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Care Home: The Priory

  • Springhill Wellington Telford Shropshire TF1 3NA
  • Tel: 01952242535
  • Fax: 01952641577
  • Planned feature Advertise here! POOR

The date of the last key Inspection was 22 October 2009. The Priory is care home for older people and also provides nursing care for individuals with complex nursing needs due to their physical health condition. The home is located in residential area and is accessible via public transport and is nearby to local amenities, such as shops and pubs. The two storey property is situated within its own grounds, offering single 0 2 0 2 2 0 1 0 0 bedrooms on both the ground and first floor. The majority of bedrooms are equipped with en suite. Bathrooms and toilets are provided on each floor and are nearby to communal areas. A lounge, dining room, kitchen and laundry is situated on the ground floor and are accessible to people who live there. Equipment and adaptations are in place for people with restricted mobility. These include a passenger lift, grab rails and lifting appliances. Staffing is provided throughout the day and night. The reader is advised to contact the service directly for information regarding fees..

  • Latitude: 52.70299911499
    Longitude: -2.5269999504089
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 37
  • Type: Care home with nursing
  • Provider: Wellcare Management Ltd
  • Ownership: Private
  • Care Home ID: 16472
Residents Needs:
Old age, not falling within any other category

Latest Inspection

This is the latest available inspection report for this service, carried out on 21st July 2010. CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for The Priory.

What the care home does well People who live at The Priory are supported to maintain contact with family and friends. People tell us that they look forward to visits. Some people visit the home and other people have relatives and friends to collect them and take them out to places of their choice. As a result people stay in touch with people who matter to them and this means that their quality of life is improved. Visitors say that the home support them by keeping them informed about things that they need to know. One relative said `Communication with families is excellent`. As a result people receive valuable support from people who are important to them. People living at The Priory are able to order food and refreshments whenever they like. One person said that she is always able to offer her visitors a cup of tea and this is important to her. Staff tell us that the home provides good care. Staff do their best to support people to ensure that their care and support needs are met. We saw staff being polite and courteous with people they were supporting and as a result the majority of people feel safe and well cared for. Staff also say that the home does well by offering team members good support. Staff feel listened to by the manager. Staff working at The Priory say they can recognise abuse and know how to record and report it. What has improved since the last inspection? The management strategy of The Priory has resulted in the new manager receiving support and assistance from two management consultancies since our last inspection. As a result we have seen a lot of work in progress. However, we have not yet seen the full impact of these changes on management practices and we will continue to monitor these. During the inspection in June we found that the medicine management systems within the home had improved meaning that people are better protected while receiving prescribed medication at The Priory. External ground work at the home has improved access and parking. The home is working with outside agencies to improve standards, especially in relation to accessing training opportunities for staff. Staff told us that they think that training opportunities have improved and a number of staff told us that they are looking forward to some forthcoming training to develop their skills and knowledge and offer a better quality of service. What the care home could do better: Written information provided by the home must include the fees charged for the service to make sure that people are fully aware of what it costs to live at The Priory. Care plan paperwork is in need of further expansion so it contains all of the details to make sure staff have written guidance on how to look after people, especially for those who have not got the capacity to let them know their needs and preferences. This must be kept up to date to reflect the current needs of people especially when health needs change, for example, following an accident. Safety assessments to minimise the risk of people of potential hazards are in need of further review. Priority must be given to bed rail safety and all equipment used on a day to day basis to care and support for people. This is to make sure they give a clear account of measures staff are advised to take to promote the safety, comfort and well being of people living at the home. Medication management systems are in need of further development to make sure that any oxygen therapy carried out within the home is fully accounted for to promote peoples well being. Staff working practices at The Priory require further consideration to make sure the privacy and dignity needs of people are prioritised as part of their daily lifestyle, especially with regards to manual handling procedures. People reported they felt that the cleanliness of the home had improved, however some of the bedrooms we visited had an unpleasant odour indicating carpets were in need of cleaning. The home management systems to ensure The Priory is kept maintained to a standard that promotes the safety, well being and comfort are in need of further development to make sure people are living in surroundings that are in a good state of repair and can meet their needs. Staff recruitment processes require further development to make sure any new team