Care Home: Prince of Wales

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Ashcroft Hollow Nursing Home

What the care home does well People who are considering moving into the home benefit from having an assessment of their needs so that they can be sure the home can meet these needs. People are encouraged to look around, chat to staff and other people that live at the Home. They are given information about the Home before agreeing to move in. Detailed care plans are developed upon admission. People`s needs are identified and recorded and those spoken to were happy with that their needs Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 are met. People have access to advice from health professionals such as dentist, chiropodist and optician where they need it, so their health needs can be met. One person said "I am really well at the moment, I don`t need to see a GP, they look after me well here". Visitors are welcome at any reasonable time, people are encouraged to maintain contact with family and friends. The home`s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. People said "I have no worries, staff are all nice, I could talk to staff if I had any problems", "I have no worries at all". Accommodation is odour free, clean, and comfortable. Bedrooms were personalised and homely. One person said, "they come into your room every day to clean it" There are sufficient numbers of staff on duty to meet the needs of people living in the home. People said "staff are all nice", "staff are friendly and helpful", "staff are all lovely, really friendly". All doors are linked into the fire alarm systems, so they close and protect the people living there in the event of a fire. What has improved since the last inspection? The manager has purchased bed rail protectors for all bed rails in use and spare sets are available if required. The use of bed rail protectors helps to ensure that people are not at risk of injury from entrapment in bed rails. People were seen being moved safely using appropriate equipment as stated in their moving and handling assessment so they are not at risk of being injured. The service user`s guide has been updated to include the current management arrangements so that people have up to date information about the home. Contracts of residency have been updated to include information regarding funeral arrangements. The bath panel in the ground floor bathroom has been replaced so to further reduce the risk of people being cut by it. An activity organiser has been employed for two afternoons per week. A resident`s forum has been introduced and this is planned to be held every three months. This gives people the opportunity to have their say about what goes on in the Home.Prince of WalesDS0000069702.V377124.R01.S.docVersion 5.2Satisfaction surveys have been sent out to some people that live in the Home and their relatives. These surveys will be used to inform quality assurance processes in the Home. Some bedrooms have been refurbished, carpets and curtains changed. What the care home could do better: Arrangements should be made for each person living in the home to engage in meaningful and stimulating occupation that matches their ability and cultural preferences. This should ensure that people living in the home are stimulated and improve their quality of life. People should be made aware that there is a choice of food available for the main lunchtime meal. Sluice room doors should be kept locked shut when the sluice is not in use. This is to reduce the risk of cross infection by people entering the sluice room without the appropriate protective clothing. To reduce the risk of accident cleaning equipment should be stored in a lockable storage space and should not be accessible to people that live at the Home. Documentary evidence must be available to demonstrate that staff undertake training on a regular basis to ensure that the workface have the skills and abilities to be able to meet the needs of those under their care. This includes mandatory training such as infection control, fire, protection of vulnerable adults and food hygiene. Two written references must be available for all staff employed. This helps the Home to ensure that only those people suitable to work with vulnerable adults are employed at the Home. The person in charge of the Home should be aware of the location of all documentation in relation to the running of the Home, for example fire test records, electricity, policies and procedures etc. Nurses should have their PIN numbers registered with the Nursing and Midwifery Council (NMC) and registration should be up to date. One PIN seen on the day of inspection had expired and there was no documentary evidence at the Home to demonstrate that the nurse had re-registered with the NMC. Key inspection report CARE HOMES FOR OLDER PEOPLE Prince of Wales 246 Prince Of Wales Solihull Lodge Birmingham West Midlands B14 4LJ Lead Inspector Deborah Shelton Key Unannounced Inspection 10th August 2009 09:30 DS0000069702.V377124.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. Prince of Wales DS0000069702.V377124.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 Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prince of Wales Address 246 Prince Of Wales Solihull Lodge Birmingham West Midlands B14 4LJ 0121 436 6464 0121 430 7560 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) Edggbasston Investments Ltd Manager post vacant Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 20 The maximum number of service users to be accommodated is 20. 