Care Home: Priory Court Nursing Home

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What the care home does well We received a good response to our written survey and in general, people who took part in the survey were very positive about the home. We received some very positive comments including; `The staff are always most helpful.` `First class care in a first class environment.` `Good Matron, good care.` `The home could not improve, they are great the way they are.` We observed carers throughout the day and noted that they went about their duties in a cheerful manner. Carers and residents clearly got along well together and their interactions were pleasant. Residents appeared comfortable and relaxed in their surroundings. The home has a thorough approach to planning people`s care which starts with a comprehensive pre-admission assessment. Information gathered at the point of assessment is used to develop a detailed care plan which is constantly updated to reflect people`s changing needs. Sensitive support is provided to people approaching the end of their life and the home takes steps to ensure that people are given as much opportunity as possible to express their wishes and set out their personal priorities in an individualised plan. Where appropriate, residents` families are also encouraged to be involved in this process. People living at the home are provided with a nutritious diet and meals are prepared to a good standard. The home is well maintained and furnished to a good standard. All those who responded to our written survey told us that the home was always fresh and clean. Careful procedures are followed to ensure that only suitable people are employed at the home. New staff members are provided with a comprehensive induction and close supervision during their probationary period. The home has a positive approach to training and currently 70% of carers hold National Vocational Qualifications in care at level 2 or above. This figure exceeds the national target which is 50%. Staff are well supported and have a good understanding of their roles. A number of people we consulted both in writing and during our visit spoke very highly of the manager of the home. People described her as supportive and very approachable, one relative told us he found the manager`s kind manner very reassuring. What has improved since the last inspection? This was the home`s first inspection since registration in November 2007. What the care home could do better: The Service User Guide is an important document which assists people to make an informed choice about where to live. It is important that the guide accurately reflects the service provided at all times. We found during this inspection that there were some pieces of information missing from the guide and that it had not been updated to reflect recent changes in ownership. The Service User Guide should be constantly updated to provide the reader with an accurate picture of the home. In addition we made a recommendation that the Service User Guide be made available in a variety of formats, for example audio and large print. We viewed a selection of risk assessments which were found to be of a generally good standard. However one risk assessment which was in relation to the provision of a bed rail, had not been fully completed, although it had been completed in part. Risk assessments are an extremely important part of an individual`s care planning and help carers to promote people`s safety and wellbeing. We have made a recommendation in relation to this matter. Residents` medication is generally well managed and there are systems in place to maintain good practice including regular internal audits. However, during our inspection we made some recommendations to further improve procedures. Information relating to PRN (as and when required) medicines should form part of residents` care plans to ensure that they receive their medicines at the appropriate times. In addition, individual competence assessments should be carried out for all staff who deal with residents` medication so as to ensure staff are aware of and are following the correct procedures. People we consulted were satisfied with the quality of meals provided and menus showed that people are provided with a nutritious and appealing diet. However, we found during the inspection that residents are not routinely offered a choice of main meal each day. Whilst residents are provided with an alternative if they specifically request it, they would benefit from being able to make choices on a daily basis. Consideration should also be given as to how people who may not be able to choose from a written menu, could be made aware of the options available, for example through the provision of pictorial menus. During the inspection some discussion took place about staffing levels in the home. Whilst current staffing levels are adequate to meet people`s basic care needs, some people told us that they did not allow carers additional time with residents, for example, to carry out activities. We were advised by themanager that this issue had been identified and that the home were in the process of recruiting additional staff for this purpose. CARE HOMES FOR OLDER PEOPLE Priory Court Nursing Home 51 Clifton Drive Fairhaven Lytham St Annes Lancashire FY8 1AL Lead Inspector Mrs Marie Cordingley Unannounced Inspection 23rd April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Court Nursing Home Address 51 Clifton Drive Fairhaven Lytham St Annes Lancashire FY8 1AL 01253 780088 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) Century Healthcare Limited Julie Margaret Millar Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing- code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP The maximum number of people who can be accommodated is: 24 Date of last inspection Not applicable. Brief