members are thoroughly checked out to be competent and safe to work with vulnerable adults and receive an effective introduction to working at the home. Management systems are in need of further development to ensure staff implement the knowledge and understanding they attain from training into their daily working practices in order to improve standards of care and support at The Priory. People living at The Priory told us that they would like to see activities within the home improving as currently a lot of people are bored. The current lack of mental and physical stimulation is affecting the quality of the care that people receive. Staff also suggested that the home could do better by providing more activities to engage people. As a result of this inspection, with the consent of the home management team, we obtained for photocopies of some of the paperwork about how The Priory meet peoples needs. This information will be used to consider further action we need to take in order to make sure the home complies with our regulations to meet National Minimum Standards for Care Homes for Older People, and ensure the health and well being of people who live at the home is promoted at all times. Key inspection report Care homes for older people Name: Address: The Priory Springhill Wellington Telford Shropshire TF1 3NA     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Adams     Date: 2 6 0 7 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: The Priory Springhill Wellington Telford Shropshire TF1 3NA 01952242535 01952641577 thepriory.home@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wellcare Management Ltd The registered provider is responsible for running the service care home 37 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 37 Date of last inspection Brief description of the care home The date of the last key Inspection was 22 October 2009. The Priory is care home for older people and also provides nursing care for individuals with complex nursing needs due to their physical health condition. The home is located in residential area and is accessible via public transport and is nearby to local amenities, such as shops and pubs. The two storey property is situated within its own grounds, offering single Care Homes for Older People Page 4 of 34 0 2 0 2 2 0 1 0 0 Over 65 37 Brief description of the care home bedrooms on both the ground and first floor. The majority of bedrooms are equipped with en suite. Bathrooms and toilets are provided on each floor and are nearby to communal areas. A lounge, dining room, kitchen and laundry is situated on the ground floor and are accessible to people who live there. Equipment and adaptations are in place for people with restricted mobility. These include a passenger lift, grab rails and lifting appliances. Staffing is provided throughout the day and night. The reader is advised to contact the service directly for information regarding fees.. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. This inspection was carried out over three days. The home did not know we were going to visit on the first day, although they were aware of our intentions to return on the subsequent days. A second inspector was present on day 2 and day 3 of our inspection. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment. (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Care Homes for Older People Page 6 of 34 Since the last Key Inspection in October 2009, there have been three additional inspections of this service. Two in February; one to check improvements and the other specific to medication issues. As a result of the inspection regarding medication we issued a Statutory Requirement notice, because we had evidence that the service had breached our Regulations. We checked compliance with the Statutory Requirement Notice on 30 June 2010 and the home had made improvements and complied. Four people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, viewing their private bedroom accommodation, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were also looked at. Where people who use the service were able to comment on the care they receive, their views have been included in this report. We sent 10 of our Have your Say surveys to people who use the service and 10 to their relatives and people who are close to them. We received 4 replies from people who live there, 4 responses from people who were close to them and three completed surveys from staff members. One health professional also responded. Their views have been included in this report. Feedback about the conclusions of the inspection was given to management team members at the end of the inspection. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Written information provided by the home must include the fees charged for the service to make sure that people are fully aware of what it costs to live at The Priory. Care Homes for Older People Page 8 of 34 Care plan paperwork is in need of further expansion so it contains all of the details to make sure staff have written guidance on how to look after people, especially for those who have not got the capacity to let them know their needs and preferences. This must be kept up to date to reflect the current needs of people especially when health needs change, for example, following an accident. Safety assessments to minimise the risk of people of potential hazards are in need of further review. Priority must be given to bed rail safety and all equipment used on a day to day basis to care and support for people. This is to make sure they give a clear account of measures staff are advised to take to promote the safety, comfort and well being of people living at the home. Medication management systems are in need of further development to make sure that any oxygen therapy carried out within the home is fully accounted for to promote peoples well being. Staff working practices at The Priory require further consideration to make sure the privacy and dignity needs of people