2. Date of last inspection 18th September 2008 Brief Description of the Service: The Prince of Wales Nursing Home is a detached two-storey purpose built home that provides accommodation on both floors for older people requiring varying levels of nursing care. The home is situated in a residential area on the outskirts of Solihull and borders of Birmingham. There is limited off road parking to the front of the property. An enclosed garden and patio is situated to the rear of the building and has seating that may be used when weather permits. The home is close to local amenities, such as a post office, a few small shops and a local park. There is a regular bus service to the town centres of Solihull and Shirley. Accommodation is divided into 16 single rooms and 2 shared rooms. Two of the single bedrooms have en-suite facilities consisting of a toilet, wash hand basin and bath; the bath is domestic in style and would not be suitable for people with mobility problems. There is level access to the entrance of the home, which is suitable for wheelchair users. A passenger lift gives access to the first floor enabling all areas of the home to be accessed. There is a range of equipment in the home such as grab rails, raised toilet seats, hoists and assisted bathing facilities for people with mobility problems. The home also has pressure-relieving equipment for those who may be at risk of developing pressure sores. Communal facilities consist of a dining room and a choice of three lounges over the two floors. A copy of the latest inspection report was available in the reception area. The service users guide stated that fees charged are dependent on the type of facility required and type of care package and needs of the individual. Specific advice on fees is available from the home manager. Fees do not include: dry cleaning, hairdressing, telephone calls, chiropodist, dentists and optician. This information was current at the time of the inspection and the reader may wish to contact the care service for updated information. Prince of Wales DS0000069702.V377124.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. This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. The visit took place on Monday 10 August 2009 between 9.30am and 5.50pm. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Audit (AQAA) was completed by the manager and returned to us. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. During this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Discussions were held with people who use the service, staff and visitors to the Home. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Two people living in the home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Two person living at the Home and five staff completed survey forms on the day of inspection; their comments are included throughout this report. What the service does well: People who are considering moving into the home benefit from having an assessment of their needs so that they can be sure the home can meet these needs. People are encouraged to look around, chat to staff and other people that live at the Home. They are given information about the Home before agreeing to move in. Detailed care plans are developed upon admission. People’s needs are identified and recorded and those spoken to were happy with that their needs Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 6 are met. People have access to advice from health professionals such as dentist, chiropodist and optician where they need it, so their health needs can be met. One person said “I am really well at the moment, I don’t need to see a GP, they look after me well here”. Visitors are welcome at any reasonable time, people are encouraged to maintain contact with family and friends. The home’s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. People said “I have no worries, staff are all nice, I could talk to staff if I had any problems”, “I have no worries at all”. Accommodation is odour free, clean, and comfortable. Bedrooms were personalised and homely. One person said, “they come into your room every day to clean it” There are sufficient numbers of staff on duty to meet the needs of people living in the home. People said “staff are all nice”, “staff are friendly and helpful”, “staff are all lovely, really friendly”. All doors are linked into the fire alarm systems, so they close and protect the people living there in the event of a fire. What has improved since the last inspection? The manager has purchased bed rail protectors for all bed rails in use and spare sets are available if required. The use of bed rail protectors helps to ensure that people are not at risk of injury from entrapment in bed rails. People were seen being moved safely using appropriate equipment as stated in their moving and handling assessment so they are not at risk of being injured. The service user’s guide has been updated to include the current management arrangements so that people have up to date information about the home. Contracts of residency have been updated to include information regarding funeral arrangements. The bath panel in the ground floor bathroom has been replaced so to further reduce the risk of people being cut by it. An activity organiser has been employed for two afternoons per week. A resident’s forum has been introduced and this is planned to be held every three months. This gives people the opportunity to have their say about what goes on in the Home. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 7 Satisfaction surveys have been sent out to some people that live in the Home and their relatives. These surveys will be used to inform quality assurance processes in the Home. Some bedrooms have been refurbished, carpets and curtains changed. What they could do better: 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. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 8 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. Prince of Wales DS0000069702.V377124.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 Prince of Wales DS0000069702.V377124.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): 1, 2 and 3 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 who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. EVIDENCE: Two people were chosen to case track during this inspection. This involved talking to the person, looking at their care files and any related documentation, talking to staff about the care that they provide and looking at living areas and the facilities available. One of the people case tracked had recently moved in to the Home. This person’s care file was reviewed to see what pre-admission assessment processes take place. