Care Home: The Priory Nursing and Residential Home

Similar services:

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

What the care home does well People who are considering moving into The Priory benefit from having their care needs assessed so that they can be sure the home can meet their needs. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people are protected from harm. A visitor commented "I have never had to complain, I have nothing but praise for the way they have looked after my relative since they moved in." The Priory provides comfortable, clean surroundings, which were mainly well decorated and furnished. The health, safety and welfare of people living at The Priory is promoted by regular safety checks and maintenance of equipment. The home is managed by an experienced and competent person to ensure the service is run in the best interests of people living in the home. What has improved since the last inspection? The manager and staff have taken steps to address all of the outstanding requirements from the last inspection. Pre admission assessments are undertaken for all people who want to live at The Priory, so that they can be sure their needs will be met. People`s care plans and medications are managed well and information is provided to staff so that they know how to support people. All staff have had training in fire safety procedures and fire drills are undertaken so that staff know how to safeguard people in the event of a fire. What the care home could do better: We made several recommendations to improve outcomes for people living in the home. The manager should review the current dining arrangements in the home, to ensure that mealtimes are a pleasant, social experience for all people living in the home. The manager should monitor staff attitude to ensure that people are treated with respect at all times. The manager should review staffing levels to ensure there are enough competent staff available to meet the individual needs of people living at the home. Arrangements should be made to make sure that all parts of the home are free from unpleasant odours. This is to uphold the dignity of people living in the home and provide a pleasant environment for people and their visitors. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Priory Nursing and Residential Home 1 Shelly Crescent Monks Path, Shirley Solihull West Midlands B90 4XA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia Flanaghan     Date: 2 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Priory Nursing and Residential Home 1 Shelly Crescent Monks Path, Shirley Solihull West Midlands B90 4XA 01217113480 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): linfieldc@bupa.com BUPA Care Homes (ANS) Ltd Name of registered manager (if applicable) Mrs Ann Carr 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 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 52 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 - Code OP, maximum number of places 52 Physical Disability ? Code PD, maximum number of places 52 Date of last inspection Brief description of the care home The Priory Nursing Home is situated in a residential area approximately two miles from the M42 and the centre of Solihull. The site is shared with privately owned sheltered housing accommodation. The home is within close proximity to a small shopping centre and the local health centre. There is limited parking available to the front of the Care Homes for Older People Page 4 of 32 care home 52 Over 65 52 0 0 52 Brief description of the care home property and a small well maintained garden to the rear with a patio and seating for use when weather permits. The home provides 24 hour nursing, residential and respite care for a maximum of 52 older people who may also have physical disabilities. Ten beds are designated for a continuing care contract with a local Primary Care Trust. The building has a basement, ground floor and first floor. Accommodation is situated on the ground and first floor and all bedrooms have an en-suite facility. At the entrance to the home there is a reception area with a passenger lift, which gives access to all areas in the home. Access for people who use wheelchairs is good as there are no steps to the front door. The dining rooms and lounges are situated on the ground floor. The home does not have a smoking area. The home has hoists and pressure relieving equipment to meet the assessed needs of the people living there. There are assisted toilets and bathrooms available and corridors are wide and spacious and enable residents to move around the home freely with any aids they require. Previous inspection reports of the home are available in the reception area should anyone wish to read them. Current fee rates are available from the home. Additional charges include chiropody, hairdressing and toiletries. Care Homes for Older People Page 5 of 32 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: two star good 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 2 star. This means the people who use the service experience good quality outcomes. The focus of our inspections is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. Our last key inspection to The Priory was undertaken on 28th January 2008. Prior to the fieldwork visit taking place a range of information was gathered to include Care Homes for Older People Page 6 of 32 notifications received from the home and a questionnaire about the home. The questionnaire is called the Annual Quality Assurance Assessment (AQAA). We received eight surveys from people using the service and three surveys from staff. Their comments, where applicable, are included in this