Care Home: Priory Paddocks Nursing Home

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What the care home does well The providers take time to ensure a smooth transition for people coming into the home, which helps address, any anxieties prospective residents, or their advocates may have. Relatives told us that they have `regular communication` with the providers, who keep them updated on their next-of-kin`s welfare. Relatives surveyed, spoke highly of the service provided, their comments included `I think the standard of care cannot be bettered`, `the carers are wonderful`, ` absolutely first-class`, `staff show consideration towards residents`, "this is the most caring and homely place you could wish for a `real home` for all residents" and `all I can say is that the carers at Priory Paddocks have an intuitive way of understanding my wife`s needs, and therefore act accordingly`. Residents told us that they like the staff, and felt the home had a friendly atmosphere, with their visitors always made to feel welcomed. Comments included `I think the staff are superb and a pleasure to be around. I`ve never met such a nice bunch of girls, certainly know how to choose them`. The owners ensure that staff are recruited correctly, and do not commence working at the home until they have received confirmation that they are safe to work with vulnerable people. New staff told us that they felt supported by the home`s induction training programme, which supports them in `gaining the skills to become a confident part of the team`. Staff told us that they "enjoyed working at the home", and felt there was a "good team spirit", which we also observed during our visit. In response to being asked `how do you think the care home can improve `a relative told us `the owners of Priory paddocks have an ongoing programme of improvements and renewals. I cannot fault them for the services they provide`. What has improved since the last inspection? The home has addressed the 3 requirements made following our last key inspection. Medication is now being transported securely around the home, to ensure that residents cannot accidentally have access to any medicines, which are not prescribed for them. Staff are using safe practice when moving and transferring residents, which will prevent any risk of injury to the resident or themselves. The home has improved their `pre-admission and care planning for residents and recruitment procedures for new staff`. There is a new part-time `Social Care Manager, a Registered Mental Nurse, who is responsible for developing the home`s social care program, to ensure it meets all the residents varying range of physical and mental health needs. The home has nearly completed their major refurbishment plan, with the kitchen being the last area to be undertaken in the New Year. The work undertaken enhances the residents living areas, and has been carried out to a high standard. What the care home could do better: The home needs to review its early morning routines, to ensure they are fully flexible, and work around individual resident`s preferences and choices, and not the homes routines. The home needs to review their staffing levels/deployment of staff, to ensure that vulnerable residents, who would be unable to use the call bell system, are not left alone in the lounge for long periods. By having a member of staff in the lounge will also help residents with their well being, and social interaction, reducing isolation. The home must monitor the contents of their fridges to make sure that food has been stored correctly, and any out of date food removed. In undertaking this it reduces the chance of residents being given out of date foods, or contaminated foods, which could make them ill. The home must ensure that the kitchen is kept clean and hygienic. Nurses need to ensure that they keep their medication records fully up-to-date to confirm that residents are being given their medication as prescribed by their doctor. The providers must complete and review their policies and procedures, to ensure that guidance given to staff is up do date and reflects current practice. CARE HOMES FOR OLDER PEOPLE Priory Paddocks Nursing Home Priory Lane Darsham Saxmundham Suffolk IP17 3QD Lead Inspector Jill Clarke Unannounced Inspection 21st November 2008 07:15 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 Paddocks Nursing Home DS0000024475.V373247.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 Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Paddocks Nursing Home Address Priory Lane Darsham Saxmundham Suffolk IP17 3QD 01728 668244 01728 668306 priory.paddocks@virgin.net 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) Mr Andrew Burgess Miss Marian Lloyd Miss Marian Lloyd Mr Andrew Burgess Care Home 37 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (37) of places Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2006 Brief Description of the Service: Its present owners, who jointly manage the home, converted priory Paddocks, previously an Edwardian country house, into a nursing home in 1987. It is situated in the village of Darsham, near the A12 and the local railway station. Village amenities include a public house, a garage which has a shop and small cafe. The home located next to a farm, is set in 2 acres of landscaped gardens with a summerhouse and ample parking. During the summer months, residents can take advantage of the patio areas overlooking the gardens. Residents can access all areas of the home and gardens via a stairwell, ramps and a passenger lift. The accommodation consists of 26 single bedrooms (19 with en-suite facilities), 7-shared bedrooms (4 with en-suite facilities) and assisted bathrooms and toilets. Although the home can provide beds for up to 40 people, until they have applied to increase their registration, and their application has been accepted, they are only registered to provide care for up to 37 people. Communal space includes 5 lounges/sitting areas and a dining room. A separate staff training facility also offers overnight stay for relatives if required. Pets are welcome at the home, which holds 2 ‘Cinnamon National Pet Friendly Awards’, and chickens roam the car park. The home has its own 12-seated mini bus, with a battery-operated tailgate, which enables easy access for wheel chair users. The bus is regularly used to take residents on trips and outings. The home is co-owned and jointly managed by two Registered Nurses, Miss Marian Lloyd and Mr Andrew Burgess. Fees range from £528.36 to £723.35 per week, depending on the room selected, and is fully inclusive of everything (including toiletries, newspapers, hairdressers, chiropody, alcoholic drinks) apart from private medical expenses and clothing. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. We (The Commission) visited the home unannounced to carry out a key inspection, where we focused on accessing the outcomes for people living at the home, against the Key Lines of Regulatory Assessment (KLORA). In undertaking this, it helps us get an idea, from a residents viewpoint, on what it is like living at home, and gain feedback on the level of care they receive. The report has been written using accumulated evidence gathered prior to, and during the inspection. A Selection of Commission for Social Care Inspection (CSCI) surveys were sent to the home in October 2008 for the home to distribute. This gives an opportunity for people using, working in, and associated with the service to give their views on how they think it is run. At the time of writing this report 4 resident, 10 relatives/visitors and 23 staff surveys had been returned, comments from which have been included. To enable us to gain feedback from people, who due to their mental frailty may be unable to complete a CSCI survey, we completed a Short Observational Framework for Inspection (SOFI) record sheet. Developed in conjunction with the University of Bradford, this enabled us over a period of 2 hours, to watch 4 residents sitting in the Blue lounge, who have a diagnosis of dementia. During this time we were able to look, and record how the residents spent their time, their mood/well being, and how well staff engaged (interacted) with the residents. Observations made, have been included in this report, within the relevant sections. Prior to the inspection the home was asked to complete an Annual Quality Assurance Assessment (AQAA). This provides the CSCI with information on how the home is meeting/exceeding the National Minimum Standards. It also provides us with any planned work they are intending to undertake during the next 12 months. Comments from which have also been included in this report. The providers Mr Andrew Burgess and Miss Marion Lloyd were available throughout the inspection, to answer any questions and provide records to support work undertaken at the home. We arrived at 7.15 a.m. so we could look at the mornings routines. We spent time talking to 3 residents in the privacy of their bedrooms, as well as gaining general feedback whilst meeting residents during the day. We also spent time talking to members of the catering staff, care staff and management team. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 6 We looked at a sample of records held at the home which included care plans, staff recruitment paperwork, training records, menus and kitchen cleaning logs, staff rotas and medication administration records. By doing this we can see whether staff are keeping their records up to date, and reflect current practice, to ensure the safe running of the home. Everyone we met during the day was very helpful and participated in the inspection by giving us feedback and providing information when asked. People living at the home prefer to be described as residents, rather than service users; therefore this report reflects their wishes. What the service does well: What has improved since the last inspection? The home has addressed the 3 requirements made following our last key inspection. Medication is now being transported securely around the home, to Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 7 ensure that residents cannot accidentally have access to any medicines, which are not prescribed for them. Staff are using safe practice when moving and transferring residents, which will prevent any risk of injury to the resident or themselves. The home has improved their pre-admission and care planning for residents and recruitment procedures for new staff. There is a new part-time Social Care Manager, a Registered Mental Nurse, who is responsible for developing the homes social care program, to ensure it meets all the residents varying range of physical and mental health needs. The home has nearly completed their major refurbishment plan, with the kitchen being the last area to be undertaken in the New Year. The work undertaken enhances the residents living areas, and has been carried out to a high standard. 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 Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 8 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 Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 9 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, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed, are given information on the home, and invited to visit, which supports them in identifying if the home offers the environment and level of service they are looking for. EVIDENCE: Since our last inspection the home has updated their Statement of Purpose, in June 2008, which gives a good level of information. This helps people know about the level of service they can expect from the home, and what is included in the fees. Although the booklet does not give information on how much it costs to live at the home, it tells the reader that a price list is available on request. The Statement of Purpose, has been mainly written in a small font size, therefore people with eyesight problems would have difficulties reading it. There was no information as to whether the booklet is available in other formats. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 10 The residents guide is written in a bigger font, and includes useful information such as how to distinguish the different roles staff undertake by their uniform. Relatives surveyed, told us that they had received enough information from the home, to help them come to a decision whether the home will be able to meet their needs. Residents surveyed confirmed that they had received a contract (copies of which was held in the office) from the home, so they were aware how much the care was costing them. The Statement of Purpose tells prospective residents that they are encouraged to visit the home and sample the atmosphere and level of service. A relative told us that their next-of-kin came to Priory Paddocks on the recommendation of several people in the area. They also told us the home is very highly respected by all, and there is a waiting list. The management meets and carries out an initial assessment of prospective residents needs, when they first apply to have their name on the waiting list. By undertaking this they are making sure that they can meet the persons needs, and where they are unable to, the person is not left on a waiting list for a placement that would not be appropriate. While people are on the waiting list the home can often arrange respite