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 11 The manager or deputy usually undertakes pre-admission assessments. A visit is conducted to the person who wishes to move into the Home and a discussion is held regarding the services that the Home offers and the facilities available. A care needs assessment is carried out which gives the Home information about the person to enable them to decide whether they would be able to meet their needs. The needs assessments seen contained contact details for external professionals such as GP, social worker and next of kin details. Standardised documentation is used to record the persons level of needs and abilities and any resources such as equipment needed and number of staff to help provide care. One of the pre-admission documents seen had not been dated or signed by the person completing the information. It is therefore difficult to identify when this information was obtained and whether it was still relevant upon admission to the Home. People are invited to visit the Home and have a look around, they are able to stay for a meal and chat to people. This helps them decide whether this Home is the right place for them. Once agreement to move in has been reached, care plans are developed and the person moves in for a trial stay of up to four weeks. Care plans are developed using the information obtained during the pre-admission assessment. An assessment is also completed which is reviewed regularly to evidence people’s changing needs and abilities. The assessment in one file had not been completed even though the person had been living at the Home for over three months. A discussion held with a person who had recently moved in confirmed that they had settled in really well and that everyone was friendly and kind. From documentation seen, discussions with the deputy and a person living at the Home, it was noted that pre-admission processes are satisfactory. Sufficient information is obtained about people using the Home’s own preadmission assessment and information sent by either the hospital or social services. The Home’s statement of purpose and service user’s guide were seen. The statement of purpose and service user’s guide is a combined document which is readily available in the Home. Each person is given a copy of this document which is kept in their bedroom. A copy is available for visitors to look at if they wish. The document was not reviewed in detail but it was evidenced that the changes requested at the last inspection of the Home have been made. The name and experience/qualifications of the new manager are now included in this document. A discussion was held regarding contracts of residency. Copies of social services contracts were on care files seen. The deputy showed evidence that Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 12 contracts between the Home and the person have been amended and the revised document has been sent out for agreement and signature by everyone living at the Home. One completed contract was seen, this had been signed by the resident and the manager of the Home. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 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 have good access to a wide range of health professionals and their health and personal care needs are met. People are treated with respect and their rights to privacy and dignity are maintained. EVIDENCE: The care files of the two people being case tracked were reviewed. Both files seen were in good order and information was easy to read and a majority was up to date. Pre-admission assessments had been completed which demonstrates that the Home assess people to help them decide that they are able to meet their needs before they move in. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 14 Care plan summary sheets record what care plans are in place and provide a quick reference guide for staff. A range of care plans were available in both files to enable staff to meet people’s identified needs. Care files were broken down into sections for ease of reading and finding information. Information is computer generated and therefore quick and easy to update. Records seen had been reviewed on a monthly basis. Evaluation records detail the tasks that the person is able to complete without assistance and those that require prompts or full assistance. Sufficient detail was recorded to guide staff of the action to take to meet needs. Daily records were completed per shift these record changes in the person’s health and general wellbeing. They record what the person has done during the day and any nursing tasks completed. It was noted that occasionally staff had recorded “…. received due nursing care, no concerns”. This is not sufficient information to demonstrate the health/wellbeing of the person during that shift. Night staff keep a record of whether each person is asleep or awake at two hourly checks throughout the night. These records were not completed on all occasions in July and August. One care plan required updating as it recorded that the person is to be nursed on a pressure relieving mattress. The deputy manager confirmed that this person no longer uses an air pressure mattress. Details regarding chiropody, nail care, hair, teeth and skin, bathing or showering are recorded in personal hygiene care plans. Oral health care plans also recorded sufficient information regarding, for example, the method of cleaning dentures. A separate record is kept which staff sign when they have assisted with personal hygiene. Records show that those being case tracked have been assisted to shower, bed bath, wash upper and lower body, skin integrity checked, hair brushed, clothing changed etc. Records are kept showing personal hygiene undertaken for both day and night. During conversations with people living at the Home it was evident that their personal hygiene needs were being met. It was noted on some care plans that they had been “approved by the next of kin”. However, the next of kin has not signed documentation to demonstrate that they have approved the information recorded in the care plan. A care plan regarding dietary needs records that the person is to be “encouraged not to eat junk food, as they are obese”. There was no Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 15 documentary evidence of any action taken to reduce this person’s weight or whether the health benefits of losing weight have been discussed with them. The care plan does not record how often the person is to be weighed. Records state that food intake is to be monitored. Food intake records seen, show that all food is eaten at each meal. There was no documentary evidence to demonstrate that any changes have been made to the person’s diet to reduce weight. Risk assessments had been completed in both files regarding the risk of developing a pressure area, and moving and handling. One file did not contain a falls or nutritional risk assessment. The deputy manager completed these