Care Home: Priory Mews Nursing Home

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What the care home does well Pre-admission and admission assessments are carried out by the house managers or their deputies. These follow BUPA`s "Quest" documentation, and are very thorough. Medication management in each house is being carried out to a good standard. Improved medication procedures and auditing are having a good effect. There is good liaison with other health professionals. Each house is kept clean and odour free. Staff induction and training follows BUPA guidelines and is well managed. The staff recruitment process is well handled, and files are kept in excellent order. What has improved since the last inspection? The manager has instigated better internal auditing procedures. This means that items missed are being quickly picked up and dealt with. There is a new emphasis on better management for prevention of falls; and on working towards better procedures for end of life care. The care planning system has been altered and improved. Care plans in each house are well completed. A new head of department has been appointed to oversee housekeeping, and additional numbers of cleaning staff are being recruited. The activities co-ordinator is developing her role, and is in the process of recruiting more activities` assistants. This is improving outcomes for residents. The new manager is developing clearer roles for other senior staff, and is providing overall leadership in the home. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Priory Mews Nursing Home Watling Street Dartford Kent DA2 6EG Lead Inspector Mrs Susan Hall Unannounced Inspection 08:15 3 and 4th April 2008 rd 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 Mews Nursing Home DS0000026199.V361150.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 Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Mews Nursing Home Address Watling Street Dartford Kent DA2 6EG 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) 01322 292514 01322 281372 gricez@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd vacant post Care Home 150 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (90) of places Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Patients detained under the Sections of the Mental Health Act may not be admitted to the home Of the 150 beds, 60 beds are registered for Dementia Nursing Care Of the 150 beds, 30 beds in one house are registered for dementia care Total number of bedspace must not exceed 150 That from time to time service users under the age of 65 may be admitted to the home. 16th April 2007 Date of last inspection Brief Description of the Service: Priory Mews Nursing Home is a purpose built home situated in a residential area of Dartford. It is owned by BUPA Care Homes Ltd., and was built in 1993. The home is made up of five single storey houses, Woodford, Beaumont Cressnor, Mountenay and Marchall. Woodford and Beaumont are both for older people with nursing needs. Cressnor is for older people with dementia, and is residential. Mountenay and Marchall are both for older people with nursing and dementia needs. Accommodation in each house currently consists of thirty single bedrooms, a large communal day room/conservatory, an integrated dining area and a kitchenette. Each one also has a small quiet room, and a house manager’s office. All bedrooms have a television, telephone and staff call point. Three of the houses are currently undergoing building work to add extensions with more bedrooms. The total number for the site will rise from 150 beds to 179 beds. Each house is surrounded by a small garden. (Most of these are currently affected by building work). There are other grassed areas between the houses. There is also a main administrative building containing offices, the kitchens, and laundry facilities. Priory Mews is located near to the town centre of Dartford, close to the Bluewater shopping complex, and can be easily reached by public transport. Dartford is connected to main line train and motorway networks. The home has ample car parking facilities. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 5 Fee levels currently range from £443.76 to £920.00 per week, depending on the assessed needs of each individual resident. Additional charges are payable for chiropody, hairdressing, newspapers and some outings. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection, which involves inspecting all key National Minimum Standards. Most other standards were also assessed. A Key Inspection entails taking into consideration all information gained about the home since the previous inspection, such as phone calls and letters to CSCI; formal notifications from the home (which is a legal responsibility); concerns and complaints made to CSCI; and any referrals made to the Social Services Safeguarding Adults department. Each home is required to complete an Annual Quality Assurance Audit. This was completed by the manager and contained very clear information. It was used as part of the inspection process. One inspector carried out the visit to the home over two days, with a total of 18.25 hours. Each house was visited, and we (i.e. CSCI) spent time in each house reading care plans, viewing the buildings, talking to residents, relatives and staff, discussing progress with each house manager, and checking medication management. We chatted with a total of 19 residents, 18 staff (apart from the manager), 3 relatives, and 1 Health Professional. The inspection included an hour spent in the lounge of Marchall House, carrying out an observational inspection (Short Observational Framework Inspection, or SOFI). This is time spent observing how residents and staff interact with each other, and carried out to a specific pattern. It confirmed residents’ comments that staff are “very friendly and caring”, and that staff behaved in a gentle, friendly and relaxed manner with these residents with dementia. CSCI sent out survey forms prior to the visit. 