Priory Residential and Nursing Home
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Inspection Report on Priory Residential and Nursing Home THE PRIORY NURSING & CONVALESCENT HOME LLANDOGO MONMOUTH NP25 4TP Date of Publication Friday, 6 March 2019 Welsh Government © Crown copyright 2019. You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] You must reproduce our material accurately and not use it in a misleading context. Description of the service The Priory Residential & Nursing Home is registered to provide nursing and personal care for up to 57 people aged 18 and over. The service is owned by Adriana Limited. The company has nominated an individual to represent the company. The appointed manager is registered with Social Care Wales. Summary of our findings 1. Overall assessment On the whole people told us they were happy with the care and support they received at The Priory. Opportunities to participate in activities are available to people however levels of social interaction and stimulation are variable. Improvements are required in the accuracy of personal plans and daily recording to evidence care and support being provided. Medication practises require strengthening. Infection control measures, hygienic practises and storage of equipment require improvement. Arrangements are in place to monitor and assess the quality of services. However recruitment practises require strengthening and improvements in the frequency of staff supervision, access to training, learning and development to support staff is required. A review of the services statement of purpose, service user guide, policies and procedures is recommended. 2. Improvements This is the first inspection following re-registration with Care Inspectorate Wales under the Regulation and Inspection of Social Care (Wales) Act 2016. 3. Requirements and recommendations Section five of this report sets out our recommendations to improve the service and the areas where the care home is not meeting legal requirements. This includes the following Statement of Purpose and service user guide. Policies and procedures. Recording, handling, safe keeping, safe administration of medications. Staff recruitment, training and supervision. Personal plans and daily recording. Management of the risk of infection. Storage of unused equipment. Staff engagement and interaction. Policies and procedures. 1. Well-being Summary Generally, people we spoke with told us they are happy with the care and support provided by staff. However, improvements are required in the levels and consistency of staff interactions with people. There are opportunities to participate in activities however levels of social interaction and stimulation are variable for people. Our findings People we spoke with and their relatives during our visit were generally happy with the care and support provided by staff. Comments made included; “I like most staff and I like living here, generally it’s good” and “staff are great”. We received five completed questionnaires from people receiving a service and all but one stated staff were caring and they were treated with respect and courtesy. Questionnaires completed by relatives were also on the whole positive with comments such as; “very caring and professional” when asked about the attitude of staff, however other comments made included; “accept the level of work care staff are under but it would be good if they had more time just to sit and talk to residents” and “staff are very friendly and helpful even when they have been understaffed”. During our visit we saw staff interactions with people were predominantly task orientated. People appeared to be spending long periods of time with limited interaction from staff. Staff did not always have the time to respond to people promptly and people’s attempts at communication were not always acknowledged. We observed some positive interactions, such as staff addressing people by their preferred names and making appropriate use of touch to help reassure them. We also observed good interactions when people received assistance with moving and transferring, whereby staff explained what they were doing and provided reassurance. On the other hand, there were occasions where there was limited interaction, and significant periods of time with no staff presence. For example, we heard a person calling out for help from their room on the floor above and we had to locate a member of staff to alert them. Additionally, we spoke with one person in their room midmorning who stated “I would just like to have a cup of tea and some breakfast, staff came in and said she would be back but she hasn’t”. Throughout our visit we saw that the main lounge was regularly left unattended and people appeared bored with several people sleeping. Additionally, during the lunchtime period, we observed limited staff interaction with abler people as staff were busy delivering meals to people who remained in their rooms and assisting people who needed more support. One person was clearly agitated and anxious to leave the dining room and requested to leave several times, some staff were seen reassuring and persuading the person to remain in the dining area. However, other staff ignored the person and walked passed with no interaction, as the person’s agitation increased we observed negative impact on other people seated at the dining table. We were told by staff this was “normal behaviour” and staff wanted to actively encourage the person to engage in the dining experience in part due to concerns that the individual was at risk of malnutrition. Feedback we obtained from staff suggested that whilst they generally considered there were enough staff, there were often challenges in arranging cover when people called in to report sickness absences at short notice. On the day of our visit we were told “I feel we could do with more care staff, today we are running one short” and another member of staff stated “some days we are short and can be two staff down”. We therefore find that whilst some people may be uplifted with staff interactions, we conclude that this may not be the case for everyone all of the time. Improvements are required to ensure people receive the right care at the right time in the way they want it. Generally, people are provided with opportunities to participate in social and recreational activities. A programme of activities was in place, an enthusiastic activity co-ordinator was employed who demonstrated comprehensive knowledge of people receiving a service, their likes and dislikes and how to get people to actively engage. Activities included games, singing, quizzes, movie matinee’s, a recent visit from children attending the local nursery and we noted themed events had been scheduled for example a forthcoming ‘Robbie Burn’s night’. Relatives and visitors we spoke with were very complimentary about the activity co-ordinator “activities are varied and interesting and delivered with real enthusiasm”. However, in the co-ordinators absence people cannot rely on staff recognising when they were bored or lonely. We found there are opportunities for engagement in social and recreational activities, however the level of stimulation people receive is variable. 2. Care and Support Summary An electronic care documentation system is in use, however improvements are required in the development of personal plans and the accuracy of documentation to evidence person centred care and support being provided. On the whole people’s rights are understood and promoted however, improvements are required in the oversight. Medication practises require strengthening in order to safeguard people and prevent poor health and wellbeing outcomes. Staff encourage people to be as healthy and active as possible, and to eat healthy nutritional food however improvements are required in the recording and oversight of this to prevent poor health outcomes. Our findings People cannot be confident they will consistently receive appropriate person centred care. We viewed six people’s care documentation. We found inconsistent and contradictory information on the electronic care system. For example, information contained in people’s assessment of needs did not correspond with information contained in personal plans. We noted one person on respite care did not have any personal information recorded, an assessment had been completed but no corresponding personal plan was in place. Another person was assessed as “unable to move independently” and we found no associated pressure care or moving and transferring risk assessment for this person. Overall we noted a lack of comprehensive risk management information for care staff to follow. For example, people requiring assistance with mobilising did not have comprehensive guidance for staff to follow ensuring safe moving and transferring of people, as required in the services ‘Managing of the Environment, Moving and Handling’ policy and procedure. Also daily recording kept within individual rooms we examined were inconsistent and contained regular gaps in the recording of care provided. We saw monthly reviews of assessed needs for each person were undertaken, however as mentioned above these were not transferred into personal plans. Care staff did not have access to comprehensive documentation providing