Description of the Service: Priory Court is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 24 older people who require nursing care. The home is situated in Lytham St Annes close to a number of facilities and amenities and a short walk from the Promenade and Fairhaven Lake. The majority of accommodation at the home is offered on a single room basis and some rooms have en-suite facilities. There are two shared rooms. There are several communal areas for the use of residents including two lounges and a dining room. In addition, the home has a well maintained garden area. Care is provided on a 24 hour basis including waking watch care throughout the night. The registered provider of the home is Century Healthcare who operate a number of care homes in the area. At the time of our key inspection we were advised that fees for care and accommodation at the home range from £412 to £636 and are assessed in accordance with individual need. All this information and more can be found in the Service User Guide which is available on request from the home. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 star. This means that people using this service experience good quality outcomes. The inspection of this home included a site visit which was carried out over one day. This visit was unannounced meaning that the manager, staff and residents did not know it would be taking place until the inspector arrived. During the visit we spent time talking with and observing residents, staff, the registered manager and a senior manager from Century Healthcare. In addition, we viewed a selection of paperwork including a selection of residents’ care plans and staff training records. We also carried out a tour of the home viewing residents’ bedrooms and communal areas. As part of the inspection we carried out a case tracking exercise, which involved us looking closely at the care provided to selected residents from the point that they moved into the home. Prior to our visit, we wrote to the registered manager and asked her to fill in a very detailed self assessment questionnaire. This questionnaire provided us with a lot of information about the home and its management, and was returned to us within agreed timescales. We also wrote to a selection of residents, their relatives and staff members and asked them to take part in a written survey. As part of the survey, people were asked to share their opinions about various aspects of the service provided. A number of completed surveys were returned to us. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 6 What the service does well: We received a good response to our written survey and in general, people who took part in the survey were very positive about the home. We received some very positive comments including; ‘The staff are always most helpful.’ ‘First class care in a first class environment.’ ‘Good Matron, good care.’ ‘The home could not improve, they are great the way they are.’ We observed carers throughout the day and noted that they went about their duties in a cheerful manner. Carers and residents clearly got along well together and their interactions were pleasant. Residents appeared comfortable and relaxed in their surroundings. The home has a thorough approach to planning people’s care which starts with a comprehensive pre-admission assessment. Information gathered at the point of assessment is used to develop a detailed care plan which is constantly updated to reflect people’s changing needs. Sensitive support is provided to people approaching the end of their life and the home takes steps to ensure that people are given as much opportunity as possible to express their wishes and set out their personal priorities in an individualised plan. Where appropriate, residents’ families are also encouraged to be involved in this process. People living at the home are provided with a nutritious diet and meals are prepared to a good standard. The home is well maintained and furnished to a good standard. All those who responded to our written survey told us that the home was always fresh and clean. Careful procedures are followed to ensure that only suitable people are employed at the home. New staff members are provided with a comprehensive induction and close supervision during their probationary period. The home has a positive approach to training and currently 70 of carers hold National Vocational Qualifications in care at level 2 or above. This figure exceeds the national target which is 50 . Staff are well supported and have a good understanding of their roles. A number of people we consulted both in writing and during our visit spoke very highly of the manager of the home. People described her as supportive and very approachable, one relative told us he found the manager’s kind manner very reassuring. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The Service User Guide is an important document which assists people to make an informed choice about where to live. It is important that the guide accurately reflects the service provided at all times. We found during this inspection that there were some pieces of information missing from the guide and that it had not been updated to reflect recent changes in ownership. The Service User Guide should be constantly updated to provide the reader with an accurate picture of the home. In addition we made a recommendation that the Service User Guide be made available in a variety of formats, for example audio and large print. We viewed a selection of risk assessments which were found to be of a generally good standard. However one risk assessment which was in relation to the provision of a bed rail, had not been fully completed, although it had been completed in part. Risk assessments are an extremely important part of an individual’s care planning and help carers to promote people’s