are prioritised as part of their daily lifestyle, especially with regards to manual handling procedures. People reported they felt that the cleanliness of the home had improved, however some of the bedrooms we visited had an unpleasant odour indicating carpets were in need of cleaning. The home management systems to ensure The Priory is kept maintained to a standard that promotes the safety, well being and comfort are in need of further development to make sure people are living in surroundings that are in a good state of repair and can meet their needs. Staff recruitment processes require further development to make sure any new team members are thoroughly checked out to be competent and safe to work with vulnerable adults and receive an effective introduction to working at the home. Management systems are in need of further development to ensure staff implement the knowledge and understanding they attain from training into their daily working practices in order to improve standards of care and support at The Priory. People living at The Priory told us that they would like to see activities within the home improving as currently a lot of people are bored. The current lack of mental and physical stimulation is affecting the quality of the care that people receive. Staff also suggested that the home could do better by providing more activities to engage people. As a result of this inspection, with the consent of the home management team, we obtained for photocopies of some of the paperwork about how The Priory meet peoples needs. This information will be used to consider further action we need to take in order to make sure the home complies with our regulations to meet National Minimum Standards for Care Homes for Older People, and ensure the health and well being of people who live at the home is promoted at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking about living at The Priory receive most of the required information about the service to help them make an informed choice about what the home can offer. People have their needs assessed prior to moving into the home which means they can be confident they will receive the care they need. Evidence: Jason Sykes, a management consultant who is the newly registered Responsible Individual for The Priory, has produced the information The Priory management team are required by law to provide, in the form of a Statement of Purpose and Service User Guide. The most recent copies of this information were given to us to review as part of the inspection process. The manager for the home told us that she keeps a record of all interested parties that are supplied with these details. The information is presented in two separate, easy to read, brochures to inform people what the home has to offer. Although the majority of this information is well laid out, its contents Care Homes for Older People Page 11 of 34 Evidence: require amending in order to inform the reader an outline of what it costs to live at this home. As this home has had limited opportunity to admit new residents since our last key inspection, we could only review the assessment procedure for one person. Paperwork we looked at confirmed that enough information had been gathered by the manager to make the decision whether the home could meet their needs before the person was admitted. As part of our inspection we visited this person to see how the home was meeting their needs. The individual was seen to be sharing a bedroom with another person. Recordkeeping as part of the pre-admission procedure did not account for the persons agreement to this arrangement. However discussion of this matter with the manager and one of the nurses confirmed that the individual concerned was happy with this arrangement, and a single bedroom had been offered to the individual on several occasions and it has always been refused. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care needs and risk assessments set out in the individual plans of care do not ensure that all peoples needs have been addressed and will be fully met. Evidence: We received varying feedback about how people and their representatives view their needs are met at The Priory. Three people visiting the home that responded to our survey told us they were satisfied with the care their relatives receive. One relative wrote, I think my father is getting adequate care and attention to fulfil his needs at The Priory. Two out of three people who live at the home stated they usually receive the care and support they needed and commented staff were usually available when they were needed. As several people who live at The Priory are unable to feedback their views, and are reliant on staff being aware of their needs and how to meet them it is important that care records are accurate and contain sufficient information so that staff have guidance to follow on how to meet individual needs and that any risks to the individual person are clearly identified. Care Homes for Older People Page 13 of 34 Evidence: In the information that the service sent us at the end of February 2010, the manager stated that, Care plans now contain information which is consistent with the needs of the person using the service. Staff are now able to refer to care plans which contain specific information regarding individual care needs and how to meet them. In order to establish whether the records of people living in the home reflected their needs, we spent time observing individuals and staff in communal areas. We had discussions with individuals about their needs and also talked to some staff team members about the care and support they offered. An in depth examination of care records of four people who live at The Priory confirmed that the recordkeeping for some individuals were lacking care plans, and that assessments of possible risks to their health, safety and welfare are either not sufficient or have not been undertaken. These were issues we identified at our last key inspection in