documents and put them on file during the inspection. For all risk assessments where a high risk was identified a care plan had been put in place to inform staff of the action they are to take to reduce the risk. Weight records for one person had not been completed since June 2009. The deputy manager confirmed that they had purchased some new hoist scales so that everyone at the Home could be weighed. These had needed to be calibrated and were not available in July. They have recently been returned to the Home and the deputy had a list of people that were waiting to have their weight recorded. Each file contained a record of professional visits i.e. GP, social worker, Optician, dentist etc. The GP records information on the Home’s records of the reason for and outcome of their visit. The two people who responded to our survey said that they always receive the care and support that they need and that the Home always makes sure that they get the medical care that they need. The medication records, storage and administration practices at the Home were reviewed for the two people being case tracked. Medication was stored appropriately in locked cupboards, a trolley and a locked fridge. The temperature of the fridge was recorded on a daily basis and was within the required temperature range. The temperature of the medication room was taken on a daily basis and records showed that the temperature of the room rose above 250C on some occasions. The deputy said that when the temperature is too high they bring in a cool air fan to reduce the temperature. However, there was no Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 16 documentary evidence to show that any action is taken when the temperature is above 250C and whether the action taken is sufficient to reduce the temperature of the room to within the safe medication storage limits. Controlled medication in use was stored and recorded correctly. The stocks of controlled medications available were in accordance with records held. The medication and records for the two people being case tracked were reviewed and found to be satisfactory. Photocopies of original prescriptions were kept with medication administration records. The manager is in the process of taking photographs of all people to keep with their medication administration records. One of the people being case tracked did not have a photograph with their medical records. During discussions it was noted that only trained nurses administer medication on a daily basis. Key custody practices were discussed and found to be satisfactory. Only one person is having their blood sugar levels monitored. There is a blood sugar monitoring kit for this person’s use only. A nurse monitors and records blood sugar levels in the person’s care file. Staff were kind and patient with those under their care. People were moved with the use of a standing hoist, staff explained to people the action they were going to take and chatted whilst assisting people. People were dressed appropriately for the time of year, hair was brushed and nails clean. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 17 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 and 15 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 are encouraged to keep in contact with family and friends and visiting is flexible. There is limited evidence to demonstrate that the lifestyle experience in terms of social and leisure activities meets the needs of those that live at the Home. EVIDENCE: A discussion was held with the deputy and conversations were held with three people that live at the Home regarding activities that take place. One person said that they prefer their own company. They had been into the lounge once but prefer to stay in their bedroom. This person was not aware of any activities that take place. The activity records in this care file were blank. One entry recorded that the person had been offered activities but had refused. There were no records to demonstrate that any one to one activities take place with this person in their room. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 18 Another person said that exercise to music takes place once per week and she enjoys this as she thinks it is good to try and exercise to keep healthy. The third person said that there is nothing to do and she is bored. A visitor said that there appears to be a problem with lack of stimulation and things to do for people. Both of the people who responded to our survey said that there are usually activities that they can take part in if they want to. There was no activity list on display and no documentary evidence to demonstrate that any activities take place. The deputy confirmed that once per week an external entertainer provides exercise to music. Someone visits once per fortnight to undertake complimentary therapies such as hand and foot massages. The Home have recently employed a member of staff to undertake activities with people two afternoons per week and a hairdresser visits once per week. The deputy was aware of the need to provide more activities and documentation to evidence that this has taken place and confirmed that they are working on this at the moment. The two care files seen recorded people’s religion, however there is no mention in care files of whether these people still practice their religion and if so, how any religious needs are met. The deputy said that they do not have any religious services in the Home currently as nobody wishes to practice their religion. It was noted that one person used to go out to church with a member of staff but due to failing health they no longer wish to go. Conversations where held with three people regarding religion, however from these conversations it could not be confirmed whether people wished to practice religion or not. There is no documentary evidence to demonstrate that the Home have questioned people regarding their religious needs and no documentary evidence to demonstrate that the Home are meeting people’s needs in this respect. Daily life at the Home was discussed with four people. It was noted that they are able to get up in the morning when they want, go to bed where they want, sit where they like and can stay in their room all day if they wish. One person said that as she needs help to get into bed staff call in and ask her if she is ready to go to bed, if not she tells them to come back later. Another person