better: Recruitment practice must be more robust to ensure no staff employed are unsafe to work with vulnerable people. It must not be recorded that a medicine has been administered until it has been administered as this can lead to confusion and mistakes. Records are legal documents and must be accurate. There should be better stock control of medicines in the home and any medicine prescribed to be given ‘as necessary’ or ‘as required’ must be included in care planning so that staff have no doubt under what circumstance it may be given and they do so consistently. Assessment records must include information about any Advanced Decisions that people have made in relation to their care or finances and any legally binding arrangements where a person is acting on their behalf, such as Lasting Power of Attorney and Independent Mental Capacity Advocacy. Knowledge about equality and diversity should be sought and integrated into the homes policies and procedures. Assessment questioning should be more open so that people can freely express their diverse and individual needs. The whistle blowing policy should include the contact details for the local authority safeguarding team, so staff have access to this information should they have concerns. The environment should be adapted to help people with dementia remain independent. Good practice guidelines based on current research should be sought. Staff should never put soiled laundry on the floor. They should follow good hygiene practices to reduce the likelihood of cross contamination.Prestbury Court Residential HomeDS0000033222.V378244.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Prestbury Court Residential Home Brimley Lane Bovey Tracey Newton Abbot Devon TQ13 9JS Lead Inspector Anita Sutcliffe Key Unannounced Inspection 11th August 2009 07:45 DS0000033222.V378244.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prestbury Court Residential Home Address Brimley Lane Bovey Tracey Newton Abbot Devon TQ13 9JS 01626 833246 01626 833236 avenscare@aol.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) Avens Care Homes Ltd Mrs Rosalyn Nolan Care Home 43 Category(ies) of Dementia (43), Mental disorder, excluding registration, with number learning disability or dementia (43), Old age, of places not falling within any other category (43), Physical disability (43) Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Mental disorder (Code MD) 2. Dementia (Code DE) The maximum number of service users who can be accommodated is 43. 16th July 2008 Date of last inspection Brief Description of the Service: Prestbury Court Care Home is registered as a Care Home providing Personal Care for forty three older people who may have additionally a degree of physical or mental disability or dementia. Health care needs are met through the local community health team, such as district nurses. The home has two floors with some bedrooms on the ground floor. There is a large conservatory, lounge, two dining areas and a sensory room. There is good outside space with a patio area and suitable furniture for use to be made of it when the weather permits. Three staff live on the premises on the top floor of the property opposite resident’s accommodation. Weekly fees at the time of this inspection ranged between £330 and £540. An additional charge is made for newspapers, personal toiletries, incontinence pads, telephone and transport and charges incurred with visiting hairdresser, dry cleaning or chiropodist. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Prestbury Court Residential Home DS0000033222.V378244.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 2 star. This means the people who use this service experience good quality outcomes. Information about Prestbury Court has been collected towards this inspection since the last key inspection 16th July 2008. This key inspection included one unannounced visit to the home. The information sent to CQC each year by the care provider gave us some numerical information about the service, such as how many people are resident and how many staff employed. It also gave the home the opportunity to tell us what they do well, what barriers there may be to improvement and what improvements are planned. Surveys were sent to people who use the service (seven were returned, mostly completed with the help of family) and staff (eight were returned) so they could comment about the home. As part of the visit to the home we looked at all communal areas, and several bedrooms. We spoke with several people who use the service and observed staff going about their work. We looked in detail at the care of two people. This included meeting them, talking to staff about the care and support they need and looking at records of their care. Since the last key inspection was completed a Random Inspection was carried out on 4th December 2008. For this we were accompanied by the Regional Lead Pharmacist. This inspection was to follow up on the requirements and recommendations made at the key inspection. Although this report is not published it is available to the public on request. People who use the service may be described within this report as clients, service users or residents. What the service does well: People said of the home: • • “I am very satisfied with the care that my mother receives from Prestbury court. Its cleanliness and atmosphere. She is well cared for.” “Always available to discuss things and very helpful. My mother seems very well looked after.” Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 6 • • • “The staff are always pleasant and smiley and unstressed normally and generally kind to the patients.” “They are excellent at looking after my mother’s needs.” “The home has a good, caring attitude; pleasant, helpful staff. Lots of activity. Always someone around. New gardening project to engage residents, which is brilliant. Excellent manager.” “The home is very caring and welcoming.” • People receive an assessment of their needs prior to admission and their care is planned so that staff know how to support and care for them. Staff treat people with respect and dignity and support their individuality. The standard of personal care provided is very high and health care needs are met with the support of local health care services. A district nurse described the standard of care as good. People are supported to lead fulfilled lives within their capability. The food provided is nutritious, well presented, tasty, in sufficient quantity and, for the most part, to people’s taste. People are protected through the ‘open door’ policy of the manager, complaints arrangements and staff knowledge of safeguarding from abuse. The home environment is homely in appearance, well maintained, warm, and clean and appears to be pleasant. The home is well equipped. Staff are provided in sufficient numbers and are skilled and knowledgeable in their work. They are very happy with the standard of training provided and are well supported and supervised. The quality of service provided is under regular review. The manager is experienced. She aims for continual improvement at the home. The provider organisation invests in the business and supports the management. What has improved since the last inspection? Care plans are now regularly updated and daily records completed to ensure that they accurately reflect the care required by each person living in the home. The actual dose of a medicine administered is now accurately recorded where the dose to be given can be variable. The statement of purpose and service user guide has been updated to provide accurate information. Activity records are now detailed. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 7 Sills at all exits are now made safe to ensure there is no possibility of people tripping and to make them easier to use with wheelchairs. The quality monitoring system has now been extended. There has been much investment in equipment, especially to reduce the possibility of pressure damage. What they could do better: Recruitment practice must be more robust to ensure no staff employed are unsafe to work with vulnerable people. It must not be recorded that a medicine has been administered until it has been administered as this can lead to confusion and mistakes. Records are legal documents and must be accurate. There should be better stock control of medicines in the home and any medicine prescribed to be given ‘as necessary’ or ‘as required’ must be included in care planning so that staff have no doubt under what circumstance it may be given and they do so consistently. Assessment records must include information about any Advanced Decisions that people have made in relation to their care or finances and any legally binding arrangements where a person is acting on their behalf, such as Lasting Power of Attorney and Independent Mental Capacity Advocacy. Knowledge about equality and diversity should be sought and integrated into the homes policies and procedures. Assessment questioning should be more open so that people can freely express their diverse and individual needs. The whistle blowing policy should include the contact details for the local authority safeguarding team, so staff have access to this information should they have concerns. The environment should be adapted to help people with dementia remain independent. Good practice guidelines based on current research should be sought. Staff should never put soiled laundry on the floor. They should follow good hygiene practices to reduce the likelihood of cross contamination. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 9 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 Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&5 Standard 6 does not apply as Prestbury Court does not provide Intermediate Care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully informed and their needs understood prior to admission. EVIDENCE: Each of the seven people who responded to survey told us that they received enough information about the home to decide if it was the right place for them. The home told us: ‘There is now information about the home in a format more suitable for people with dementia. All prospective residents and families are invited to look around the Home, come for lunch or trial day if so wished. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 11 Every resident is assessed before admittance, either in their home or elsewhere.’ We looked closely at the care of the last person admitted to the home. Although they were unable to hold meaningful conversation with us we saw them on several occasions; they appeared to be settled and contented. We spoke with the ‘key-worker’ responsible for their care and they were able to describe the support and care she needed and they had a good knowledge of her as an individual. We looked at records of the person’s assessment, necessary so that their care can be planned. Assessment records were quite detailed. There was much clear information, including that of any risk to their well-being, such as falls. The records were signed and dated as they must be as legal records. We discussed with the manager the need for assessment to include information relevant under the Mental Capacity Act and deprivation of liberty safeguards. Currently the home is not recording this information, which it must so that people are properly protected in law. We also discussed the importance of ensuring people’s diverse needs are understood and recorded on admission. We found there was a lack of insight into this. We confirmed that the manager, or deputy in her absence, visits each potential new resident in their own home when ever this is possible. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s care and medical needs are met but the handling of medicines has the potential to lead to mistakes. People are treated with dignity and respect. EVIDENCE: Six people who responded to survey told us that they always receive the care and support they need and one said they usually do. All told us that they always get the medical care they need. We looked closely at the care of two people who use the service and in less detail at two others. We found that each person had a plan of how their care and support is to be delivered and for most it was clear that people, or their representatives, are involved in planning their care. There was clear detail and each plan had been regularly reviewed so the information for staff is up to Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 13 date. Each of the eight staff who responded to survey told us that they are given up to date information on the needs of people they care for. Care plans contained risk assessment, such as prevention of pressure sores, and important information such as how to assist people to move safely. People looked very well cared for. The standard of person care appeared to be high. People commented in surveys on the high standards of care, one saying: “They are excellent at looking after my mother’s needs”. We saw that effort had been taken to ensure people were dressed and groomed as they would wish; with attention to individual detail. Records indicate that the home ensures medical attention is provided as necessary. At the point of the previous key inspection concerns were raised about the care of some very frail people at the home, some who developed pressure sores. The home has responded very robustly to ensure this does not happen again. We asked staff how they are to prevent pressure sores occurring and found they were knowledgeable about it. The home reports: ‘Pressure care training is now in place. A key worker system in now in place. All beds now have specialist mattresses to reduce the likelihood of pressure sores and specialist care beds are now in situ for those that need them.’ We spoke with the district nursing team leader. She told us: “Vastly improved. Over all the difference is amazing and we now have confidence in the home. Staff competence has improved and the standard of personal care is high”. We looked at how the home supports people to manage their medicines or how they manage them on their behalf. We were told that no people currently manage their own medicines. There had been previous concerns regarding the management of medicines. This formed part of a random inspection December 2008 and led to the issuing of a requirement. On this occasion we saw staff administering medicines to people. The trolley was secured when left, so that people are not at risk from unsupervised access. Controlled drugs were correctly stored and their use recorded. Medicines were signed into and out of the home so that audit of their use is possible. This reduces the likelihood of mishandling or mistakes. Variable doses were recorded and two staff check any change in medication to prevent mistakes. However, we found some medicines in stock which were out of date, indicating poor stock control. We also found that medicines, described to be administered ‘as necessary’ or ‘as required’ were not part of the care planning, which they must to ensure continuity of use and proper monitoring. We also found that a senior care worker was signing for medicines before they are given. This is practice which could lead to mistakes being made and was immediately brought to the attention of the manager. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 14 We saw that staff fully engaged with people in their care. They were polite, friendly, unhurried and respectful. We were told that people can choose to lock their bedroom door for privacy should they wish and they know key pad numbers so they are not restricted. Family visiting told us that staff are always kind and a visiting district nurse said staff were very caring. Prestbury Court Residential Home DS0000033222.V378244.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to lead fulfilled lives within their capabilities and the standard of food is high. EVIDENCE: Two people told us through survey that the home always arranges activities that they can take part in if they want and four told there it usually does. A list of planned activities is displayed within the home for people to see. The home employs an activities worker who visits every afternoon. We were shown an activity ‘log’ which details which activities people have joined. It also described where one-to-one time had been spent with people to prevent social isolation. We were present for a musical event and saw people dancing. We saw that a garden party in July had included a BBQ. There are lots of pets within the home and there had been a visit from the donkey sanctuary, we Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 16 were told, much enjoyed. In addition people had newspapers, books and were sharing company with each other in the differing communal areas of the home. The home reports: ‘All service users are enabled and encouraged to lead as normal life as possible, by personalising their room and making the home their own by having the confidence to make choices on all aspects both socially and culturally. A full time Activity Lady is employed - with balanced program. There are trips out - musical events within the Home, arm chair activity and so forth. Families are welcomed and offered lunch etc. A choice of food is avaiable for all meals, and people know they can ask for alternatives.’ Three people told us through survey that they always like the meals at the home, two told us they usualy do and one said sometimes. We had a meal at the home to test the quality and speak with people. There was a choice of two meals, one vegetarian. Sauce was served seperately to provide more choice and meet people’s tastes. The food was nicely presented, well served and staff were attentive and helped people discreetly. People told us there was more than enough food, at the weekends they were offered wine, sherry or ginger beer and the meat was always tender. A visiting district nurse confirmed that very frail people receive adequate fluids and diet and we saw from records that people’s nutritional needs are assessed and planned. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected through the arrangements made at the home but this could be further improved. EVIDENCE: The home reports that: ‘All service user families are talked with and encouraged to express any concerns they may have. Also questionnaires ask for their opinion. We have a good rapport with all Agencies. Staff receive training in adult protection and there are new concerns / complaints forms.’ All those who responded to survey told us there is someone they can speak to informally if they are not happy and five of the seven told us they know how to make a formal complaint. The complaints policy is mentioned in the written guide to the service and in more detail in the ‘Statement of Purpose’, available to all. Timescales for response and the provider (owner) and Commission contact details are included in case people do not want to complain to the manager. We saw that ‘concerns’ forms are available in the entrance to the home should people wish to use them and we saw that the manager makes herself available to people and visitors. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 18 We have received no complaints about the home and the home reports that they have received no formal complaints about the service. Each of the eight staff who responded to survey said they knew what to do if someone has concens about the home. We asked three and they were able to describe how to respond should they believe an act of abuse had occurred. Staff were also able to tell us where the whistle blowing policy (how staff can take concerns to the authorities should they need) was kept. However, we found that the policy did not include the contact details for the local authority safeguarding team and recommend that this is included. There has been one safegaurding alert made against the home within the last 12 months. Issues raised concerned care of the very frail and pressure sores and have been discussed in the outcome group ‘health and personal care’. The safeguarding process has now been concluded for many months. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A pleasant environment but independence could be better promoted and hygienic practices need to be followed at all times. EVIDENCE: The inspection included a tour of the premises. Overall it appears to be a pleasant environment with many homely aspects. People living in the home have a choice of communal areas in which to spend their time, take part in activities and receive visitors. These include a large conservatory and outside areas where there is suitable furniture to enable people to sit outside and enjoy the fresh air and sunshine when the weather Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 20 permits. We saw people apparently contended sharing spaces, such as the entrance hall. All areas of the home were well decorated and comfortably furnished in a homely style. However, with little exception there has not been much adaptation to help people with dementia maintain their independence in the home. For example, much of the décor is one colour (cream) which makes orientation difficult. Neither was there much pictorial information, such as to where the toilet is located or bedroom found. This could be very much improved upon. We were told that anyone moving into the home is encouraged to personalise their room and this was evident in the rooms visited. The manager stated that a risk assessment is completed each time a new person occupies a room. A maintenance worker is employed to ensure that the home is safe and to assist people moving into the home. There has been much investment in equipment; for mobility, moving and handling people safely and pressure relieving to prevent pressure sores. Staff told us they have all the equipment they need at this time. The home reports: ‘There is a Parker bath system, including Jacuzzi bath, various showers, hand rails fitted and so forth. Wheel chair / frame friendly to ensure all service users have independence. There are window restrictors to ensure safety. Surroundings are comfortable and safe and in good condition. Ramps are in place to facilitate going to the outside areas of the home. The garden is enclosed and kept to a good standard. There are various areas for sitting, including a summer house. Although we arrived early morning we found the home to be fresh and clean. Five of the seven people who responded to survey told us the home is always fresh and clean and one person said it sometimes is. One person mentioned cleanliness as a commendation of the home, but another felt the cleanliness of the home could be improved. Staff told us they have protective clothing (such as gloves) to prevent cross contamination, and we saw those in use. There is also liquid hand soap, paper towels and hand gel so staff can follow the hand washing policy and prevent cross infection. However, despite a ‘non-touch’ policy, whereby staff should not need to handle soiled laundry at all, we saw some apparently dumped on the floor in the laundry. This is poor practice. The home reports that twenty six staff have received training in infection control and that there is an action plan to deliver best practice in prevention and control of infection. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 21 Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from staff who are caring, competent and in sufficient numbers to meet individual needs. However, recruitment practice puts people at risk. EVIDENCE: One person who completed a survey told us: “The staff are always pleasant and smiley and unstressed normally”. Six people who responded to survey told us that staff are always available when they are needed and one told us that they usually are. Six staff told us through survey that there are always enough staff to meet the individual needs of all the people who use the service and two told us there usually are. When we visited we found sufficient staff to meet people’s needs. There were forty three people resident. The home reports that they have not had the need to meet any staffing shortfalls through the use of agency or temporary staff in the three months prior to completing their questionnaire. This provides consistency for people. The home uses a key working system; this means there is a named staff Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 23 member to specialise in one person’s care. They have also