October 2009, when we made two statutory requirements for the home to demonstrate they had made permanent improvements to the way they care and support for people at The Priory. Although some improvements to the care paperwork are evident, our findings could not offer us assurance people are receiving all of the care they require. Our findings confirmed that further improvements are needed before the requirements we made can be fully complied with. Recordkeeping could not confirm whether basic care needs and specific care needs were being met. For example: The records for one person did not give details to staff about how to provide oral hygiene, hair washing, finger and toe nail care or appropriate catheter care. The home uses a simple recording tool, but it seemed to suggest that the persons hair had not been washed for twenty one days and that the cathether bag had not been changed for four. Upon meeting this person it was apparent the individual could not meet their own needs for these matters and it was not evident that the staff had attended to her personal care needs. We observed this to be the case for at least two other people met during our inspection. One of the above people seen did not appear to have full mental capacity, but this need had not been accounted for or taken into consideration in their records, to protect their welfare. When we went to meet a person who has an infected pressure sore on the first inspection day, there was no evidence or information in the individuals records of any measures or precautions to take to manage this infection. At the time of our visit, part of the dressing to this area had started to peel off, and the persons relative was Care Homes for Older People Page 14 of 34 Evidence: touching it. This matter was discussed with the manager, and two days later, although contact had been made with the doctor for this issue no short-term care plan to manage the infection had been devised. It was also a concern that the recordkeeping for this person did not clearly identify to staff how to manage the pressure relieving mattress seen in place to make sure the equipment was functioning at its optimum settings to prevent further pressure sore development. Our findings confirmed this person was bedridden, and lacked the ability to communicate with staff. Review of the use and recordkeeping for similar equipment for two other people at risk of developing pressure sores was also in need of this type of improvement. The recordkeeping for one person accounted for their body weight to be less than 55 kg, however the pressure relieving mattress in use on the individuals bed was set at 70 kg. These practices not promote the safety and well-being of people living at home. Records failed to inform us that ongoing assessments of peoples needs had been carried out and kept up-to-date. This has had an impact on the care people have received and our findings indicate people did not receive the care and support they required to keep them safe and well. Our findings also established that although staff were reviewing care plans on a monthly basis they did not reflect the changes in their care as a result of their medical conditions or issues which have the potential to challenge their safety. Analysis of the home accident book confirmed that one person had suffered injuries as a result of moving and handling incidents on three occasions. When the care paperwork for this individual was explored, records lacked appropriate up to date details to offer staff guidance to reduce the risk of further injury. Moving and handling assessments were available in peoples rooms, however they were not up to date and did not fully provide the action or equipment (hoist) needed to keep people safe. Although observation of manual handling practices seen in the home during the inspection were carried out safely and effectively, we observed staff were not making the choice of appropriate equipment to promote the dignity of individuals in communal areas. One person was observed to be transferred on a mechanical hoist attached to a sling which exposed the persons underwear. During our tour of the home we became aware that many people were being cared for in bed with safety rails in place. It was evident that some of these bedrail installations were not adequate to keep people safe. When this matter was explored further we could find no evidence of routine checks we expect to be carried out in line with Health and Safety Executive recommendations for the safe use of this equipment. We pointed this out to the management team and by the second day of the inspection they had carried out a review of the bedrail installations in the home with the outcome that Care Homes for Older People Page 15 of 34 Evidence: they were in need of 8 sets of extra high and extra long bed rails to keep people who require this equipment safe in bed and to be fully compliant with professional guidance. Lack of appropriate details in the assessments to keep people safe were discussed in depth with the manager, and a management consultant who has been appointed to support the home management team to make permanent improvements to its care and support practices. By the second day of the inspection some improvements to recordkeeping was evident. The home have also contacted a local professional organisation to organise a variety of training including care planning for its team. This individual was visiting the home to arrange this training at the time of our inspection. As a result of our last key inspection in October 2009, our findings raised concerns about how the home managed its medications for people living at the home. As a result a random inspection by our pharmacy inspector was carried out in February 2010.Inadaequate medication management systems resulted in a statutory notice being issued in order for the home to make permanent improvements for this matter. A second inspection by our pharmacist at the end of June 2010 confirmed the actions