14 completed forms were received from residents, relatives and staff. These contained very positive responses about the home. One of the relatives commented, “We are very happy with the quality of those who provide care; and the house manager leads by example”. Another (from a resident) stated “All the staff are very caring, and go out of their way to help. I receive help very promptly. I am very happy with the home, especially the staff.” One relative noted that their resident often had to wait for staff, and another felt that there were “not enough staff”. The overall impression was that these comments summed up the home. While it is making good progress, and staff are reported as being kind and caring in each house, some houses cannot demonstrate that the numbers of staff are sufficient to meet residents’ needs. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 7 The home has been through a difficult period over the past six months. A number of relatives raised concerns in October 2007 which were investigated by the Social Services Safeguarding Adults team. The current manager left, and BUPA immediately put in an Interim Manager for a few months. Staff said that her input had been extremely helpful. She has been succeeded by another Interim Manager, who is currently in post while BUPA recruit a registered manager. The current Interim Manager will be referred to as “the manager” for the rest of this report, for ease of reading. Staff, residents and relatives spoken with during the visit, all expressed confidence in the manager and her leadership. She is being assisted by a Clinical Services Manager over a six month period, who is giving direct input into each house. The home has clearly made sustained progress over the past few months with improvements in some significant areas. What the service does well: What has improved since the last inspection? The manager has instigated better internal auditing procedures. This means that items missed are being quickly picked up and dealt with. There is a new emphasis on better management for prevention of falls; and on working towards better procedures for end of life care. The care planning system has been altered and improved. Care plans in each house are well completed. A new head of department has been appointed to oversee housekeeping, and additional numbers of cleaning staff are being recruited. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 8 The activities co-ordinator is developing her role, and is in the process of recruiting more activities’ assistants. This is improving outcomes for residents. The new manager is developing clearer roles for other senior staff, and is providing overall leadership in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Priory Mews Nursing Home DS0000026199.V361150.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 Mews Nursing Home DS0000026199.V361150.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): 1-5 (standard 6 does not apply to this home). Quality in this outcome area is good. The home provides detailed information for prospective residents. There are good systems in place for effective pre-admission assessments. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose has been recently updated, and gives clear details of the layout of the home, and the access to communal areas. There is a clear definition of what is included in the fees (nursing & personal care, housekeeping, laundry, health services); and what is not included in the fees (hairdressing, escort fees, chiropody, newspapers, visitors’ meals, toiletries). Activities outside the home may include an extra charge, and information about this will be displayed beforehand. The document clearly states that the home can provide long term care, respite care, convalescent and postoperative care for older people. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 11 Two of the five houses are for older people with nursing needs; two are for older people with dementia and nursing needs, and one house is for older people with dementia who need residential care. It is possible for residents to move from one house to another if their needs change (e.g. for people with dementia to move from residential to nursing care). The Service Users’ Guide contains relevant information, but needs amending and updating. It is set out in large print, and contains information about daily life such as: meal times and menus, activities and outings, how to make a complaint, and a précis of the Statement of Purpose. The manager was fully aware of the need to update this document with some altered information, (e.g. change of manager), and CSCI are confident that this will be carried out soon. All residents – whether privately funded, or funded by Local Authority – are provided with the terms and conditions of residency of the home, and with a contract. Contracts are signed by the resident or next of kin/advocate as appropriate. BUPA has developed their own pre-admission, admission, and ongoing assessment programme, known as “Quest”. These assessments are very detailed, taking in all aspects of each person’s life. Details include: personal and healthcare needs; communication ability; lifestyle preferences and cultural needs; mobility; mental state and cognition; dietary needs; medication; and end of life preferences. Pre-admission assessments are carried out for each house by the respective house manager or deputy, and sometimes by both staff together. Resident survey forms confirmed that residents and relatives found the pre-admission process helpful, and that detailed information was obtained about residents prior to admission. Quest assessments were viewed in each of the five houses for recently admitted residents. Each one had been well completed. Priory Mews Nursing Home DS0000026199.V361150.