said she calls staff to tell them when she wants to go to bed. People said that they choose what clothes they wear each day and try to be as independent as possible. People can choose at what time of day they wish to bath or shower. They have a choice of having personal care assistance by either male or female care staff. The deputy was aware of the people who preferred to have their personal care only by female staff. One lady spoken to said that she did not mind if male staff provided personal care to her because the men were all so nice. Another person said that she preferred female staff and that most of the Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 19 time her wishes were met but when they are short staffed she occasionally is cared for by a man but she didn’t really mind on the odd occasion. The Home have an open visiting policy and a visitor to the Home confirmed that they are able to visit at any reasonable time and are made welcome by staff. The deputy confirmed that they try to keep ongoing communication with relatives either via telephone, in person or via email if this is the preferred choice of communication method. All people spoken to said that the food was OK. On the day of inspection lunch was served at 1.20pm. The deputy confirmed that lunch is usually served between 1pm – 1.30pm, most people eat in the dining room but they are able to eat in their bedroom or the lounge if they prefer. One person spoken to said that there is a choice of breakfast. The deputy confirmed that the chef asks people every morning what they would like. There is a choice of cereal, toast or cooked breakfast. The deputy said that some people have things that are not recorded on the menu for example one person likes beans on toast or cheese on toast for breakfast sometimes. There was no documentary evidence to demonstrate this. There was also no documentary evidence to demonstrate that people are given a choice of the main lunchtime meal. The deputy confirmed that they do not record the meal choices of people but they will do this in future as proof that a choice of meal is available. One of the people who responded to our survey said that they usually like the meals at the Home and the other person said that they only sometimes like the meals. People spoken to on the day of inspection said that the food was “OK”. The deputy was unable to find any information, for example minutes of meetings, to demonstrate that people’s views and opinions have been sought regarding the meals at the Home. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 20 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 and 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 living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. EVIDENCE: The Home have received two complaints since the last inspection. These have been investigated by the Home. Detailed information is recorded regarding any action taken, discussions held and the outcome of the complaint. Letters to the complainant are available on file. Both complaints are now closed. The complaints procedure on display on the noticeboard. This has been updated as requested at the last inspection and now records the name of the new manager. Complaint forms are available on the noticeboard for people to complete if they have any worries or concerns. The deputy said that there is an open door policy at the Home, people are encouraged to come and speak to the manager or any other senior member of staff if they have any problems. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 21 All people spoken to said that they had no complaints. Two surveys were completed by people living at the Home during the inspection, both people said that they knew how to complain and confirmed that there was someone informally to speak to if they were not happy. The deputy manager printed off a copy of the Home’s training matrix, this demonstrated that some staff have undertaken training regarding the protection of vulnerable adults. The deputy and manager have undertaken training regarding deprivation of liberty safeguarding recently and intend to cascade the information to all staff. The manager has apparently updated the protection of vulnerable adults policy but the deputy was unable to locate this at the time of inspection. The Home’s annual quality assurance assessment records that this policy was reviewed and updated in June 2009. An issue was identified at the last inspection regarding the methods used by staff to assist people to move in their chair/bed. Staff were seen transferring people from wheelchair to chair using correct equipment and moving and handling techniques during this inspection. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 22 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 and 26 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. EVIDENCE: The Home has two floors and is a purpose built facility. The ground floor has two lounges and dining room. Both ground floor lounges were clean and hygienic. Whilst people were in the dining room eating their breakfast a domestic was cleaning and vacuuming the main lounge. Two people sitting in nursing chairs were being assisted by staff to eat their breakfast in the main lounge. After breakfast these people were taken from this lounge to a smaller lounge. A member of staff said that they are moved because the chairs are too big for the main lounge as they would restrict the Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 23 number of other people who would be able to use the lounge. Both people were seen in the smaller lounge during the afternoon of the inspection a member of staff is allocated to sit with these people. There was no documentary evidence to demonstrate that these people are given the choice of which lounge that they prefer to be in each day. The dining room was clean and had sufficient space for everyone to eat their meal in this area if required. Food is served from the kitchen via a serving area into the dining room. The rear garden was viewed. There has been no work to re-lay the paving slabs to the rear garden, they are still uneven and would present a trip hazard. The deputy said that there are still plans to extend the Home to the back of the building. This issue has been raised at previous inspections and remains outstanding. Bedrooms are located on both the ground and the first floor. Bedrooms seen were