safety and wellbeing. We have made a recommendation in relation to this matter. Residents’ medication is generally well managed and there are systems in place to maintain good practice including regular internal audits. However, during our inspection we made some recommendations to further improve procedures. Information relating to PRN (as and when required) medicines should form part of residents’ care plans to ensure that they receive their medicines at the appropriate times. In addition, individual competence assessments should be carried out for all staff who deal with residents’ medication so as to ensure staff are aware of and are following the correct procedures. People we consulted were satisfied with the quality of meals provided and menus showed that people are provided with a nutritious and appealing diet. However, we found during the inspection that residents are not routinely offered a choice of main meal each day. Whilst residents are provided with an alternative if they specifically request it, they would benefit from being able to make choices on a daily basis. Consideration should also be given as to how people who may not be able to choose from a written menu, could be made aware of the options available, for example through the provision of pictorial menus. During the inspection some discussion took place about staffing levels in the home. Whilst current staffing levels are adequate to meet people’s basic care needs, some people told us that they did not allow carers additional time with residents, for example, to carry out activities. We were advised by the Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 8 manager that this issue had been identified and that the home were in the process of recruiting additional staff for this purpose. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Priory Court Nursing Home DS0000070681.V356546.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 Priory Court Nursing Home DS0000070681.V356546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s thorough assessment procedures ensure that carers have a good understanding of people’s needs before they move into the home. This means that people can be assured they will receive the care they need straight away. EVIDENCE: People who took part in our written survey told us that they had been provided with a good amount of information about the home prior to them (or their relative) moving in. Some people we consulted also confirmed that they had been encouraged to visit the home, to have a look around and meet staff and residents. In their response to our written survey one person told us that they found the manager very helpful during their initial enquiries and were ‘very reassured by her friendly and straight forward manner.’ Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 11 A Service User Guide is provided to people at the point that they express an interest in moving to the home. This document includes a variety of information, for example details of facilities and services available within the home, as well as information about staffing and daily routines such as meal times and activities. However, at the time of our visit we noted that there were some pieces of information missing. In addition, the guide had not been updated to reflect recent changes in ownership. We made a recommendation that this be addressed and that the guide be updated in line with the National Minimum Standards. In discussion, it was confirmed that the Service User Guide is currently only produced in a standard written format. We advised the manager that the guide should be made available in various formats, for example large print and audio to ensure that everyone has equal access to the information. There are processes in place to ensure that pre admission assessments are carried out with people before they move into the home. This means that the manager can be certain that a person’s needs can be met and that the home is right for them before they move in. It also means that staff have a good understanding of the care needs of new residents and can provide the right level of care straight away. During our case tracking exercise we viewed pre admission assessments for a number of residents. We found that assessments were very thorough and covered all areas of daily living. The assessments we viewed also contained social histories. These cover areas such as previous employment, relationships and significant life events. Social histories are important as they help carers to recognise and value the uniqueness of each resident and plan their care in a person centred manner. Priory Court Nursing Home DS0000070681.V356546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home are provided with a good standard of care and treated with dignity and respect. EVIDENCE: People who responded to our written survey told us that they were very happy with standards of care at the home. We received some very positive comments which included; ‘People are cared for in all the right ways and treated with respect.’ ‘My relative is looked after with great kindness.’ ‘Staff are first class, definitely most attentive.’ Another relative who responded told us they found their loved one’s condition very upsetting but said that the excellent care provided at Priory Court had helped them to come to terms with their situation. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 13 We viewed a number of residents’ care plans and found that these were completed to a good standard. The plans were very comprehensive and provided a detailed picture of people’s care needs. We were also able to confirm that the care plans had been regularly updated to ensure they reflected people’s changing needs. In addition, there was written evidence that residents and where appropriate their relatives, had been involved in their development. During our visit we spoke with carers who were able to demonstrate the importance of monitoring people’s health. We saw a number of examples where prompt action had been taken in response to concerns about a resident’s health and records showed that people were regularly supported to access medical advice from their GP for example. The home has procedures in place to assess and manage risks to residents in areas such as falling or developing pressure sores. We viewed a number of risk assessments and found that in general they were comprehensive and had been regularly updated. Where appropriate, information from risk assessments had been transferred to people’s care plans to ensure that any action required to reduce risk was carried out on a daily basis. However, we viewed one risk assessment relating to the provision of bed rails which had not been fully completed. This was discussed with the manager during our visit. We viewed the home’s medication store and found that medicines were stored in a safe and well organised manner. In addition, medication administration records were in good order with no errors or omissions noted. We were advised by the registered manager that thorough medication audits were regularly carried out so that any errors could be quickly identified, and records were also available to confirm this. Some of the residents at the home are prescribed certain medicines on a PRN (as and when required) basis. We viewed medication administration records for these residents and found that in some cases there was not enough information about when these PRN medicines should be administered. We made a recommendation that this information be improved to ensure that residents received their PRN medicines at the appropriate times. All staff who deal with residents’ medication are qualified nurses with additional training in this area. However, to further protect residents we made a recommendation that an individual competence assessment be carried out for any staff member dealing with medication to ensure that they are aware of and following correct procedures. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 14 Carers we consulted understood the need to promote people’s privacy and dignity and were able to give examples of how they went about this on a daily basis. Throughout our visit we observed carers providing support and noted that they addressed residents in a kind and respectful manner. Residents appeared relaxed and comfortable and seemed to enjoy positive relationships with carers. One resident said of the staff ‘’Nothing is too much trouble for them, they are grand.’’ The home has a very pro-active approach to providing end of life care. We saw a number of examples where people who were approaching the end of their life had been supported, along with their significant others, to discuss their concerns and anxieties, explore the options available to them and make clear their personal priorities for care. Individual plans had been created to ensure people’s wishes were clearly documented so that carers were fully aware of them. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to engage in meaningful activities and maintain contact with friends and families. Meals provided are of a good standard but people would benefit from having more choice at mealtimes. EVIDENCE: All the care plans that we viewed contained information about people’s interests and preferences in relation to hobbies. The manager advised us that wherever possible, attempts were made to provide activities that were in with residents’ preferences. Records in the home confirmed that activities such as reminiscence, gentle exercise and visiting musicians were provided on a regular basis. However, activities is an area which has been identified for development by the home. At the time of our visit we were advised that the home were in the process of recruiting a dedicated activities organiser to further develop this area. In Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 16 addition, plans were in place to improve the range of activities provided for people with Dementia. We spoke to a number of staff members who told us that staffing levels did not always allow time to spend with residents to carry out activities. This was discussed with the manager who advised us that this issue had been identified and agreement had recently been reached that staffing levels could be increased. Through discussion we were able to establish that there had previously been little opportunity for residents to take part in trips outside of the home. However, at the time of our visit the home had recently acquired a vehicle and the first trip out had taken place just days earlier. We were told that trips out would now be offered on a regular basis to enable residents to take part in their local community. All the people who responded to our survey told us that they were able to receive visitors (or visit) at any reasonable time. In addition, people confirmed that they were able to receive their visitors in the privacy of their own rooms or in one of the communal areas. At the time of our visit one resident was enjoying some beers and a chat with a friend who had come to see him. People we consulted were in general very positive about the meals provided at the home. A resident we talked with said ‘’The food is first class, I have never been disappointed.’’ During our visit we joined residents for lunch and sampled a meal. The meal was nicely presented and of a good standard. We viewed menus which showed that people are provided with a varied and nutritious diet, and on the day of our visit there were a number of options available for the main meal. However, we viewed records of meals served which indicated that it was not standard practice at the home, to provide alternatives for the main meal on a daily basis. In discussion we were advised that there was always an alternative available if someone didn’t want what was on the menu, but that people had to specifically request it. We recommended that a choice of meal be made available on a daily basis and that consideration be given as to how people who are not able to make use of a written menu be made aware of the options available for example, through pictorial menus. Priory Court Nursing Home DS0000070681.V356546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are enabled to express concerns and can be assured that any concerns they do raise are taken seriously. Staff have a good understanding of the home’s safeguarding and whistleblowing procedures which helps them to promote the safety and wellbeing of residents. EVIDENCE: The home has a complaints procedure in place which is clearly written and easy to understand. This document gives guidance in how to raise a complaint and outlines the steps that will be taken by the home in this event. The procedure also provides contact details of other agencies the complainant can contact if they are not satisfied with the action taken within the home. We confirmed during our visit that the complaints procedure is currently only available in a standard written format. We made a recommendation that it be made available in various formats for example, large print and audio, to ensure everyone has equal access to the information. We viewed records of complaints received at the home and found that any concerns raised had been taken seriously and dealt with promptly. In the case Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 18 of one relative, the manager and senior managers from Century Healthcare had arranged to meet with him to discuss some issues that he had raised. The Commission for Social Care Inspection have not received any concerns or complaints about this home since its registration in November 07. There have been no incidents reported to us to cause concern. The home has a Safeguarding Adult policy and procedures in place. These documents provide guidance to staff in the event that they suspect that a resident has been the victim of, or is at risk of, abuse of any description. The home also has a whistle blowing procedure in place which describes to staff, their responsibilities to report any concerns and assures them that they will be supported by managers in this event. Staff we consulted were well aware of the safeguarding and whistleblowing procedures and also told us that they were confident that any concerns they did report to management, would be properly dealt with straight away. As part of their induction, all new staff members are provided with in house training in safeguarding and abuse awareness. However we made a recommendation that additional training be provided, particularly for those staff working in senior positions. Priory Court Nursing Home DS0000070681.V356546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at this home are provided with comfortable, clean accommodation. People are encouraged to have their personal possessions with them so that they feel at home in their surroundings. EVIDENCE: We carried out a tour of the home and found all areas to be clean, warm and comfortable. However, we did note that although well equipped and very clean, the bathrooms and hair salon were quite clinical in appearance. We pointed this Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 20 out to the manager who told us that this had been identified and that plans were in place to make the areas more homely. Since taking over the home, Century Healthcare have made a number of improvements to the environment and have refurbished a number of areas. We were advised that plans are in place to carry out further improvements including the redesign of the home’s garden area, to make it more accessible to residents. The majority of accommodation at the home is offered on a single room basis and some of the bedrooms have en-suite facilities. There are two shared rooms which we viewed and noted the presence of privacy screens. The bedrooms we viewed were nicely personalised with people’s own possessions such as pictures and ornaments. People who responded to our written survey told us that the home was always fresh and clean. One person wrote ‘The home provides a scrupulously clean environment rarely bettered anywhere.’ We viewed staffing rotas that showed there are ample domestic staff employed to maintain the high standards of cleanliness and hygiene. The home has clear infection control procedures in place and training records confirmed that the majority of staff have received training in this area. In the self assessment questionnaire the manager stated that she was not yet familiar with the Department of Health guidance ‘Essential Steps’. This is good practice guidance in relation to infection controls and includes specific guidance for care homes. We made a recommendation that the manager obtain this guidance and ensure that the home’s policies are in line with it. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive their care from carefully recruited staff who are motivated and competent to carry out their roles. EVIDENCE: We viewed a selection of staff files and these demonstrated that the manager follows careful procedures when recruiting people to work at the home. Records confirmed that all prospective staff members had been required to attend a formal interview and provide a full employment history. Where gaps had existed in a person’s employment history, there was written evidence that the manager had investigated them. Prior to an offer of employment being made, various background checks are routinely carried out including a Criminal Records Bureau check and references from previous employers. At the start of their employment carers are provided with induction training which is in line with Skills for Care standards. In addition, new staff members are regularly supervised. One new carer we spoke with told us that he had received regular appraisal and probationary reports since he joined the home. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 22 We talked to people about staffing levels and in general people felt that current levels were adequate to meet people’s daily care needs, but didn’t always allow for time to carry out one to one activities, for example. However, in discussion we were advised that agreement had already been reached to increase staffing levels and that the home were in the process of recruiting for this purpose. The company has a good approach to training and records showed that staff are supported to complete their mandatory health and safety training soon after their employment. In addition, a core programme for carers which includes additional areas such as abuse awareness and caring for people with Dementia has been developed. However at the time of our visit, the core training programme had not been fully implemented and no carers had received training in working with people with Dementia. We recommended that this be addressed as soon as possible. Currently, approximately 70 of staff hold National Vocational Qualifications in care at level 2 or above. This is a good achievement and exceeds the national target of 50 . We spoke to a number of carers who appeared well motivated and demonstrated a good understanding of their role. Carers told us that they felt well supported and that the manager of the home was always available to provide advice and guidance. One carer said ‘’Julie’s door is always open and she is always so approachable.‘’ In addition staff confirmed that they were provided with regular one to one supervision with the manager where they could discuss issues such as training and personal development, for example. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home which is run in the best interest of residents. All aspects of the service are monitored by the manager and registered provider. EVIDENCE: The registered manager of this home has a great deal of experience and holds a number of qualifications including the Registered Manager’s Award. Residents, their relatives and staff we consulted both in writing and during our visit, spoke very highly of the manager describing her as very supportive and approachable. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 24 There are a number of systems in place to help the management monitor quality at the home. These include regular satisfaction surveys for residents, their relatives and other stakeholders. In addition, meetings for residents and their relatives have been organised where people can express their views and make suggestions about the running of the home. It is recommended that results from satisfaction surveys be published in the Service User Guide following each survey that is carried out. The home does not deal with any residents’ financial affairs but a small amount of petty cash may be held for some people. Records are kept of any transactions and wherever possible two people witness entries made. The home has a designated health and safety officer who assists with the training of staff and the development of various procedures such as fire safety and infection control. Staff we spoke with confirmed that they had been provided with training in the mandatory health and safety areas such as moving and handling, at the start of their employment, this was also confirmed by viewing records. The home confirmed in writing that all the required checks and maintenance of equipment and facilities take place as necessary. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 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 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 26 NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP1 OP1 OP9 OP9 Good Practice Recommendations The Service User Guide should be constantly updated so that it provides an accurate picture of the home. The Service User Guide should be made available in a variety of formats so that everyone has equal access to the information. Information relating to PRN medication should form part of residents’ care plans so that they received their medicines at the appropriate times. Individual competence assessments should be carried out for all staff members who deal with residents’ medication to ensure that they are aware of and are following the correct procedures. Residents’ should be routinely offered a choice of main meal on a daily basis. The home’s complaints procedure should be made available in a variety of formats for example, large print and audio. DS0000070681.V356546.R01.S.doc Version 5.2 Page 27 5. 6. OP15 OP16 Priory Court Nursing Home 7. OP26 8. 9. 10. 11. 12. 13. OP27 OP30 OP30 OP33 OP38 OP38 The Department of Health guidance ‘Essential Steps’ should be obtained and the home’s infection control procedures reviewed to ensure they are in line with the guidance. Staffing levels should be kept under constant review to ensure that they are in line with residents needs. Carers should receive training in working with people with Dementia. Carers should receive additional training in abuse awareness. Results from internal quality assurance processes such as satisfaction surveys should be published in the Service User Guide. The home’s internal audit procedures should include the monitoring of Risk assessments to ensure that these are fully completed and regularly reviewed. Risk assessments should be carried out with regard to access to and security of the home throughout the day. Priory Court Nursing Home DS0000070681.V356546.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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