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): 7-11 Quality in this outcome area is good. The home is providing effective health care, with an emphasis on meeting individual needs. Some additional oversight of care planning and wound care is being carried out, and is bringing about improvement in identified areas. Medication is being well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Quest documentation provides clear direction to nursing staff for making decisions about individual care plans. The process prompts them to set up care plans in the event of specific data. For example, the system will remind them that a resident with diabetes needs a specific care plan in respect of their eating and drinking. At least two care plans were viewed in each of the five houses, with a total of eleven care plans viewed overall. They are reviewed on a monthly basis, and good auditing systems ensure that any items missed are quickly picked up by senior staff. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 13 The manager is currently being assisted by a clinical services manager, who is very proactive in helping senior staff in each house to see the benefits of good auditing systems, and helping them to improve residents’ involvement with their own care planning. There was evidence in most houses of discussions taking place with residents, as well as relatives, about care planning. This is more applicable to Woodford and Beaumont houses, where residents have sufficient capacity. It was good to see that this is still taken into account for residents with dementia, where possible. Senior staff have received training in the Mental Capacity Act, and this is in the process of being delivered to all staff. This enables staff to assess the amount of understanding that individual residents have in regards to decision making. Some houses had signed evidence that care plans are discussed with the resident or relative (as appropriate), but one house did not show this so clearly, and this was pointed out to the manager. The clinical services manager is currently working to improve the falls management plan. There are weekly checks across the houses to find out numbers of resident who have had a fall, and to see if there are any patterns – e.g. to assess the time of day, weekends, where the event has occurred etc. If any resident sustains more than one fall, the clinical services manager goes through their care plan in detail with the house manager concerned. Items checked include the person’s sight, hearing and communication ability (e.g. to find out if can they see and reach the call bell); mobility, footwear (e.g. if slippers are safe to use); medication, and other practical issues. The whole care package is examined to see anywhere that risks of falling can be reduced. Community nurses are accessed as an outside resource to provide additional advice and support. There is a good rapid response team in the area to check a resident’s condition if needed. Residents can choose the GP they wish to have. However, the home is fortunate to have two GP practices which oversee the home, and most residents choose to register with one of these. One practice oversees four houses, and another oversees the fifth house. GPs visit each house on a regular basis (usually at least twice per week). Additional health services are obtained from other health professionals such as Speech and Language Therapist, Occupational Therapist, Physiotherapist, Dentist and Optician. There was plenty of evidence in care plans to show that nursing and care staff access these as needed. Houses caring for residents with dementia also obtain assistance from Community Psychiatric Nurses, Psycho-geriatricians, and Consultant Psychiatrists as applicable. Each resident is assessed for any equipment needed prior to admission. This includes pressure relieving mattresses and cushions. It was noted that care plans detail the specific type of mattress in use, and clearly show if pressure ulcers have been present on admission, or if they have developed in the home. All wounds, bruises and injuries are documented. Most houses have excellent documentation, graphing the state of the wound at each dressing change, and Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 14 with a written description. One identified house had some gaps in wound care documentation, and this was brought to the attention of senior management staff. This had already been recognised by the manager and clinical services manager, and was being addressed. Medication management and storage was inspected in each house. Each house has a clinical room, and where oxygen was in use, there was a hazard warning sign on the door. Storage in each house was satisfactory, with no overstocking, and external medication kept separate from internal