employed a deputy to support the manager. Each of the eight staff who responded to survey told us their induction covered everything they needed to know to do the job when they started and that they receive training that is relevant to the role, helps them understand and meet the individual needs of people, keeps them up to date and provides enough knowledge about health care and medication. A new member of staff told us how much she loved the work. Seven staff we met told us their training is excellent and listed the training they receive. This includes mandatory health and safety (such as fire safety) and training necessary to provide good care, such as diet and nutrition, pressure area care and dementia care. A visiting district nurse complemented the staff on the care being provided and said staff competence had improved. The home reports that fourteen of the twenty two care staff have completed National Vocational Qualifications (NVQ) in care to level 2 or above. This is an indicator of staff competence. We looked at whether the recruitment practice at the home protects people from staff who may be unsuitable or unsafe to work with vulnerable adults. We examined the records of three staff employed since the previous inspection. We found that two of the staff started at the home before the list of people who are unsuitable to work with vulnerable adults had been checked. We also found that none of the three had the required two written references. The manager said she telephones past employers but that is not in itself sufficient. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager leads by example, is competent and aims for continual improvement. EVIDENCE: The registered manager has many years experience of running the home and has achieved NVQ level 4 in care and management. In discussion she clearly demonstrates that she knows the home and the people living in it well. She told us that she operates an ‘open door’ style of management. Both staff and the people living in the home were seen to approach her with confidence and Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 25 to be listened to. There were frequent visitors to the office throughout the inspection and everyone was well received. A district nurse told us that the manager has worked very hard and with professionals associated with the home. Each staff who responded to survey told us that they feel they have enough support and the ways they share information usually works well. Comments from people’s family include: “Excellent manager” and “Always available to discuss things and very helpful”. The manager looks to continually improve the service provided and has demonstrated that this can be achieved. To obtain people’s opinion of the home surveys are sent to people in the home able to complete them and all family. They had also been sent to staff, but we were told none were returned. Staff confirmed that there are regular staff meetings and there is supervision of their work. We saw that many aspects of the home are regularly audited, such as accidents. We were told that the provider visits the home unannounced on a monthly basis as they are required to do, so as to monitor the service, but there were no reports available to evidence this. Those reports have been received by the Commission since the inspection visit. We discussed the Mental Capacity Act and deprivation of liberty safeguard legislation which the home must understand and comply with. We found that some staff have been on training workshops and documentation about it was available at the home. Training has been started for all staff. To assist the people living in the home with making sundry purchases the home has an account specifically for that purpose which has a float provided by the home for them to draw on. No money is kept for people but people have lockable storage space for any valuables they keep. Detailed records are made of items bought, receipts are kept and each month given to relatives who reimburse the home. The manager said that the system works well. We saw no environmental hazards which were not assessed. Staff receive the mandatory health and safety training. We had no health and safety concerns about the service other than the handling of laundry, previously mentioned. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement Timescale for action 30/09/09 2 OP29 19 (1) 3 OP9 13(2) Medicines must only be signed for as given when they have been given so as to prevent confusion and mistakes. No staff must work in the home 30/09/09 until all checks (as per Schedule 2, 1-9) have been completed (including two written references) and the manager can be confident that the person is safe to work with vulnerable adults. Where a medicine is to be given 30/09/09 ‘as necessary’ or ‘as required’ this must be part of planned care so that there is consistency in its use. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Assessment information should include any legal DS0000033222.V378244.R01.S.doc Version 5.2 Page 28 Prestbury Court Residential Home 2. 3. 4. 5. 6. OP3 OP9 OP18 OP22 OP26 arrangements in place which protect people who do not have capacity to make decisions on their own welfare. This includes information on Advanced Decisions, Lasting Power of Attorney and Independent Mental Capacity Advocacy. Assessment should contain more open questioning so that people are confident their diverse needs will be recorded and understood. There should be a stock control method for medicines so they are not kept when out of date. The home’s whistle blowing policy should contain the contact details of the local authority safeguarding team so this is easy for staff to access. The home should be adapted for people who have dementia, in line with current good practice, to help them maintain their independence. Soiled laundry should be contained so that there is no risk of cross contamination. Prestbury Court Residential Home DS0000033222.V378244.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission SouthWest Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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