report. The visit took place over one day and staff and people who live at the home did not know that we were coming. The manager was present during this visit and answered questions about the management and running of the home. We did this inspection with an expert by experience who spoke to people who use the service and to members of staff. An expert by experience is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care. Four service users were case tracked. This involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were also reviewed. We looked around the building to make sure that it was warm, clean and comfortable. Our assessment of the quality of the service is based on all this information, plus our own observations during the visit. At the end of the visit we discussed our preliminary findings with the manager. What the care home does well: What has improved since the last inspection? What they could do better: We made several recommendations to improve outcomes for people living in the home. The manager should review the current dining arrangements in the home, to ensure that mealtimes are a pleasant, social experience for all people living in the home. The manager should monitor staff attitude to ensure that people are treated with respect at all times. The manager should review staffing levels to ensure there are enough competent staff available to meet the individual needs of people living at the home. Arrangements should be made to make sure that all parts of the home are free from unpleasant odours. This is to uphold the dignity of people living in the home and provide a pleasant environment for people and their visitors. Care Homes for Older People Page 8 of 32 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into The Priory benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: The manager said that the service user guide had recently been updated and copies given to all the people living at The Priory. This ensures that people have the necessary information about the home before they move in. One person told the expert by experience that she liked the new book about the home she had been given. The case files of two people admitted since the last inspection were examined to assess the pre admission assessment process. The manager said that it was usual practice for her to visit people who are considering Care Homes for Older People Page 11 of 32 Evidence: moving into the home to undertake an assessment of their needs and abilities. Files examined contained a pre admission assessment of each persons needs and abilities. This means that sufficient information was available so that the home could confirm they could meet each persons needs and develop care plans. The home also obtains records from the Primary Care Trust Single Assessment Process and from individuals own care manager where appropriate. Care Homes for Older People Page 12 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are met. Support from staff is not always given in a way that maintains their dignity. Evidence: We looked at the care files of four people as part of our case tracking process. This process enables us to make decisions about how the home is meeting the needs of the people living there. Each person had a care plan, daily records and monitoring records. Care plans were based on information secured during the initial care needs assessment and were developed as staff got to know the individuals strengths and limitations. Care plans were available for the identified needs and abilities of each person and supplied staff with the information needed to make sure the persons needs were met safely and appropriately. Care plans also detailed peoples likes and dislikes which gives staff information as to Care Homes for Older People Page 13 of 32 Evidence: how to assist people to meet their needs in ways that they preferred. There was information about peoples past lives and interests which enables the staff to have something meaningful to talk to people about. People had risk assessments undertaken for identified risks such as falling over or out of bed. Monthly reviews were undertaken for moving and handling, nutrition and skin soreness. The home develop care plans for short term care needs. For example, one person had a urinary tract infection which necessitated a visit from the GP and a course of antibiotics was prescribed. Comprehensive short term plans were developed to ensure staff meet the persons needs. Care plans were evaluated monthly and were updated as changes occurred. There was evidence that external healthcare professionals such as GP, Optician, Dentist, Dietician, Speech and language therapist and Tissue Viability Nurses see people. This ensures that they receive specialist healthcare input to meet their needs. Care reviews are held with people living at the home and their representatives so that they have the opportunity to discuss their care requirements. Monthly weight records were maintained in the case files examined that demonstrated that people were maintaining their weight. Staff update daily records at the end of each shift so that there is a clear picture as to the health and well being of each person living at the home. Systems are in place for the safe management of medicines in the home. A monitored dosage (blister packed) system is used. Medication is safely stored in locked trolleys, which are kept in locked clinical rooms on each floor. The rooms were tidy and organised. A medicines fridge is available with daily recordings of the temperature, which is within recommended limits. The rooms are temperature controlled ensuring that the medications are stored within recommended limits to maintain their stability. The facility for storing controlled drugs (CD) is satisfactory. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct. Medicine administration records (MAR) for the people identified for case tracking were Care Homes for Older People Page 14 of 32 Evidence: examined and had been completed correctly. Their medicines were audited and found to have been dispensed correctly. People appeared to be well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and personal preferences. The expert by experience observed some poor interactions between staff and people living at the home. For example, they observed a carer who did not respond to a person who was asking for help and a carer transporting a person in a wheelchair without explaining what they were doing. These, and examples of other instances were brought to the attention of the manager on the day of our visit and in a telephone conversation after the inspection. We also saw staff treating people with kindness and respect during the time we were in the home. Visitors confirmed that they thought the staff were very kind and understanding with the people. One person visiting the home said my relative is very happy here, their mobility has improved and they are coming out of their room and mixing with other people. I cant thank the staff enough for their kindness. A person living on the ground floor told the expert by experience that, the girls are very nice to you here. The manager should monitor staff attitude to ensure that people are treated with respect at all times. Care Homes for Older People Page 15 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current arrangements for activities are limited for people who require nursing care and as a consequence may not always meet their needs, expectations and interests. Failure to provide the required support for people during meal times does not respect and promote their dignity or health. Evidence: The manager told us in the AQAA how the home has improved in the last 12 months in respect of daily life and social activities for people. She reported that the home have recruited a carer into activities, alongside their care job. This had added a new dimension to our activities programme as the carer has developed the arts and craft aspect of activities into a very personal experience for our residents of all abilities. She also reported that the home could do better by developing more activities to suit nursing clients of limited abilities and to develop activities to include a weekend programme. We asked the expert by experience to assess the daily life and leisure activities of people in the home. Care Homes for Older People Page 16 of 32 Evidence: The expert by experience reported, There is a large lounge on the ground floor. There isnt one situated on the upper floor therefore residents with nursing needs have to come downstairs to use this facility. This area again appeared very luxurious and spacious, having large airy windows overlooking the activities of the street outside and the comings and goings of buses and people to shopping centre opposite. It houses a large television set, an area with a kitchenette area and a few dining tables just off. This kitchenette area is used for cooking activities for the residents and doubles up as an area where relatives can make a cuppa if necessary. The soft furnishings and curtaining were appropriate and of good quality and intact. The chairs were in a semi random form rather than the usual round the walls setting. Residents were observed to be fully engaged with the activity lady discussing current affairs. The activity lady was reading a newspaper to people while some of the ladies knitted. This corresponded with the large activity timetable clearly visible on the wall which detailed a wide range of craft, entertainers, entertainment and gentle keep fit. The manager explained that three individual people provided a total of 36 hours per week of activities. Residents from the upper, nursing floor have to come downstairs to participate in these events. Peoples preferences regarding their religion are supported and respected and church services and Holy Communion are held at the home regularly. The expert by experience was invited to join people for the miday meal and joined some people from the first floor in the newly created small dining room. The people remaining on the first floor were served their meals on trays in their rooms. The expert by experience reported, I made my way to the small dining area where the ladies and gents from the nursing floor were sitting. The cook had arrived with the trolley and at one point 6 carers were lined up with trays and waited for the meals to be plated up to deliver, on trays, to the nursing floor or the dining room next door. I shared a table with three other people. My meal was warm (not as warm as I expected) and tasty. The meat was tender and the vegetables, broccoli, cooked from fresh rather than frozen and of the mushy type. It was nicely presented as opposed to being slapped on a plate in a messy manner. This dining room was made quite noisy by the carers chatter and checking back on who was having what for lunch, banging of spoons and the clatter of metal against the trolley along with the clanking of plates. It felt little better than a servery with a couple of tables in and much like a works canteen. It was not in my opinion stimulating, pleasurable or in any way dignified for the nursing floor residents that had chosen to take lunch in this area. There was no background music and just a jug of orange squash for refreshment was offered on the side table. Care Homes for Older People