care to give the person a chance to meet the staff and anticipate life with new people and surroundings. The home encourages all residents to undertake a months trial period, before accepting on going residency so that the new resident is happy with the home they have chosen although the home does not hold residents to a timed commitment. When a vacancy does occur the management will undertake a more comprehensive assessment, which is completed before the resident moves in. The management told us they felt this was an important start of a process in getting to know the new resident, and help build up a repore with them. When a suitable vacancy occurs, the member of staff who has got to know the resident, will offer to pick them up on the day of admission and bring them to the home. The Residents Guide says a welcome gift of the toiletries will be in your room for your personal use. The basket of attractively wrapped toiletries was seen in a vacant room, awaiting a new occupant. The guide also informs the new resident the name of their personal key worker who will assist them with any needs, or wishes or queries they may have. Time spent talking with 3 residents in the privacy of their bedrooms confirmed that they felt the home was able to meet their needs. This reflected the information given our relative/advocates surveys, who in reply to being asked if the home met the needs of their friend/relative 8 had replied always and 2 usually. Comments included Im very satisfied with all the loving care that (persons name) receives at Priory Paddocks and the home provides a good and caring service to its residents. The homes own quality assurance survey undertaken in September 2008, showed 92.7 satisfaction, with the overall delivery of care provided, with 1 person commenting on the excellent care and attention. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 11 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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect their nursing and physical care needs to be monitored by experienced trained staff and treated with respect. There are systems in place to ensure residents receive their medication/ treatment, as prescribed by their Doctor. EVIDENCE: Guidance on how staff are to support residents with their care, is contained in residents individual care plan, which is kept in their bedroom. This enables the resident, or where appropriate their advocate, to read the guidance staff have been given. We found the information in the care plans covered all aspects of the residents physical and nursing care needs. Where there are concerns over the persons health, appropriate action is being taken such as requesting the residents General Practitioner (GP) to visit them. Preventative care was also being undertaken to protect residents welfare for, example, assessing the condition of the persons skin on a mission, to identify if there is a risk (due to their physical/medical condition) of their skin breaking Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 12 down, and supply pressure relieving mattresses and cushions to prevent this happening. Records showed that staff continues to monitor the condition of skin monthly, or earlier if required, recording any areas of redness, or skin starting to break down. Where skin has broken down there is information on what action nursing staff are taking to treat the area and promote healing. With the permission of the resident concerned, we spent time going through their care plan with them, to confirm that the information written meets their current needs; which they said it did. The resident was able to easily direct us to where their care plan was kept, and confirmed that they had read it. We also looked at the care plans for 2 residents who have dementia. Both care plans covered the same areas of physical care needs as the first care plan we had looked out. Both care plans had information on the state of the residents mental health, which reflected the high level of support they required with all aspects of their care. However, 1 residents care plan gave a more detailed, informative report undertaken by a member of the homes nursing team (Registered Mental Nurse). It gave a better insight on the abilities of the person, and how they react to different situations including social interaction. The level of information helps staff looking after the resident, to gain an insight on how the resident might react to different situations, and give guidance on how to support them. Discussions with the providers confirmed that this has been undertaken since we last visited, following our recommendations that the care plans need to be more informative, taking into account peoples emotional and social needs. The home aims to undertake this assessment for all the residents with mental health needs, which will support them in monitoring the residents well being. Staff record what interaction they have had with the resident on a daily report sheet in the care plan. The ones we looked at tended to be more task orientated, stating what physical tasks such as bathing, or changing the resident had been undertaken. Staff had not mentioned the residents emotional state, unless it was seen as a negative, such as shouting out. When feeding back to the providers we used the example of a new residents daily report that gave detailed information on what staff had done for that person, such as wash them. However there was no information, especially as the person was new to the care setting, on how they were settling in, and emotionally dealing with the change in their circumstances. We also fed back to the providers, that staff need to ensure, taking into account that care plans are held in residents bedrooms, that the information they write into the care plan could not lead to any embarrassment for the resident, or their advocate. Instead, staff should write a general statement such as skin looks sore in areas - please see nursing records, rather then write an explicit account of the part of the residents personal anatomy they are referring to. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 13 Information on the nursing Kardex is not held in the residents bedroom but in the handover area, giving more detailed information on nursing care intervention, and visits from health professionals. This information is then passed on to staff during the handover session between shifts, to keep staff fully up-to-date on what is happening with the residents, and any extra nursing care needs they may have. Where it was noted that a resident was losing weight, records showed that the home had sought advice from the hospital dietician/GP, and the agreed action being taken, such as giving supplement nutritional drinks, to support the resident. The AQAA informed us that they attend to medication with careful consideration for the standard, and that they are sensitive to the individual needs of the resident with the method of administration, the timing and formulations used. However, this was not fully reflected by a comment made by a member of staff we surveyed, who felt by giving the 8 a.m. medicines from 7 a.m. onwards, was too early, as they found that some residents were still half asleep when they were giving the medicines out. They felt that if the tablets were given later, that residents would accept them more readily. When we started our inspection at 7:15 a.m. we were informed that the residents upstairs, who normally had their medication at that time had already been given it. Therefore we could not assess if residents had been fully awake when the medication had been given. However, as observed in the next section of this report (Daily Life and Social Activities) we did note that some of the residents who had been sat up ready for breakfast, had fallen back to sleep. The providers also told us that they maintain accurate records of drug administration available for viewing and our procedure can easily be evaluated with a site visit. During our visit we looked at the systems the home has in place for recording that residents have been given their medication as prescribed. Although we found the majority of the medication had been signed for (to confirm that it had been given) we also identified that staff were not always accurately completing the Medication Administration Records (MAR). For us to be able to identify if it was a failure of staff completing the records, or staff had forgotten to give the resident their medication we spent time checking the amount of tablets left in boxes, against the homes records to confirm that the totals held were correct. In undertaking this we were able to identify that the residents concerned, had been given their medication, and it was the record keeping that was at fault. Some tablets such as Senna (given to people for constipation) we were unable to audit because staff had not written down how many they had given the person. Good practice was seen with keeping up-to-date information on residents current level of Warfin tablets they should be taking, with their MAR chart. This is because the amount taken depends on their most current blood Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 14 results, therefore by having the records together; acts as a double check for staff to ensure the correct, safe dose, is given. The home currently uses a bound notebook, with hand written page numbers as their controlled drug register. Through wear and tear not all the page numbers were readable, and there was no index at the front to record the names of the residents who were having controlled drugs. This would support staff in being able to go directly to the page number, that is currently in use. A sample check of the controlled drugs held for 1 resident was carried out. In undertaking this we could see that the drugs were being held in a secure drug cupboard, and the home has systems in place, to ensure that medication is being given out safely. The procedure included having a second person to witness the medication being dispensed, therefore reducing the chance of any mistakes happening. Records are being kept of any medicines no longer required by the resident, prior to the drugs being taken away to be safely disposed of. The providers informed us that they are currently looking at their whole system of ordering medication, and how it is dispensed from the pharmacist, to see if there is a more flexible system that would meet the needs of the home and residents. Discussions with a resident confirmed that they were receiving their tablets as prescribed, and the home had never run out of their medication. We assessed how staff observed residents privacy and dignity throughout the inspection. This was undertaken whilst walking round the home, during our observational assessment in the blue lounge, and through individual discussions with residents. We asked a resident if they felt staff treated them with respect, and ensured their privacy whilst they are receiving personal care, their reply was in the main yes. The majority of interaction with staff when talking to residents was good, with staff addressing residents by their preferred name. A shortfall was identified whilst observing in the blue (dementia care) lounge, when a member of staff moved the chair the resident was sitting in, without informing them first. Priory Paddocks Nursing Home DS0000024475.V373247.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff liaise with residents to ensure they are offered a choice of home-cooked meals, which meets their preferences. Residents are able to choose if they want to take part in organise social activities, which includes trips around the local area, and are supported to keep in contact with their family and friends. EVIDENCE: The AQAA informs us that the home has always succeeded in delivering a range of activities via our social committee, they go on to tell us that the information about activities is circulated to encourage relatives or their friends to attend. Details of forthcoming activities at the home was displayed on the notice board and included going Christmas shopping in Ipswich, calendar making, and chair aerobics. We were interested to find out from a resident what was involved in chair aerobics and were informed that we bounce ourselves around in the chair, which they said they enjoyed. We asked another resident if there was enough going on to keep them occupied during the day. They replied that they cant seem to get motivated but they had gone out for lunch one day- which is very nice. A relative told us sadly the indifferent weather has restricted some of the outdoor activities such as sitting out in Priory Paddocks lovely gardens on my visiting days. However, we have Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 16 been to a local garden centre for tea, to Kessingland Wildlife Park for a picnic and just up the road for a pub lunch. They went on to say that a visit to Snape for the Christmas lights had also been planned. Other comments from relatives included (under what do you feel the care home does well) included instilling a friendly atmosphere for residents and visitors, providing a variety of entertainment and outside trips and activities are arranged to help stimulate and involve those who can and wish to participate. When we asked staff what they felt the home could do better, 3 staff commented on