medication. Liquid medication and eye drops are routinely dated on opening. No out of date medication was found. Each clinical room has a drugs fridge. Room and fridge temperatures are recorded daily and are satisfactory. Medication Administration Records (MAR charts) were examined in each house, and it was commendable that in each house these were clear and accurate records, with no gaps in signatures. Handwritten entries are signed for by two staff. Some sticky labels were in evidence for additional items of medication prescribed during the month. This practice is no longer acceptable, as labels can peel off, and could provide a risk of missed medication, or medication being given to the wrong person if it was re-applied on the wrong chart. Additional entries must be handwritten. The manager said she would inform all staff concerned, and talk with the Pharmacist. Medication is administered by trained nurses in four houses, and by trained senior care staff in Cressnor, which is residential. Homely remedies such as paracetamol and simple linctus can be given, and there is a list in each house signed by the GP concerned. Medication reviews are carried out to ensure that residents are only given the medication they need, and do not have unnecessary medication. New auditing systems are assisting good management. Residents spoke positively about the standards of care given, with comments such as “I am very impressed. Staff are always ready to help”; and “I am very happy here; staff are excellent.” Residents and relatives are encouraged to discuss end of life care as part of the admission process, in the event of a resident being taken seriously ill at any time. This shows individual preferences, and enables discussion about the value (or not) of hospitalisation if someone is dying. Additional input is obtained from the Palliative Care Team in Dartford, and from the nearby Ellenor Foundation Hospice. Emotional support is also offered to relatives. The home aims to enable residents to die with dignity in the place of their choice, and with family or friends available as wanted. Spiritual input is obtained as requested. Priory Mews Nursing Home DS0000026199.V361150.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): 12-15 Quality in this outcome area is good. The home provides a good variety of activities and outings, but there are insufficient staff to carry out the programmes effectively. This is in the process of being dealt with. Food is well managed, and is sufficiently nutritious and well balanced. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities co-ordinator to oversee all the activities in the home, and she is currently working with the manager and house managers to employ an activities assistant for each house. Two new assistants have already been recruited. Each activities assistant will take responsibility for their individual house, under the co-ordinator’s direction. They get to know individual residents, their likes and dislikes, and their preferences about joining in with activities, or having one to one time given to them. Individual records are maintained, and some of these were seen in care plans. Some are very well completed, and others are in the process of improvement. Each resident has a “life map” completed, showing their history, and friends/family/ previous work and lifestyle etc. Life Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 16 maps viewed on Cressnor, the residential house, were seen to be particularly good. In-house activities include items such as arts and crafts, skittles, bowls, ball games, music and movement, quizzes, reminiscence, bingo and board games. “Pat” dogs are brought in, and outside entertainment, such as theatre groups and singers. One of the houses had recently had some classical musicians entertaining them, and residents had really enjoyed this. Each house has a notice board displaying the joint activities and events for the coming month, and the activities staff work to a theme each month. This month was “All things British”, and includes special parties and events for St. George’s Day. One resident said, “The carers and activity staff are very caring and most helpful.” Links with the community are fostered by inviting local groups in, as well as taking residents out. One of the houses had invited local residents from a sheltered housing complex into the home for a cream tea and entertainment. This enables residents to have the opportunity of building friendships with others in the community. Church services are arranged every two weeks in different houses, and residents can go from one house to another to attend these. Outings are arranged between April and September (and may go into October if the weather is good). Trips include visits to garden centres, trips on the river at Maidstone, coastal trips, and drives in the country. A minibus is hired as needed. Feedback is obtained from residents and relatives, so that good decisions can be made about future events. Care staff join in with activities as much as possible, and this is mostly one to one input in houses with nursing care (Woodford and Beaumont). Some residents did not feel there was currently enough stimulation in these houses, but this is recognised and is being improved. Cressnor (dementia residential) has four care staff on duty throughout the day, which is just sufficient to enable them to spend time taking part in activities. However, this unit is being extended from 30 to 42 beds, and will need considerable numbers of additional activities and care