Page 17 of 32 Evidence: The expert by experience observed people being assisted to eat by staff who did not sit down. They stood over them in a manner that did not allow the person they were assisting to relax and enjoy their food at their own pace. The expert by experience reported, One member of staff was available to assist six residents with their meals, two of whom needed physically feeding rather than assisting. The carer who was feeding the lady next to me had to keep getting up and going to stand over another resident and pop a spoonful into his mouth, then go over and do the same for the two ladies on the next table. At no time did she sit down next to the residents, it was a spoonful here and a spoonful there sort of approach. The rest of us were on dessert but one person had not even begun their main course and was still sitting unattended and unstimulated in their chair, whilst this charade of lunchtime, featuring a trolley and a queue of carers, and other diners eating, played out in front of them. The person started to cough at one point and as a response to this the carer poured some squash into a glass and dashed over to give them a sip. The person concerned did not seem able to sip and choked uncontrollably, bringing a flood of tears to their eyes. A thought flashed through my mind that maybe this person should be having thickened liquids. The person looked very frail and quite poorly. At this point a carer I recognised from the nursing floor upstairs came over from the serving queue and spoke with the carer who was assisting with the meals. She went to ask for a pureed meal from the trolley and popped it on the table next to the coughing resident..... To go cold. Eventually as we were finishing our meal the carer finished giving the main course to one person and started to try to give the pureed meal to the coughing person. The person did not want it and I would imagine the mushy looking mess was also cold. I felt dreadful. The mealtime was a very unsatisfactory and an undignified attempt at giving lunch to a few of the nursing floor residents. There must be a more pleasant, dignified and safer way of doing this. The carer would not have been able to explain to the resident, with limited cognitive ability, what they were being served. Each part of a liquidised meal should be served individually so that people can enjoy the taste of each part of the meal. When we shared this information with the manager, we were told that the chef purees each item in the meal separately and a carer may have mixed the foods together. We looked at the care records for the person and noted that they should have thickened liquids due to a poor swallow reflex. The manager also questioned the carers about the persons food intake at lunch and they reported that the person had eaten their meal. The expert by experience summarised by saying, I am greatly concerned about the lack of interaction and dignified, consistent, appropriate support for the residents with Care Homes for Older People Page 18 of 32 Evidence: nursing needs on the upper floor. I found the dismissive and uncaring attitudes of some staff quite shocking. I also feel the present situation where meals are being taken upstairs on trays is not acceptable. I was very sad to see the half hearted dining provision offered to the residents from the nursing floor in the small dining area. In my opinion the provision of meals for the nursing floor needs rethinking altogether. I dont understand why, if a dining area really cannot be provided upstairs, that the trolley being placed at the end of the corridor upstairs was a bad thing. It has got to be better than the current half attempt that is being given now. Care Homes for Older People Page 19 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate policies and procedures to safeguard people who use the service. Evidence: The home has a formal complaints policy which is accessible to people living in the home and their families. One person told us they would tell their family if they had any concerns so they could sort it out with the manager. A visitor commented I have never had to complain, I have nothing but praise for the way they have looked after my relative since they moved in. We looked at the record of complaints and concerns maintained in the home documenting the action taken by the home regarding each issue raised. The service has recorded ten complaints in the last 12 months, none concerned care practices. Evidence was available that the manager and provider makes a timely and objective response to concerns raised and the outcome is recorded. In our surveys we asked people if they knew how to make a complaint. We received eight responses and all said they knew how to complain if they were unhappy with the Care Homes for Older People Page 20 of 32 Evidence: service. One person commented most of the staff are very helpful. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff have received abuse awareness training and the manager is aware of her role and responsibilities in safeguarding people. The home also has a copy of the Local Authority policy for Protection of Vulnerable Adults on each floor. This ensures staff can refer to the document if they are in any doubt on what to do in the even of suspected abuse. Staff spoken with were aware of safeguarding and the majority of all staff had attended relevant training. Care Homes for Older People Page 21 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with comfortable surroundings to live in. Evidence: The home is a three-storey building and access is available to all areas via a passenger lift. Accommodation is situated on the ground and first floor and all bedrooms have an en-suite facility. There are two dining rooms on the ground floor and two lounges, which provide a pleasant place for people to sit, if they choose to. There is an activities room, which has a small kitchenette where relatives can make drinks. There is no lounge or dining room on the first floor where people requiring nursing care live. The expert by experience commented, First impressions are that of a relatively new, two storey, high-class, well maintained building in a very pleasant residential location with views over the golf course to the rear. Parking at The Priory was a little difficult as the site and car park is shared by privately owned sheltered flats with designated parking. The reception area, decor and furnishings appeared to be of high quality and it was spotlessly clean with no malodours on entering the premises. The carpets in this area appeared to be of good quality and safely intact. The lift from the upper floor exits here in reception where access can be gained to the lounge and the dining rooms. Care Homes for Older People Page 22 of 32 Evidence: Bedrooms seen were personalised and some people had brought in their own items of furniture, which helps them to have comfortable and familiar surroundings. All bedrooms have a nurse call facility so that people can summon help, as they require. The expert by experience reported The corridors and bedrooms on the ground floor, where we started our tour, reflected the overall genteel and luxurious appearance of the care home and were spotlessly clean. The majority of rooms to the ground floor were adorned with the residents own furnishings, pictures and televisions. There were no malodours in this area. The carpets and paintwork in the corridor areas looked a little tired and in need of updating but the manager explained that Bupa had a refurbishment programme in place. All of the doors to each of the rooms were open on to the corridor. The expert by experience toured the first nursing floor and reported, The upper floor mirrored the ground floor with the exception of the lounge and dining areas which on the upper floor were replaced by the situation of more rooms. This floor did contain a pervading smell of urine which was stronger in some of the areas, particularly around the sluice where it smelled really awful. The rooms were again open to the corridor. There were a couple of gentlemen and ladies who were clearly very poorly and nursed in bed. I did wonder if they would have chosen to be on show to everyone walking down the corridor in such a state of ill health and the dignity of it. Again the carpets and decor needed a little updating here. The laundry room is situation in the basement and there are good systems in place for the management of laundry and the disposal of waste. Systems are place to manage the control of infections. For example, we saw staff using plastic aprons and gloves and there are handwashing facilities in public areas. We received eight surveys from people living at the home, six of which say the home is always fresh and clean and two say it is usually fresh and clean. Care Homes for Older People Page 23 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not always available to meet peoples needs on the nursing floor. People are protected by robust recruitment procedures. Evidence: We looked at staffing levels, recruitment processes and staff training during our visit to see if the home was providing suitable staff who will meet the needs of people using the service. The manager told us there were 48 people living in the home on the day of the inspection visit. On the ground floor there were three care assistants. On the first floor there were two registered nurses and five care assistants. We looked at the homes staffing rotas which show how many staff are, and have been on duty. These demonstrated that the staffing levels set by the home are usually achieved. Laundry, catering and cleaning staff are employed to make sure that nursing and care staff do not spend undue lengths of time undertaking non-caring tasks. It would appear that there are enough staff on duty to meet the needs of people living in the home. However, some people did not feel that staff were always readily available to help them. In the eight surveys returned to us seven people felt there were usually staff available to help them. One person stated there were always staff available. Care Homes for Older People Page 24 of 32 Evidence: During conversation with the expert by experience, when asked about using their call buzzer to summon help, one person commented they dont always come if you do (use the call buzzer). A visitor told the expert by experience that in their opinion, there werent enough staff to meet the diverse needs of people on the nursing floor. We asked in our surveys to staff what they thought the service could do better. One staff member replied Improve staffing levels and staff quality and more support and management for the nursing floor. The expert by experience expressed concern at the length of time it took for staff to answer buzzers on the first floor (nursing). She reported At around 11.30 a person was shouting help, help. I looked around and couldnt see anyone to alert so went in to their room. The person told me they were desperate for the toilet. The buzzer was not within reach. I went to find a carer by which time the person was getting distressed and crying. I went back to reassure them and found an office with a young carer in. They were sitting doing paperwork. I explained the person needed the toilet and the carer looked at me for a second or two, I then asked if they would go to help the