clean and no unpleasant odours were noted. Décor was a bit dated in places but was acceptable. Call alarms were located near to beds in the rooms seen. Furnishings were in a good state of repair but some were worn and old looking. Bedrooms had been personalised with pictures and ornaments and had a homely feel. Each room has a lockable drawer to enable people to store personal belongings. The keys to these drawers are kept in the nurses station. People do not have their own key to the drawer. One person spoken to was concerned that his bank book was locked away in his drawer and he did not have access to it until the manager returned from annual leave. The deputy said that if someone wants access to their top drawer they need to ask a nurse who will open it for them. People should be risk assessed to identify the risk of people having their own key to their lockable space, keys should be given to those people at low risk. There is a bathroom and shower room on the ground floor. A member of staff spoken to said that not many people have showers as they prefer to have a bath. At a previous inspection it was noted that the ground floor bath had large crack on bath panel and had been cut underneath so that the hoist could be used. This has now been repaired with new bath sides. They do not match the colour of the bath, however they cover up the crack in the panel. Wheelchairs were stored along the corridor. Hoists and slings were being stored in the bathroom. A member of staff confirmed that there is a lack of storage space for these items. Access to the first floor is via stairs or a passenger lift. There are two further bathrooms on this floor, one which has a manual bath chair and another which had cleaning equipment including sprays, mop and bucket, chair and other Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 24 items blocking access to bath. The deputy confirmed that all bath chairs are in good working order and staff are able to use any of the bathing areas. Staff are able to operate the manual chair if this is the person’s preferred bathing area. The Home’s annual quality assurance assessment records that rooms have been painted and families have had the opportunity to choose the colour. New curtains, dining room chairs and a carpet cleaner have been purchased. It also records that the Home plans to refurbish the reception area, nurses station and manager’s office, to purchase new furniture for all bedrooms and replace some of the old curtains. The people who responded to our survey both said that the Home is always fresh and clean. Sluice rooms used to clean commodes are available on each floor. There was a notice on sluice room doors saying keep shut, one door was closed the other open. These doors were not locked when not in use. Disposable gloves and aprons were seen in use appropriately by staff during the inspection. These were also available in the laundry. Liquid soap and disposable hand towels were seen in bathrooms. These are available to try and reduce the spread of infection. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 25 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 and 30 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. There are sufficient numbers of competent staff on duty to meet the needs of people living in the home. Recruitment practices do not always ensure that the people living there are protected, which could impact on their safety. EVIDENCE: Staffing levels were discussed with the deputy and a copy of the duty rota was taken for review. Staffing levels on the day of inspection were in accordance with the numbers recorded on the duty rota. Staff on duty on a daily basis are as follows:Morning 4 care staff, nurse, domestic, chef, laundry assistant Afternoon 3 care staff, nurse, kitchen assistant Night 2 care staff, nurse Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 26 Two afternoons a week there is also an activity worker. The manager does not work nursing/care shifts and is supernumerary to the staffing establishment. The deputy works 12 hours per week on a supernumerary basis. The deputy is a trainer and uses her 12 hours supernumerary time to complete paperwork, help the manager update systems and to provide training to staff. Care staff are not involved in domestic, catering or laundry duties. Everyone spoken to praised the staff saying that they were kind, caring and always tried their best. Two people that live at the Home said that there are a lot of agency staff used. The deputy said that agency staff are used but the Home have their own bank of nursing and care staff and these are used firstly before an agency is contacted. The Home’s annual quality assurance assessment document records that eight shifts have been covered by agency staff within the three months before 6 July 2009. Staff were attentive to people’s needs on the day of inspection and appeared to have a good relationship with those under their care. During the inspection people spoke positively about staff saying that “staff are all nice”, “staff are all good, there are men and ladies to care for you”, “the staff are nice, they come in all of the time and clean my room”. A visitor said “the staff are all lovely, really friendly. There is a new manager who listens and is trying hard to improve things”. The two people who responded to our survey said that staff are always available when you need them and they always listen and act on what you say. The Home’s annual quality assurance document records that eight care staff have got the National Vocational Qualification at level 2, this means that 38 of care staff have this qualification, this does not meet the standard of 50 of care staff achieving this qualification in all care homes. The staff personnel files of all newly employed staff since the last inspection were reviewed. These three files contained application forms, criminal records bureau checks, health declarations and protection of vulnerable adults checks. Two of the files only contained one written reference. The deputy said that they are in the process of chasing the outstanding references. One application form did not have the general education history and dates of attendance section completed. Copies of passports, marriage or birth certificates were available as proof of identity. Copies of training certificates showing training undertaken before and during employment at the Prince of