taken by the home had greatly improved, and safe systems were in place for this aspect of the service. As a result of these findings we reduced our focus on inspecting medication management practices at this inspection. However. during a tour of the home we met an individual who is reliant on continuous oxygen therapy to help with their breathing condition. Inadequate storage arrangements for this compressed gas seen in the persons bedroom triggered us to explore the matter further. Our findings confirmed that a lack of recordkeeping meant the home could not account for the safe receipt, storage, administration, and management of this therapy. Care plan records lacked details to account for the day-to-day management of this care need. Recordkeeping had not been developed to offer staff guidance for any foreseeable emergency management of equipment failure and the use of portable oxygen equipment. By the end of the second day of the inspection it was positive that remedial action had been taken by the home management team to rectify this matter. As a result of our findings we obtained photocopies of the care plans of three people which reflected the above matters in order for us to consider further action to take to ensure permanent improvements at The Priory enable people to experience effective safe and appropriate care. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Priory do not take part in regular in house activities and will benefit from the home developing activities that will meet peoples specific needs, wishes and aspirations as this will enable people to have a better quality of life. The Priory welcomes visitors, enabling people living at the home to stay in touch with the people who matter to them. Evidence: People living at The Priory said that they were bored and that activities do not happen on a regular basis. There is no evidence of any activities being provided; people go to bed from 5.30 in the afternoon and the acting manager commented that the home is, like a ghost town after 7pm. The home has landscaped gardens but we found no evidence that people can take advantage of them. One relative said that the home could improve by finding somewhere for her Mother to sit outside to get some fresh air. People told us, There is not much to do. I would like more There is nothing to do but watch TV. This is disappointing. Care Homes for Older People Page 17 of 34 Evidence: I just sit all day. I am bored. I would like to do something different than just sit here and look at one another There are long days and long nights. Some people told us that they were not bothered about the lack of activities as they didnt want any but the majority of people reflected that the home is not meeting their social or recreational needs and this is clearly impacting on the quality of the service provided. Staff agreed that there was a lack of activities taking place within the home but due to time restraints they felt that they could not improve this situation. The home has been without an activities co-ordinator for at least nine months,although we acknowledge that they are in the process of recruiting one. As a result people are not being motivated or stimulated mentally or physically and the care staff do not have the time to address these needs. People told us that they were generally satisfied with the meals provided by the home and everyone we spoke with said that they could have hot or cold drinks whenever they requested. This suggests that the home is responsive to meet peoples dietary needs and people like to be able to share a drink socially with their friends and relatives when they visit. This enables people to have some control over their lives. We saw the meals being served in two areas of the home; meals are plated up in the kitchen and given to people, most of whom sit in their armchairs. This means that some people may be in the same place all day long. People are offered a choice of meal, but there is no option for different portion sizes. Although cold drinks are available, the jugs are cracked and worn and people drink out of plastic cups. We discussed the daily routines with the manager, who suggested that people were able to make lifestyle choices, but again, the records we saw did not confirm this. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure so that people and their representatives know how to raise concerns and complaints. Staff say that they would recognise and be confident in reporting abuse; but we are not assured that people are kept safe by the homes day to day practices. Evidence: People living at The Priory are able to speak out if they have a concern or complaint and told us that they would feel confident to do so. Relatives told us that when they have raised issues and concerns they have been listened to and their complaints have been responded to appropriately. However, the homes systems for recording complaints and their outcomes are in need of further development to provide a robust audit trail of good practice for identifying, receiving, handling and responding to complaints. The manager and her consultant agreed with our findings and committed to review all processes. This will enable the home to show how they respond to complaints and make improvements to the service as a result. Staff told us that they were aware of what constitutes abuse and that they would have no hesitation to report poor or abusive practice. The manager told us that she is prioritising training for staff in relation to safeguarding and to date over half have the staff team have received the training. Within the last six months the home has been involved in safeguarding investigations Care Homes for Older People Page 19 of 34 Evidence: in relation to the safe use of medication. The home has addressed the medication shortfalls identified in the safe guarding referrals and the manager provided information of the improved systems. However, we could not confirm at this inspection, her detailed improvements in relation to temporary staff. There is no record of induction of agency staff; even though they may be left in charge of the home, including the medication administration during the night. We are concerned that the service is not safeguarding people because of poor recruitment practices and identified unsafe care practices, that are described within this report and this means that people are potentially at risk of harm. The wellbeing of residents cannot be fully safeguarded until all staff are fully trained and operating within policies that ensure the home is complying with our regulations. Although aspects of staff training have improved in the past 6 months, further work is needed so the additional training has been put into practice to make sure that people receive a consistent, satisfactory service and the home meets National Minimum Care Standards for Older People. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Priory are provided with a comfortable and welcoming place to live however redecoration and refurbishment will make it more homely, and improved safety measures in some areas will improve peoples health and wellbeing. Evidence: At the time of our visit we looked around the home to see if the environment was safe and well maintained. The home was clean and tidy although some communal areas and bedrooms require redecoration to make The Priory a nicer place to live. We also observed several minor repairs to fixtures and fittings as a result of wear and tear, such as broken panes of glass in fire exit doors in need of attention and these had not been accounted for in the home maintenance book. Externally, there have been improvements to the driveway and to the speed ramps making it easier to access and park at the home. All three people who responded to our survey said that the home was usually fresh and clean, however our findings confirmed that some bedrooms were not free from offensive, preventable odours. These conditions do not offer people pleasant, private personal spaces to relax and rest. Another bedroom was seen to contain a portable electric heater. Discussion of this matter confirmed that a risk assessment had not Care Homes for Older People Page 21 of 34 Evidence: been devised to ensure this equipment is used safely. Findings recorded earlier within this report in relation to bed rails and pressure relieving mattresses confirm that equipment safety is in need of review at The Priory. On the first inspection day some equipment, such as shower chairs were in need of thorough cleaning. These had been acted upon by our second visit. However action to improve and secure the clinical waste bins had not been carried out. The above findings indicate that the service needs to develop an auditing system to make sure they can demonstrate they keep living conditions for people at The Priory as safe as possible, and that they have all the adaptations and equipment necessary to meet peoples assessed needs. We were not able to test hot water supply to the home as maintenance work to the boilers was being carried out on both days. Upon visiting the laundry systems appeared to be operating satisfactory and appropriate protective equipment was freely available for staff use. Handwashing facilities were available in appropriate locations around the home. When we visited The Priory in October 2009 we were concerned about the storage arrangements for substances used within the home that could be hazardous to health. Although during this visit staff told us that they have received training and had required paperwork to support its safe use we still saw that identified products were not being stored or used safely and this could place people at risk of harm. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not safeguarded from the risk of harm and abuse because the homes recruitment process is not robust. The lack of a detailed induction process for staff to undertake within the home may mean that they do not have the knowledge to safely support vulnerable people . Evidence: Staff told us that they were happy working at The Priory although they felt that morale could be improved. Observations of staff supporting people on the day of the inspection were very positive. Staff carried out personal care tasks discreetly and in a relaxed and unhurried manner. One person who had been supported to sit in the lounge told us that she felt that she was in safe hands. People living at The Priory felt that staff were very busy and not always able to meet their needs when required. This comment was also made by a staff member suggesting that there may not always be enough staff on duty to meet peoples needs in a timely manner. For example one lady told us that she regularly had to wait to be taken to the toilet. She said, Staff do not understand how uncomfortable and painful it is. She indicated that sometimes she does not get the help she needs in time, which causes great embarassment. Staff have limited opportunities to spend time with people living at the home other than when supporting them with their personal care Care Homes for Older People Page 23 of 34 Evidence: needs. Our observations confirmed this. People living at the home, staff and their visitors reflected that they would like more opportunities to spend with people thus being able to meet peoples social and emotional needs and not just their personal care needs. Many of the people living at the home reside in their bedrooms for much of the time and we found that some did not have access to or the ability to use call bells and are therefore completely reliant on staff vigilance and checks. Staff told us that they felt that training opportunities were improving and our findings confirmed that a lot of training is now being planned. However our review of the records of four permanent staff members suggested that they did not receive a full induction to the home, which means that they could potentially lack important information as to how to keep people