person. The carer stood up and went off to the room. Fifteen minutes later a buzzer was sounding. I have to say it is quite a quiet buzzer but I wasnt sure if the staff carried pagers on them such as the ones I have seen used in other care homes so I waited for a response. I looked around the corridors again, but again could not find anyone to answer the buzzer. I dont know if it was break time, but there were no closed doors on the upper floor where one could assume that staff may be helping another resident, yet I couldnt find a single member of the team. I found this extremely worrying for a unit with such highly dependent residents. I had earlier seen five members of the care staff working around the corridors. The numbers and skill mix of staff should be kept under review at all times to meet the changing health, welfare and social needs of people living in the home. The manager should be able to demonstrate that the current needs of residents are considered when deciding the staff complement. This should make sure there are sufficient competent staff on duty to meet the changing needs of people living in the home. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. Training records showed that 11 out of the 17 care staff employed in the home have a National Vocational Qualification in Care (NVQ) in Care at level 2 or above. This should mean that people living in the home are cared for by competent staff. Care Homes for Older People Page 25 of 32 Evidence: A training matrix is maintained and used to record staff training and to identify any gaps in learning. Records demonstrate that all staff complete an induction programme and receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. Care Homes for Older People Page 26 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a competent person and is generally run in the best interests of the people who live there. Evidence: From evidence seen the service is well managed and the manager has the skills, experience and support needed to fulfill her role. The manager, a registered nurse, has applied to us for registration. She was previously the deputy manager at The Priory, taking over the roll as manager in 2008. Staff, people living in the home and visitors said the manager was approachable and regularly spent time on both units. The organisation is seeking to employ a deputy manager to support her in the home. One person commented in their survey, The manager who is overworked requires an assistant. The home has a quality assurance system in place to obtain the views of the residents, relatives and other stakeholders about the service. BUPA conduct annual quality Care Homes for Older People Page 27 of 32 Evidence: assurance audits through its Customer Satisfaction Surveys. The results of the most recent survey underaken had not yet been shared with the manager by the organisation. Regular meetings are held with staff, and minutes from these were seen. The manager said she intends to hold regular residents and relatives meetings. Reports were available for Regulation 26 visits made by the provider to monitor the care and service they provide. The systems in place for keeping peoples money safe remain unchanged since our last visit. Records seen indicate there are sound procedures in place for handing peoples money and personal effects given to them for safe keeping. Based on records seen and from talking to staff it was evident that steps had been taken to provide care staff with regular supervision both in practice and on a one to one basis. A random sample of the maintenance recordes were checked. Safety records seen were up to date and included fire safety, lift service, hoisting and bathing equipment service, gas and electricity. A full time maintenance technician is employed and carries out routine repairs and safety checks. This person also completes routine checks on areas such as hot water temperatures and fire safety equipment. No health and safety hazards were observed on the day of the inspection visit. Care Homes for Older People Page 28 of 32 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 29 of 32 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 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 2 10 12 The manager should monitor staff attitude to ensure that people are treated with respect at all times. Opportunities for people to engage in meaningful and stimulating activity should be reviewed to ensure it is accessible to all people, whatever their needs or abilities. This should enhance the quality of life for people living in the home. The home should re-consider the current dining arrangements and ensure that people are supported at mealtimes in a dignified manner. Food groups should be liquidised separately and served separately so that people can enjoy the taste and texture of individual foods. Arrangements must be made to make sure that all parts of the home are free from unpleasant odours. This is to uphold the dignity of people living in the home, improve infection control and provide a pleasant environment for people. The numbers and skill mix of staff should be kept under review at all times to meet the changing health, welfare and social needs of people living in the home. The manager Page 30 of 32 3 15 4 15 5 26 6 27 Care Homes for Older People should be able to demonstrate that the current needs of residents are considered when deciding the staff complement. This should make sure there are sufficient competent staff on duty to meet the changing needs of people living in the home. Care Homes for Older People Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - 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!