Wales Nursing Home were available on file. Staff training and induction records were reviewed. It was noted that all staff will complete the Home’s new induction training which has changed since the Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 27 last inspection. A standardised induction booklet is available and according to the deputy, all staff both new and existing have had to complete this induction training. Records seen had no documentary evidence to demonstrate how it was identified that staff were competent at a task or were aware of action to take in certain circumstances. There are no written records to show how competency is assessed. The deputy said that staff are not part of the staffing numbers until they have completed their induction. A senior member of staff observes their working practices and a member of staff assesses their competency. The deputy said that they do not have a written test or have to demonstrate in writing that they know how to complete a task/understand a principle. Supervision of staff is apparently linked to the induction. Documentation seen did not demonstrate that staff induction is completed in line with the Common Induction standards modules one to four. Nine nurses are employed at this Home. The professional identification number (PIN) of three nurses was checked to ensure that they have current registration with the Nursing and Midwifery Council. This registration enables them to continue practicing as a nurse. One registration seen had expired in July 09, another was up to date and the third was due to expire on 31 August 09. There was no documentary evidence to demonstrate that paperwork had been completed to renew registration. During the inspection the deputy tried check to see if the expired registration had been renewed but was unable to do so. The deputy was advised to check all PIN numbers to ensure that they are in date and to devise a system to easily monitor the PIN without having to search through each individual staff file. The deputy manager has attended a “train the trainers” course and is able to train staff at the Home. The deputy said that she is able to undertake manual handling training immediately with staff when an issue is identified or training is out of date. A training matrix is available which records all staff and details of training undertaken for 2008/2009. A copy of the training matrix was taken for review. The training matrix shows that some staff require training/updates regarding fire, infection control, moving and handling, food hygiene and first aid amongst other things. The deputy said that she undertakes training whenever she can. Staff training videos are also available as refreshers for staff until they are able to undertake training provided by the deputy. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 28 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, 33, 35, and 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 management arrangements ensure that the home is well run, which benefits the people living there. The health, safety and welfare of the people living there is not always promoted and protected, which could put them at risk of injury. EVIDENCE: The manager who was newly in post at the last inspection of the Home is still in the process of being registered with us and is awaiting a date for interview. The manager has completed NVQ levels 4 & 5 in Care and the Registered Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 29 Managers Award. The manager has the relevant qualifications and experience and had previously worked in the Home as a registered nurse. Since the last inspection a deputy manager has been employed. The deputy has managed a Care Home previously. The manager was on annual leave at the time of inspection and the deputy assisted with inspection process. On call arrangements were discussed and it was noted that the manager is on call when she is not on duty, if they are not able to contact the manager the deputy is on call. This ensures that staff have access to help and guidance twenty four hours per day. The deputy was very knowledgeable and helpful and was able to assist with most of the inspection process although she was not able to find some documentation required i.e. details of fire checks, electrical checks etc. It is important that the deputy is aware of the location of all paperwork when she is left in charge of the Home. A recommendation was made at the last inspection that inventories of personal belongings are reviewed and kept up to date. The Inventory of personal belongings in the care files of the people being case tracked were blank. This recommendation therefore remains outstanding. The Home do not manage finances on behalf of anyone. Relatives/advocates are involved in all financial matters. Financial records are therefore not kept. Quality assurance systems and practices were discussed. A relatives and residents meeting was held in June 09. This is the first meeting since the new manager took over. The agenda for this meeting was seen. The deputy said that approximately seven people attended. The manager has apparently written up the minutes of the meeting but they could not be found on the day of inspection. The agenda noted topics for discussion such as menus, plans for extension, refurbishment, birthdays, toiletries, complaint procedures, visitors and resident questionnaires. The deputy confirmed that they are planning to hold these meetings approximately every three months. Satisfaction surveys were recently (July and May 09 respectively) sent out to residents and relatives, two visitors surveys have been returned and five residents surveys. All recorded positive responses about the Home. The deputy confirmed that audits are undertaken regarding accidents, care plans, medication, kitchen and bedrooms. A blank care plan audit was seen, no other documentation was seen regarding audits undertaken. The deputy said that she tries to audit one care plan per week and gave a copy of the audit tool used. The completed documents are then apparently stored on the care files. None were seen in the two files reviewed. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 30 From discussions with the deputy it was noted that quality assurance systems are improving and further work is being undertaken to ensure that the quality of the service provided meets the needs and expectations of those that live at the Home. Staff appraisal and supervision takes place on a regular basis. Supervision consists of a tick list where staff tick when they have observed staff working practice and a space for comments regarding any discussion held. Supervision is used to identify any training needed. A selection of records were examined to see if the Home have adopted appropriate systems and practices regarding health and safety. Records show that hot water temperatures are monitored each month. Some of the temperatures recorded would present a scald risk as they were above the recommended temperature of 430C. For example some of the temperatures recorded in July were 490C, 500C and 520C, temperatures were taken again in these areas a week later and all were below 430C apart from one room which was taken again a week later and had reduced to the required temperature. Where temperatures are above the recommended maximum, evidence should be available to demonstrate that immediate action has been taken to reduce the risk of scalding for people that live in the Home. Records show that the Lift was serviced on 4 August 2009. The deputy was unable to find some of the up to date health and safety information requested regarding hoist servicing, landlord’s gas safety certificate, some fire test records etc. These records should be available on all occasions to demonstrate that appropriate action has been taken to ensure that equipment and facilities are safe to use. Information recorded in the Home’s annual quality assurance assessment details that health and safety checks on equipment has been undertaken. Records were available to show when the fire officer has visited the Home and details of weekly fire alarm and automatic detector points tests. Fire extinguishers were checked last 21 April 09 by an external specialist fire company, the certificate of inspection was seen on file. Records to show that emergency lighting has been tested had not been completed and there were no records to show that staff have undertaken a fire drill. The deputy confirmed that staff regularly undertake fire drills although details of these are currently not recorded. It was noticed that some people were being transferred in the lounge in wheelchairs which did not have footplates in place. The deputy said that this is people’s choice as they say that the footplates hurt their legs/feet. The deputy showed a care plan which recorded that footplates are not to be used because the resident said that they hurt their feet. This care plan had apparently been approved by the next of kin. The next of kin had not signed the care plan and there was no risk assessment in place to demonstrate what the risks are of Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 31 being transported in a wheelchair without foot plates were and whether these risks had been discussed/explained to the person and or their representative. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 32 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 2 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 33 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 OP29 Regulation 19 Requirement Two written references must be obtained for all staff that work there to ensure that ‘suitable’ people are employed to work with the people living there. Timescale for action 10/09/09 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 OP8 OP9 Good Practice Recommendations People should be weighed as often as their care plan states to ensure their health and well being is not at risk. There should be a photograph of the individual on their Medication Administration Record (MAR) so that unfamiliar staff would know who to give the medication to and ensure people get the medication they are prescribed. The arrangements in respect of activities needs further development to ensure residents are adequately stimulated. 3 OP12 Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 34 4 OP12 Care plans should contain more information about how to meet individual’s religious needs so that staff can respect the person’s beliefs. Documentary evidence should be available to demonstrate that people are offered a choice of meal on a daily basis. Paving slabs to the rear of the building should be re-layed as they are uneven and present a trip hazard to people who may wish to walk in the garden. Risk assessments should be used to identify those people capable of having a key to their lockable space in their bedroom. These people should be offered a key of their own. Suitable arrangements must be made for the storage of the homes equipment etc. so that it does not impinge on the facilities for residents. Sluice room doors should be kept locked when the sluice is not in use. Evidence that nurses have current registration with the Nursing and Midwifery Council (NMC) should be available in their records to ensure that suitably qualified staff are providing nursing care. An effective quality assurance and quality monitoring systems should be implemented and include feedback from all stakeholders in order to monitor the services and facilities and put systems in place for continuous improvement. Inventories of people’s belongings should be reviewed regularly to ensure that people still have their belongings and they have not been mislaid. Footplates must be used with wheelchairs unless a risk assessment demonstrates alternatively. This is to ensure the safety of the people living there and reduce the risk of accidents. A suitable storage area should be identified for the storage of cleaning equipment, any chemicals used for cleaning should be stored in a lockable space and people who live in the Home should not have access. DS0000069702.V377124.R01.S.doc Version 5.2 Page 35 5 6 OP15 OP19 7 OP19 8 OP22 9 10 OP26 OP29 11 OP33 12 OP35 13 OP38 14 OP38 Prince of Wales 15 16 OP38 OP38 Documentary evidence should be available to demonstrate that staff undertake fire drills on a regular basis. Records should be available to demonstrate that all fire safety equipment such as emergency lighting is checking on a regular basis. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 36 Care Quality Commission Care Quality Commission West Midlands 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. 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. Prince of Wales DS0000069702.V377124.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!