the social activities, feeling there was not enough to stimulate some of the residents. Their comments included a full-time social care person instead of a part-time one, more carers to provide more time to give better social care and activities, and we have a lot of residents with dementia and they mainly sit in the lounge all day -not doing a lot. A relative also commented that residents were sat in front of a television and left. Taking into account these comments, we decided to undertake our 2-hour observation (SOFI), in the blue lounge, observing 4 people with dementia, so we could assess how much interaction they had with staff during that period. We started the observation at 10:45 a.m. keeping a record of how much interaction a resident had within each 5-minute period. During this time although we could hear staff in an adjoining room and corridors speaking, there was periods of 35 minutes, and 30 minutes where there was no member of staff left in the lounge, to interact and monitor the residents well-being. During this time the television was on, which 1 resident was seen to take an interest in. Out of the other 3 residents we were observing, 1 spent their time looking out at the garden, or with their eyes closed. The other 2 would also sit for long periods with their eyes closed, although the movements they were making during some of the time, showed that although they had their eyes closed - they were not asleep. Where we observed one member of staff come in and put a drink out of reach for a resident until it cooled down/could be assisted to drink it, we observed the drink being removed by another member of staff, without the resident being offered the drink. We observed a positive reaction from 3 of the 4 residents when a member of staff came in and went around speaking to each person individually, and handing out magazines to 2 residents. Good practice was observed with the member of staff using the pictures in the magazine as a discussion point. The residents concerned became much more alert, and this continued after the member of staff had left the room, as they continued on and off to look at the magazine for short periods. We noted that the resident who was watching television only had interaction with 1 member of staff during our observation for a brief (5 minute) period. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 17 Towards the end of our observation period, the lounge became busy as other residents (accompanied by staff), started coming in for lunch, and joined the residents we were observing. We gave a brief summary of our findings to the providers who found it useful, and said that they would look at addressing the situation by having a member of staff available in the lounge during the morning, as this had been happening during the afternoon. The AQAA informed us that staff keep records in the residents bedroom so visitors can see what the residents have socially participated in, which we looked at when visiting residents in their bedrooms. Looking at 1 residents sheet, we found out that had enjoyed/taken part in, a Halloween party and Firework display, as well as aromatherapy sessions at the home. For 1 resident with dementia there was a good level of information on what type of social activities they prefer, and how they may react in different social situations. As we drove up to the home at 7:15 a.m. we saw that most of the lights were on, residents radios and televisions could be heard playing as we walked around the corridors. This added to the busy atmosphere, as staff assisted residents with their personal care, and preparing breakfast. Discussion with the night staff identified that after completion of the six oclock round when they check residents are comfortable and dry, and sit residents up ready for breakfast. From discussions it was clear that residents who are able to say that they did not want to get up at this time, could settle back down again. However it was not clear, all recorded in residents care plan, if it was the more vulnerable residents choice, or residents fitting into the routines of the home. The home has developed good links with the local community who are invited to social occasions they hold during the year. A relative informed us that the home has a good reputation in the local area. This and previous inspections has identified how the home benefits from having one of the providers on duty each day, especially at weekends which helps in building is up with visiting relatives. They also keep to good communication links through update letters and encouraging relatives and advocates to attend social functions. Residents we spoke with liked the meals provided, with 1 person telling us that their biggest complaint about food is keeping it hot. Residents also told us that they were given plenty of cold drinks and tea. Staff described the food as being excellent with 1 member of staff asking if brown bread could be offered as well as white. Care plans gave information on residents individual nutritional needs, including any special supplements and diets. The Residents User Guide gives information on meal times during the day and informs the reader that breakfast is served in the bedroom between 7:30 and 8:30 a.m., lunch between 12.30 and 1 p.m., (bedroom or dining room) and supper between 5 and 5:30 p.m (bedroom or dining room). The booklet also informs readers that hot drinks are served mid-morning, mid-afternoon and in the Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 18 evening before they retire to bed. Facilities are also available for staff to make residents snacks outside these times. The main dining room downstairs provides a pleasant dining area for residents, and residents were seen to be coming downstairs prior to lunch, which encouraged social interaction with other residents and staff. The blue lounge (where we had been undertaking our observation) became busy as lunchtime approached, as staff brought in other residents in their wheelchairs/specialist chairs. Space become very limited, especially when the medication trolley was brought in. There was no dining table, instead residents had individual tables put in front of them, and were assisted as required, by the attentive staff. Residents were being offered a glass of sherry or wine with their meal, which one resident described as lovely. In the kitchen a record is kept of the meals served each day, which on the day the inspection was Fish/Fish Pie or Quiche. Discussion with the chef identified that they knew residents individual preferences, and were happy to cook something different for the resident if they didnt like any of the choices on the menu. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 19 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, 17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place which residents and advocates were aware of, and staff are trained to safeguard the interests of people they care for. Residents and their advocates can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: Relatives/advocates surveyed told us they knew how to make a complaint the complaint procedure is displayed on the wall in the entrance hall where visitors sign in or out on arrival and departure. Residents surveyed told us that staff listen and acted on what they said, and if they had any concerns they knew who to speak to have them addressed. This reflected our findings when asking residents during the inspection, if they knew who to speak to if they were unhappy. Where people had raised concerns they told us that the home had always responded appropriately, with one person commenting that any matters raised has been dealt with immediately. Both the Statement of Purpose and Residents Guide gives information on the homes complaints policy. Staff told us that they knew what action to take if any concerns are raised, and the AQAA confirmed that staff had undertaken safeguarding training, to protect residents welfare. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 20 The AQAA also inform us that at the time of completing, they had received 6 complaints during the last 12 months, which they had upheld, and resolved within a 28-day period. Feedback received in the staff surveys raised concerns over a member of staffs conduct and that some institutional abuse is apparent. Staff said that they had raised the issues with the management, and felt their concerns had not been addressed. Discussions with the management, and records seen, showed that some of the issues raised had been discussed with the person concern. However, there was no evidence of any follow-up through conversations or supervision, to ensure all the issues raised and been dealt with appropriately. Following our feedback, the providers/management confirmed that they would be addressing the situation through supervision, support, and where required - extra training. All the staff we surveyed, confirmed that the provider had carried out Criminal Record Bureau (CRB) checks, and obtained references to validate their identity prior to them taking up their post at the home. The AQAA tells us that the home actively encouraged the advocacy service to which we are a member, and we make every effort to convey residents to the polling stations for voting during elections and support them with postal votes. The home has delivered training to their staff on the Mental Capacity Act (MCA), and that each resident has a statement with regard to their ability in the light of the MCA. This will support the home in identifying where residents are able to make an informed decision about their care, and where they are not able to, what action staff are taking to ensure the care provided is what the resident would have chosen. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 21 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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers residents a well-maintained, clean, comfortable, homely, safe environment that meets their range of mobility needs. EVIDENCE: The AQAA informed us that the home have finally completed a major refurbishment that has lasted over three years. Work undertaken includes creating a new sitting area upstairs close to the nurses station, a new laundry and main entrance with a large extending canopy. The large canopy will protect residents from adverse weather conditions, when getting in an out of transport. Discussions with residents and staff, and observation whilst walking around the home visiting residents in their bedrooms, showed that the refurbishment work has been undertaken to a high standard. The layout makes use of space giving residents a mixture of 5 sitting areas, as well as a well-maintained accessible garden. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 22 The new bathroom will offer residents a comfortable, relaxing bath/shower area, which includes a thermostatically controlled Spa bath, specialist shower chair, body dryer and sound system. To ensure privacy, as the bathroom has see-through walls, there are electronically controlled window blinds. The provider shared their plans on removing the bath from another bathroom (which also doubles as a hairdressing room), opposite the new bathroom, and upgrading the hairdressing facilities, so they can make it an even more pleasant experience for people using the service. The home currently has 33 bedrooms, 23 of which have en-suite facilities. The refurbishment has given the home 4 new bedrooms bedrooms, all en-suite, and the providers confirmed that they will be making an application to increase their registered numbers in the near future. All the residents we visited had personalised their bedrooms, and told us that the rooms were comfortable, and meets their needs. A relative in their survey describe the home as very pleasant, and homely. Residents we spoke with confirmed our observation of the communal areas and bedrooms we visited, are being kept clean and odour free. However, the same standard of cleanliness in the kitchen did not meet the standard of the rest of the home. When we visited at 7.30 a.m. in the morning we found flour and dried liquid stains on the work surfaces and windowsills, that dried food had built up on the ceiling of the microwave, the toaster had food remnants from the previous nights tea, and the top of the cooker had not been cleaned. According to the daily cleaning log signatures confirmed that all these areas had been cleaned the day before. In the fridges we found foods that had not been covered, or dated to say when they had been opened. This could lead to a resident being given foods, which are past their best. We asked to see the food safety manual but were informed by the kitchen staff that they did not have one. Discussion with the provider identified that they did have a manual in the office, and that they had received the training, but had decided not to use the file until the new kitchen was built. This led to discussions, due to the slippage in the hygiene of the kitchen, that they should start using it now, so they can monitor the cleaning routines. Before leaving the home, reassurances were given from the provider that shortfalls that we had identified earlier had been addressed, and the microwave was now gleaming. The staff are undertaking regular checks of the fridge, to ensure that they were storing food at a safe temperature. The providers confirmed that work on the new kitchen would take place after Christmas, which will be much larger and be equipped to a high standard. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 23 We visited the new laundry which now has a dedicated laundry assistant, who takes responsibility for ensuring that all the residents clothing is properly washed, ironed (if applicable) and return to the right person. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 24 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, and skilled in meeting residents changing physical needs. EVIDENCE: Residents we surveyed told us that staff are always or usually available when they need them. When we asked a resident if, when they rang their call bell did staff come straight away, they replied not really - sometimes a short wait further discussion identified that the wait was around the busy times of the day, such as during mealtimes. To get around this, the resident said that they generally leave asking to use the toilet during this time. A relative felt that staff tended to take their break together, leaving no one available to keep an eye on things. We were in the staff room, which is away from the main building, when 2 of the 5 care staff on duty came over for their break, which left cover of 3 carers and 1 nurse in the home during this time. Staff surveyed were asked if there is enough staff to meet the individual needs of the people who use the service. Out of the 23 replies, 2 said always, 18 usually and 3 sometimes. Comments from the staff included we do meet the needs of the people who use our services, but when we are short staff due to illness we have to work harder, another member of staff told us that 8 (staff) is not sufficient to give good quality care/when when this number is on things like nail care get missed. A relative commented on their survey, that Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 25 sometimes little things like washing residents faces after they had eaten their meal, or staff remembering to put residents glasses on can be forgotten. Another relative told us once or twice they have found their next-of-kins fingernails had not been cut and were not clean, however they went on to say this was soon dealt with. The observation session (SOFI) identified that there was long periods (see Daily Life and Social Activities section of this report) where residents in the lounge, who have dementia, did not see a member of staff, missing out on the positive social interaction this would give. The Statement of Purpose informs us that the staffing levels during the mornings are 9, made up of 2 Registered Nurses and 7 Care Assistants (from 8.30 a.m. to 2.00 pm) and 1 Registered Nurse and 4 Care Assistants in the afternoon (1.45pm to 10.15 pm). However, discussions with the provider, and feedback from the staff surveyed, identified that they have 1 less carer (giving a total of 8 staff) in the mornings, at weekends. In the homes own staff quality assurance survey there were comments over the need to increase the staffing levels, as staff felt that the overall resident dependency had increased but not the number of carers. The providers told us that they will shortly be making the application to increase their registered numbers to 40 residents, and inline with this, they will be increasing their staffing levels to 10 in the mornings. After leaving the inspection, we noted that the updated Statement of Purpose they had given us, reflected the increase in registered numbers, but not the increase in staffing levels, therefore will need to be amended. Residents we spent time with liked the staff, and felt confident in their abilities to look after them properly. This reflected the feedback we had received in the relative surveys, who when asked if they felt the care staff have the right skills and experience to look after people properly had answered with always or usually. They also told us that they felt the home could meet the different cultural and diversity needs of the residents. Comments made included I believe that everyone receives the level of care according to their needs. The majority (21) of staff told us that their induction had covered everything that they needed to know about the job, to get them started with only 2 saying it only partly (you can only learn on the job) did. Other comments from staff included I have worked at Priory Paddocks a long time and have been truly amazed how the induction and foundation training scheme has blossomed, carers are given the right information to do their job effectively, and I enjoyed my induction and soon to be starting my NVQ. The home benefits from having a full-time training manager (who has been nominated for Assessor of the Year Award), who guides staff through their induction and NVQ training. Information supplied in the AQAA, shows that out of the 31 permanent care staff employed at the home, 20 have achieved a NVQ level 2 or above with a further 6 carers working towards this qualification. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 26 The AQAA informs us that Priory Paddocks was nominated as outstanding employer of the year in November 2007 by Suffolk Brokerage, an organisation that externally examines the homes training with particular regard for induction and NVQ training. All but 1 of the staff surveyed, told us that they were receiving training relevant to their role, which helps them understand and meet the needs of the people they are looking after, keeping them up to date with new ways of working. Staff told us that we are encouraged to do training courses and are offered a bonus for the training we do. Other comments included I have recently attended a training session on the Mental Capacity Act, and we have excellent nurses who update us on all changes in practising good care. However, 3 members of staff commented that where they normally attend 6 to 8 training courses as a minimum per year, this year had received no, or very little training. The AQAA tells us that due to being overwhelmed for a while because of all the building work going on, the providers had acknowledged that the ongoing training of staff was reduced for a while, however this is now back on track. Discussions with the training manager, and information advertising forthcoming training days, confirm that this is now happening. The AQAA tells us that the homes recruitment programme has improved as we attend to and are fully appreciate the importance of the protection of our residents. We looked at the recruitment paperwork for a new member of staff, and found that the home had undertaken checks on their identity to confirm that they were allowed to work with vulnerable people, before they started work. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 27 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, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect the home to be managed by experience staff, who are committed to providing a good level of care within a safe environment. EVIDENCE: The home benefits by having a provider, Miss Marion Lloyd or Mr Andrew Burgess (both of whom are registered nurses) on site 7 days a week, taking an active lead in monitoring the level of service provided to residents. A General Manager, and Training Coordinator/Assistant Manager, both of whom work fulltime, supports them. Residents we spoke with knew who the providers are, and confirmed that they see them regularly. Relatives surveyed wrote positively of the management, telling us they seem always to be improving where ever possible, a great deal of thought appears to be given to the running of the home. They praised the staff who they described as most Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 28 caring and wonderful making it a very pleasant, caring place as homely as it is possible to be. The staff we spoke to during the day and feedback from their surveys showed that they generally enjoyed working at the home, and felt that there was normally a good team spirit, which reflected on the positive atmosphere for the residents. Staff surveyed was asked if their manager met with them to give support and discuss how they are getting on with their work. Replies (from those who had answered) were mixed between sometimes (8), often (8) and regularly (6). The AQAA informs us that all staff receive regular supervision. The findings are carefully audited and summarised to create an agenda for the all staff meeting. Discussions with the General Manager confirmed that they aimed to undertake 4 supervisions (2 less then recommended in the National Minimum Standards) with staff, 2 of which are group supervisions, and 2 are on one were a one-to-one basis where they receive individual feedback on their performance. We looked at the supervision for a member of staff whose issues about their work practice we had discussed earlier (see Complaints and Protection section of this report) and found that they had not been receiving 4 supervisions a year. The home gains feedback from people using and working at the home, through their own Quality Assurance Questionnaires and Staff Satisfaction surveys. The home sent 42 questionnaires out in September 2008, to the closest relative/friend or associate of each resident and received 35 replies. The questions asked where the same as the home had asked 3 years previously when they had undertaken their last survey, therefore they were able to analyse areas that they had improved in, or where they are not doing so well. The questionnaire covers the environment, internal cleanliness, quality of management, quality of care staff, delivery of care and catering services. The quality of management section covers the owners, qualified nurses and office staff. To the question asked do they appear capable of managing at Priory Paddocks there was a 94.3 satisfaction. The results of the surveys have been analysed, and a report produced in November 2008, which shows where shortfalls have been identified, and the providers plan of action to address them. Discussions with the providers confirmed that they had been updating their fire risk assessment, to take into account the new extension. The when we receive the homes AQAA, they had not completed all the required information concerning the maintenance of equipment, policies and procedures. We use this information to check that the home is having equipment serviced and checked, therefore safe to use and that the guidance given to staff (policies and procedures) is up to date and reflects current good, safe, practice. When we arrived at the home we asked the missing paperwork and were given a copy to take away. However although the information had been completed on the first page (maintenance of equipment) the required information on policies and procedures had still not been completed. Conversation with the providers, Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 29 and information written in the AQAA shows under, our plans for improvement in the next 12 months, that they still have work to do creating and updating written policies. The AQAA completed in February 2007, also identified policies and procedures, which were not in place (which included hygiene and food safety) and others that had not been reviewed for over 4 years. It is important that this work is undertaken so there is written evidence of the practices that they are promoting throughout the home to benefit, and ensure the welfare of the people they are looking after. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 30 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 2 10 2 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 3 18 3 3 3 3 3 3 3 3 2 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 3 2 X 3 2 2 3 Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 31 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. 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. Refer to Standard OP1 Good Practice Recommendations The home needs to monitor their Statement of Purpose to ensure that the information given, reflects current practice. The home needs to have systems in place to monitor that Nurses are fully completing the residents Medication Administration Records, and where any gaps are identified, that checks are undertaken to ensure that the resident has been given their medication. The home needs to review its early morning routines, to ensure they are fully flexible, and work around individual residents preferences and choices, and not the homes routines. DS0000024475.V373247.R01.S.doc Version 5.2 Page 32 2. OP9 3. OP12 Priory Paddocks Nursing Home 4 OP27 The home needs to review their staffing levels/deployment of staff, to ensure that vulnerable residents, who would be unable to use the call bell system, are not left alone in the lounge for long periods. 5. OP37 The home needs to have systems in place to ensure that they have all the policies and procedures updated on a regular basis This will ensure that the information held reflects current practice, and evidences that staff are being given up-to-date guidelines to protect the welfare of the people they are looking after. Priory Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Paddocks Nursing Home DS0000024475.V373247.R01.S.doc Version 5.2 Page 34 - 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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