safe. Again, this may be because of poor record keeping or could mean that people receive a service from staff who do not have the knowledge or skills to support them safely thus placing them at risk of harm. At a recent Safeguarding meeting we were informed that temporary nursing staff are fully inducted before being left in charge of the home but when this was explored at the inspection there was no written evidence to confirm this and discussion with the manager established that nurses were only given verbal hand overs. This means that the home has no way of proving that staff left in charge of the home have been made aware of necessary procedures for medication management and emergency situations. We looked at the homes recruitment processes to see if they ensure that people only work at The Priory after they have been assessed as being safe and fit to do so. We looked at six staff files and there were vital omissions in most: We could not find any evidence of POVA/ISA first checks. When this matter was discussed with the acting manager she informed us the checks had been carried out however they were not available for inspection. Staff files must contain evidence these checks have been completed prior to a staff member starting work in the home. Most people had two references, but they were not all appropriate and credibility had not been established. Any controversial information in either a reference or CRB check had not been checked or subsequently assessed. The eligibility of staff from overseas to work in the UK had not been verified. The manager has a responsibility to ensure that all staff employed by the home are suitable and she may have placed people at risk of harm or abuse. The manager recognised that she lacked training in this area and committed to ensure that she received training and support to carry out the safe recruitment of new staff before any one else is appointed. She also stated that she will review recent recruitment files to ensure that all checks have been carried out and that decisions to appoint staff are risk assessed when appropriate. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Priory does not have effective management arrangements in place to promote the health, safety and welfare of people who live there; this means people cannot be confident they will be receive a safe and effective service. Evidence: The manager of The Priory has been in post since January 2010. She told us that she has had previous experience of managing a care home in Wales. Since our last inspection visit in February the proprietor has engaged two management consultant teams; one on a short term basis to improve medication arrangements within the home and the other to support with general issues to enable the home to be managed more effectively and efficiently. This is a welcome action as improvements to this service have not previously been carried out within the timescales that we expected. Although the manager of The Priory has been in post for six months and has had the support of the second management consultants for six weeks we are concerned that the health and safety issues raised by CQC on the day of the inspections had not been Care Homes for Older People Page 25 of 34 Evidence: identified by the internal management, suggesting a lack of relevant knowledge and experience to ensure the effective and safe running of the home. This may potentially place people living at the home at risk. In the AQAA dated February 2010 provided by the home the manager stated that We have provided an environment in which people feel safe and cared for We ensure that he environment is safe and well maintained. Our findings within this report confirm there continues to be is a lack of effective processes and systems to identify, manage, monitor and report risks. (Please see Health and Personal care section for details). We saw written records which show that a representative for the company conducts monthly unannounced visits to monitor the quality of the service. We observed reports produced as a result of visits since January 2010. These show that issues important to people living at home are not monitored or followed through. For example they have not identified our findings such as bed rail safety, POVA/ISA checks for staff, COSHH safety, cleanliness, manual handling assessments, access to staff and call bells. The monitoring forms (Regulation 26) we have seen do not evidence that they check the improvements required in their previous report. Robust monitoring should be able to identify when improvements need to be made and our observations made at this inspection and evidenced throughout this report indicate the home has not been managed or monitored effectively by the company for some time. The management should not wait for the regulator to inform them of any deficiences but should have their own monitoring systems in place. People and their relatives are given opportunity to put forward ideas to improve the service by using a suggestion box at the entrance of the home and we were informed that the management consultants intended to obtain additional views by sending out questionnaires to people, their representatives and staff in August 2010. This means that people will have more opportunities to share their views of how the service is run. We did not scrutinise how the home manages the finances of the people whose care we looked at however arrangements were checked at the last key inspection in October 2009 when systems were reported to be satisfactory We looked at a selection of documentation to confirm checks of services and equipment, to ensure The Priory is well maintained. Random checks of service records for hoisting equipment, gas and electricity supply were satisfactory thus ensuring peoples safety. However several other records we looked at established that this aspect of the home management had not been effectively acted upon and some paperwork was not available for inspection. For example the