staff to provide sufficient numbers of staff for providing stimulating activities throughout the day. Visitors are made welcome in all houses, though some have a more rushed atmosphere than others. Two relatives spoke very highly of the welcome in one house, stating that staff are always available to answer questions, and that the care of visitors as well as residents is excellent. Visitors can stay for meals, and some like to stay and share these with residents. Another relative stated in a phone call that they had difficulty in asking staff questions, as they are “always busy” in that house. The manager is aware that more input is needed in this house. Residents have the opportunity to make changes to menus, and are invited to put forward their ideas and preferences. Menus were seen to contain a good Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 17 variety, and are put together to ensure suitable nutrition. There are two choices for the main meal each day, and residents make a choice beforehand. If a resident then changes their mind about what they have chosen, they can choose an alternative, with items such as salads, jacket potatoes, omelettes, and soups always available. The home has one central kitchen where meals are prepared, and the food is taken to each house in hot trolleys, and dished out by the staff. This enables them to monitor the amount of food and the consistency. Residents said “I am always given food I like to eat”; “the food is usually ok”; and “ the food is always good”. Additional snacks are always available, including fresh fruit, and are provided on a daily basis to each house. Snacks are actively offered at set intervals in the houses including dementia care, as it is recognised that many residents who wander or are agitated need additional calories. One relative stated that they are “very pleased with the home” and that their “relative had put on weight” (who was previously underweight). The chef manager oversees all kitchen staff and supervision, and is currently recruiting another cook. The kitchens were seen to be clean and well organised. Food temperatures are checked before they leave the kitchens, and when the trolleys arrive at the houses. The chef manager does spot checks to ensure records are properly completed. Even though this is such a large home, the cooks still manage to produce home made cakes, pastries and soups, and the residents welcome this. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 18 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. There are ongoing improvements with the way in which complaints are handled and dealt with. An extensive investigation shows that residents are being protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place which has been produced by BUPA. This is a lilac coloured leaflet, setting out the avenue for making complaints, and the response times for acknowledgement and judgement. The back page includes details for contacting the home manager, the regional managers, and the head office, and clearly states the pathways to follow for complainants who are unsatisfied with any initial response made to complaints. People are encouraged to put complaints in writing, so that responses can be clearly established. The complaints leaflets are prominently on display in each of the houses. It may be beneficial to add details of the local Social Services team to the local complaints procedure, to remind residents and relatives that this is another avenue for them to follow. The complaints log showed quite a high number of complaints in 2007, with a significant reduction so far during 2008. Staff and relatives feel that this is largely due to a change in management since November 2007. An interim Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 19 home manager was put in place for a short period of time, and now the home has another interim home manager since February 2008. Staff said that the home has improved due to the interim managers working hard, genuinely caring about the residents, staff being more valued, and having more input on the “floor”. The home has a system for compliments as well as complaints, and there have been six written complaints since January 1st 2008, and nine written compliments. The complaints log and the recorded data showed that complaints which are put into writing are taken seriously and are properly addressed. Some contact with relatives indicated that some houses are better than others at handling verbal complaints. Areas of weakness had already been identified by the manager and the clinical services manager, and they are arranging additional input into houses as needed. The home has had a large scale enquiry managed by the Dartford Social Services Safeguarding Adults Team since October last year, concerning one particular house. This was investigating complaints and concerns put forward by a number of relatives and residents, and concerns about seven deaths in this one house during a short period of time. All of the concerns have been thoroughly investigated by the Safeguarding Adults team, in conjunction with police and BUPA management. There were no suspicious circumstances identified around the deaths. The investigation highlighted shortfalls in the home. BUPA have been co-operating with Social Services throughout the proceedings. Staff and relatives stated that they feel the home has now “turned a corner”, and after a period of settling down, is now moving forwards again. They are confident in the current manager’s ability to continue taking the home forwards. There have also been changes in the management and running of the house concerned, providing new leadership for staff. The deputy manager oversees staff training, and there are good records showing that all staff receive training at induction, and ongoing training, in the protection of vulnerable adults, and prevention of abuse. Staff recruitment is well managed, ensuring that staff are properly vetted prior to commencing employment. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 20 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): 19-22; and 24-26 Quality in this outcome area is adequate. The home’s environment does not do credit to the general impressions of the home. Refurbishment is needed in all areas. The housekeeping is improving with the recruitment and training of additional staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The administration block and all five houses were viewed. This included looking at all communal areas, toilets and bathrooms, storage areas, and as many bedrooms as practically possible at those times. The immediate impression on entering the administration block was of poor quality décor, and old fittings and furniture. The houses reflected the same impressions. Décor is generally “tired” and needs upgrading in all areas, although some houses were more obviously in need of upgrading than others. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 21 There is currently only one maintenance man, although the home was just recruiting a second one. Maintenance staff have many day to day jobs and responsibilities to carry out, and also carry out repainting of bedrooms as they become vacant. Carpeting needs replacing in many areas. Furniture and fittings are generally satisfactory, but are quite basic. There is a quiet room in each house for residents and relatives to meet together. These are poorly decorated and maintained. One health professional commented that looking at the state of these rooms and the offices in each house, would put people off wanting to place a relative there, as it would make some people think that it also indicates low standards of care. The home is currently undergoing extensive building work to add extra beds to three of the five houses. This has caused an inevitable amount of disruption. Many outdoor areas will need re-landscaping when the work is finished. Newly built bedrooms (which will have en-suite facilities) will highlight the lower quality of bedrooms in the existing houses. These bedrooms do not have ensuites, and are quite small in comparison to the new bedrooms. The whole site would benefit from complete refurbishment and upgrading, to bring the facilities up to the standard expected by the general public for a BUPA home. The manager stated that she understands that when the extensions have been completed, that the existing facilities will be upgraded. There is a requirement for BUPA to inform us of the planned dates for refurbishment. Each house has four bathrooms and additional disabled toilet facilities. Most baths have an integral hoisting facility. Other equipment such as raised toilet seats, grab rails and pressure mats were seen to be in evidence. Hoisting facilities are satisfactory in all houses, but there is very limited storage, and there is a requirement to review this. Hoists are stored in small cupboards with two in each. They are often needed in a hurry, and the specific hoist needed is often the one at the back. Hoists should be stored so that they can be easily accessed, and so that there is sufficient space for recharging them. Each house was found to be clean in all areas. A new housekeeper has been appointed, and is working hard to increase numbers of housekeeping staff for each house. There has been a general shortage of housekeeping staff, and this was reflected in some of the recent complaints. Each house now has one cleaner on duty seven days per week, all day, and on four days, there is an extra cleaner on duty in the mornings. This enables them to carry out tasks such as cleaning skirting boards and behind beds – which were formerly being missed. The housekeeper is training all domestic staff in using the home’s carpet cleaning machine, and is ensuring that all housekeeping staff are properly trained to carry out their tasks. Water temperatures, wheelchair checks, and fire alarm testing are carried out by maintenance staff. Thermostats are fitted to hot water outlets to prevent scalding, and bath temperatures are checked prior to use. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 22 The home has a large laundry facility for all houses, in the administration building. This has three commercial washing machines and three commercial tumble dryers. It is staffed by three laundry staff per day, who carry out laundry for each house separately. This enables them to track any item which has lost its name tape. The laundry is well designed with separate entrances for dirty linen and clean linen. All items of personal clothing are laundered and ironed on these premises. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 23 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): 27-30 Quality in this outcome area is adequate. Staffing levels need to be reviewed against dependency levels in all houses, but with dementia/nursing houses as a priority. Staff recruitment and training is very well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels were requested in each house, and time spent talking with different levels of staff helped to determine how well these work in practice. Woodford: has 4 carers and 3 nurses (including the house manager) in the daytime; and 1 nurse and 2 carers at night. Beaumont: has 2 nurses and 5 carers in the mornings; 2 nurses and 3 carers in the afternoons; and 1 nurse and 2 carers at night. Cressnor: has 1 house manager or deputy, and 4 carers in the mornings and afternoons; and 3 carers in the evenings and at night. Mountenay: has 2 nurses and 5 carers in the mornings (including the house manager); 2 nurses and 3 carers in afternoons/evenings; 1 nurse and 2 carers at night. Marchall: has 1-2 nurses in mornings and 2-3 carers (total of 5); and a total of 4 in afternoons/evenings. (This is currently lower as there are only 20 residents). There is 1 nurse and 2 carers at night. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 24 Levels of staffing are not clearly determined according to residents’ dependency levels, and the home was unable to demonstrate that there are clear procedures for how to carry this out and confirm satisfactory staffing levels. We discussed using the “Residential Forum” tool with the manager as one way of showing a clear process. The area of most concern regarding staffing levels was in the dementia with nursing houses (Mountenay and Marchall). Residents with dementia do not necessarily settle down in the afternoons and evenings, but there are lower staffing levels then. In fact, some residents with dementia become more active at these times. This means that there are insufficient staff to give one to one care (such as taking residents out for a walk), or spending time with a resident who is agitated and needs help to calm down. The numbers do not allow for care staff to work with activities staff in providing group activities either. At night, there is one trained nurse on duty, and giving out medication can take a long time for people with dementia. This leaves two care staff giving personal care, and many of these residents need two staff to assist them. This does not leave anyone else to watch over the rest of the residents, who may be calling out or wandering. In the dementia/residential house (Cressnor) this is less of a problem at night, as most residents can be assisted by one staff member. Staffing levels need to be reviewed in all houses to ensure there are sufficient staff for all needs. In some houses, there may be as many as 12-15 residents who need help at meal times, as well as personal care to give, medication and dressings, toileting and activities, as well as documentation to be carried out. The home must be able to demonstrate that staffing levels are always sufficient. However, it was noted that recruitment is taking place in all areas. This is partly due to the extensions to provide additional beds, and partly due to recognition that staffing levels have generally been quite low. Residents and relatives spoke highly of staff in all houses. Comments were received such as: “the care is absolutely excellent, I can’t fault it. The staff are wonderful”: and “I am very impressed; staff are always ready to help. I am very happy here; the staff are excellent”; and “The staff are helpful, caring and friendly. It is a very happy home.” BUPA encourage care staff to complete NVQ 2 and/or 3, and have assessors who come into the home to deliver training and carry out ongoing monitoring of NVQ trainees. The current percentage of care staff trained to NVQ 2 or 3 is 58 which is good. New staff are expected to carry out this training, and this is made clear during the interview process. Four recruitment files were inspected for recently recruited staff. The files are excellently put together, and included all requirements. Each new member of staff is given a BUPA guide; a job description; and their own training portfolio book. The BUPA guide Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 25 contains details such as health and safety policies, and an introduction to basic food hygiene, fire safety, and understanding dementia. The induction booklets ensure that each section is signed by the staff member and their mentor. Training is given for use of specific equipment. Staff one to one supervision records are included at the back of this book. In addition to mandatory training, all staff are given instruction in dementia awareness and the application of the Mental Capacity Act. Senior staff are given more detailed training in dementia care. There is a recognition that the home should ideally have more trained nurses who are RMN, (Registered Mental Nurse) as well as RGN (Registered General Nurses). However, there is a general shortage of RMN nurses, and BUPA are compensating as much as possible by ensuring higher levels of dementia training for senior staff. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 26 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): 31-38 Quality in this outcome area is good. BUPA has provided the home with a suitable interim manager, who has brought about a new stability, and is taking the home forwards again after a difficult period. She is assisted by competent and reliable administrative staff and house managers. They are building an effective team to enable the home to run well. This judgement has been made using available evidence including a visit to this service. EVIDENCE: After the previous manager left, BUPA immediately arranged for a temporary interim manager from within BUPA to step in to lead the home. Staff spoke highly of her input, and said that she had helped to restore confidence. She was unable to continue in this role, and has been replaced by the current Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 27 interim manager, who has an established track record of running other homes to a good standard. She has started meeting regularly with all of the house managers, and has formal monthly meetings with all heads of department. She is promoting the ability for house managers to network between houses, so that they become interdependent, rather than competitive. She makes a point of speaking with each house manager daily, and visits each house on one day each week, looking at specific issues – such as viewing care plans, talking with residents and staff, and checking for any concerns raised. There is an open door policy for staff and relatives to speak with her at any time. The company have not yet forwarded her application to CSCI for registration. A senior staff member said that she is giving more time for one to one discussions with staff; is available to visit houses whenever the need arises; and is encouraging staff to move forwards with their own training and abilities. She has the support of the staff, and they are confident in her leadership and abilities to provide continued improvement with the home. She is very well assisted by the clinical services manager, who is actively working alongside staff in each house in developing practical aspects of the work such as care planning, falls management programme, medication management and end of life care. Her input into these areas has shown specific and sustained improvements. The home has monthly visits carried out by the Regional Manager, using the BUPA “Early Warning Audit Tool” (EWAT), as well as CSCI regulation 26 visits. These processes ensure that an independent viewpoint is maintained, with external auditing to back up the internal processes. Residents and relatives meetings are due to be held more frequently. One house has already had a meeting under this manager’s leadership, and meetings are booked for other houses. A relative who had attended a meeting said it had been very helpful. BUPA survey forms are sent out at least yearly, and some surveys have been conducted over the previous recent months. These are always audited and the results made available. The manager is arranging for specific surveys for areas such as housekeeping, laundry and food. Large companies have a Provider Relationship Manager (PRM) within CSCI for liaison purposes. The PRM stated that the Organisational Financial Viability Assessment had been carried out for the last year, and the accounts for the previous year have been reviewed by the CSCI finance department. They are of the opinion that BUPA is financially viable. Residents’ personal finances are not dealt with by the home, but by the residents themselves, their next of kin, or an appointed advocate. A small number of residents have small amounts of pocket money in the home. This is stored securely, and is held in individual accounts. All receipts are retained, and records are available for authorised people to view. The accounts are audited externally. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 28 Staff supervision sessions are carried out at least every 2 months, and staff also have yearly appraisals. One to one supervision is being delegated to immediate seniors/line managers, so that they are aware of training implications and any personal needs. Policies and procedures are reviewed yearly by senior BUPA management. The policies are always available for staff to refer to. Maintenance and servicing records are reliably carried out by the maintenance man, and confirmed that suitable health and safety checks are in place. Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 1 2 3 2 X 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 3 Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 (2) (b,d) Requirement To provide CSCI with an action plan for the proposed dates for refurbishment throughout the home; including improved décor, and new carpeting, furniture and fittings according to assessments. To ensure that outdoors communal space is well maintained, and meets the needs of all residents. To provide CSCI with an action plan for relandscaping (as needed), by the given date. To ensure there is sufficient storage space for equipment. The providers must be able to demonstrate that there are a suitable number of qualified, competent and experienced staff on duty at all times, relevant to the dependency levels of residents. This includes nursing and care staff, activities staff, housekeeping, catering and maintenance staff. To provide the home with a registered manager. Timescale for action 31/05/08 2 OP20 23 (2) (o) 31/05/08 3 4 OP22 OP27 23 (2) (l) 18 (1) (a) 30/06/08 30/06/08 5 OP31 8,9 31/07/08 Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 31 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 OP1 OP9 Good Practice Recommendations To ensure that the service users’ guide is amended and updated as needed. To ensure that sticky labels are not used on medication administration records, but that any additional entries are handwritten, and clearly signed by two appropriate staff. To continue to work towards higher numbers of activities’ assistants, enabling residents to have more choice and opportunity for fulfilling and stimulating activities. 3 OP12 Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Priory Mews Nursing Home DS0000026199.V361150.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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