home fire safety Care Homes for Older People Page 26 of 34 Evidence: management records. We are also aware that the homes maintenance person, who is responsible for carrying out bed rail safety checks has not received training for the task required of him. This could make people vulnerable. Staff supervision is not yet taking place on a regular or formal basis. We found that the deputy manager has not received formal support since her appointment. Staff confirmed the lack of supervision however also said that overall they felt well supported and could approach the manager at any time if they had a query. A regular and recorded opportunity for staff to spend time with their manager will provide them with greater opportunity to reflect on their practice and thus improve the quality of the service provided overall. As a result of our findings we will be considering further action we deem to be necessary in order to make sure permanent improvements are made and maintained at The Priory. Photocopies of documentation were obtained throughout this inspection to use as part of our decision making process for this matter. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plan records must 30/11/2010 demonstrate that people using the service experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights. This will reduce the risk of people receiving unsafe or inappropriate care, treatment and support. 2 9 13 Systems to manage oxygen therapy must be developed and implemented to ensure it is handled safely securely and appropriately in line with published guidance about how to use medicinal compressed gases safely. This will make sure that people prescribed oxygen therapy will receive it as they require it in a safe manner. 30/11/2010 Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 29 19 The home must ensure that they carry out all required pre appointment safety checks on all staff who are recruited to work at the home.(as per schedule 2 of the Care Homes Regulations 2001). This is to ensure that only people who are fit to be carers are recruited to work within the home. 30/11/2010 4 30 19 All staff, including agency working at the home must receive training and induction in relation to the work they are to perform and the manager needs to keep a written record to demonstrate this. This is because the manager must be able to demonstrate that people working within the home are competent to do the job required of them to keep people safe and well. 30/11/2010 5 37 17 The registered person must ensure that service users are protected against the risk of unsafe or inappropriate care and treatment arising from a lack of proper information about them. 30/11/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that peoples personal records including medical records are accurate, fit for purpose, held securely and remain confidential 6 38 13 Systems to manage any 30/11/2010 required equipment must be developed and implemented to ensure this equipment is supplied, fitted, and properly maintained to make sure it is used correctly and safely in line with professional medical device guidance. These actions will ensure people will benefit from equipment that meets their needs and ensure they are not at risk of harm from unsafe aids to maximise their safety. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The management of The Priory are advised to review the contents of the Statement of Purpose and Service User Guide to ensure it contains all the necessary information people need to know about how much it costs to live in this home. This will ensure people have all the information they need to make an informed decision living at The Priory. Care Homes for Older People Page 31 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 3 The management of The Priory are advised to make sure the paperwork for any individuals sharing accommodation confirms the agreement of this arrangement with both parties concerned. This will ensure the home has all of the documentation to confirm people are happy to share their personal living space with another individual. All individuals who have challenges to their mental capacity which affects their decision making should be assessed in order to plan the delivery of the care, treatment and support they require. This will make sure their needs assessment centres on them as an individual to consider all aspects of their mental and physical individual circumstances to plan their immediate and longer-term needs. 3 7 4 10 The Priory must devise systems which account for and promote the dignity of people living at home for all aspects of care and support practices including the use of moving and handling equipment. This will make sure people can be confident staff will respect their privacy and minimise feelings of ill being and embarrassment. People living at the home must be provided with a range of activities that are appropriate and meet their individual needs and capabilities.This is to promote wellbeing and ensure that the social needs of people living at the home are met. We strongly recommend that the staffing levels within the home are constantly reviewed to ensure people receive all of the care they need in a timely manner and that staff can also meet peoples social and recreational needs thus improving their overall quality of life. The manager should ensure that training received is of good quality to reduce the likelihood of poor staff practices within the home. The home should develop an induction training system to incorporate Skills for Care to ensure staff receive full and comprehensive information about the role they are to undertake within the home. The appropriate measures must be taken to ensure all chemicals are securely stored. This should ensure that Page 32 of 34 5 14 6 27 7 30 8 30 9 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations people are not placed at risk. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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