Archived: Prestwood House

Prestwood House is a residential care home providing personal and nursing care to 37 people at the time of the inspection. The service can support up to 59 people across three floors, each of which has separate facilities. Some of the people at Prestwood House are living with dementia.

People’s experience of using this service and what we found

We found a number of improvements had been made since the last inspection. People now received safe care when they were supported with their mobility and assessments of people's capacity were now recorded. The provider had also improved their complaints process and some improvements had been made to the home environment. However, we identified further improvements were still required.

Improvements were required to the standard of documentation and care records. We found some care planning documents and risk assessments were generic in nature and required updating to ensure they reflected people’s individual needs. People’s fluid intake had not been consistently monitored to ensure people were not exposed to health risks. Although some aspects of the home environment had improved since the last inspection, further work was required.

People told us they felt safe and staff knew how to identify and report concerns relating to people’s safety. Risks were assessed and managed to reduce the risk of avoidable harm. People received support to take their medicines safely. There were enough staff available to meet people’s needs. Staff were safely recruited.

People were asked for their consent before care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s needs were assessed and documented to ensure they received consistent support from a trained staff team. People received sufficient amounts to eat and drink to maintain their health. Staff received training relevant to their role and understood people’s individual needs well. Some improvements were required to the home environment.

People were supported by a caring staff team who knew people well. People were supported to maintain their independence where possible and their dignity was valued and respected. People were encouraged to make daily living decisions and staff supported them to make their own choices.

People were supported by a staff team who knew them well and understood their needs and preferences. People and their relatives were involved in the assessment and planning of their care. People were supported to participate in activities and follow their own interests. People knew how to raise a concern if they were unhappy about the service they received.

People, relatives and staff felt the service was well managed. The manager and provider had made improvements since the last inspection. People and staff were given opportunities to share feedback about the service. The manager undertook regular auditing to ensure the quality of care provided. Staff worked well with other partner agencies to ensure people’s needs were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 18 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Prestwood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Prestwood House is registered to accommodate 59 people in one building. Some of the people living in the home are living with dementia. At the time of our inspection 40 people were living at the home. Prestwood House accommodates people in one building and support is provided on three floors. There are a variety of communal areas that people can access.

There is a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Some people were placed at an increased risk as we saw poor moving and handling during our inspection. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Improvements were needed to the environment to support people living with dementia.

The actions plan the home had in place did not identify all areas of improvements. Improvements were needed to how complaints were responded to. We found concerns with some information including how pressure management was documented within the home. There were no systems in place to review documentation in the home however the provider had identified this as an area of improvements.

We found people were happy with the care they received. They were supported in a kind and caring way by staff that were trained and new them well. New staff had the opportunity to participate in an induction which they enjoyed. Staffs suitability to work within the home was checked by the provider. People’s privacy and dignity was maintained and people were supported to remain independent and make their own choices. Friends and visitors felt welcomed by staff and were free to visit at any time.

Risks to people were considered and reviewed and this included the environment and equipment. There were enough staff available to offer support to people and they had received training and were aware of procedures to protect people from potential harm. Staff were also aware of whistleblowing procedures and were confident to follow this if needed. They felt supported and listened to by the home manager.

Medicines were managed in a safe way. The home was clean and well maintained and infection control procedures were in place and followed. The home worked alongside health professionals and when needed referral and support was provided. People enjoyed the food and were offered a choice. People also had the opportunity to participate in activities they enjoyed.

Audits were taking place and information was used to make improvements within the home. The provider sought feedback from people and relatives. We were notified of significant events and the provider was displaying their rating.

Prestwood house provides residential and nursing care for older people some who maybe living with dementia. The service was registered to provide accommodation for up to 59 people. At the time of our inspection 37 people were using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not always involved with reviewing their care and did not always receive personalised care that was in line with their preferences. We found people’s care needs were not always recorded correctly to ensure the correct action was taken.

People felt safe and were supported by staff that had an induction and training that helped them support people. Equipment was maintained and tested to ensure it was safe for people to use. When risks to individuals were identified we found staff knew about these and they were managed to keep people safe. Medicines were stored, administered and recorded in a way to keep people safe from the risks associated to them. There were enough staff available to support people.

We found staff understood the importance of gaining consent from people and when needed people’s capacity had been assessed. When people were unable to make decisions these had been considered and made in people’s best interests.

People had access to health professionals and referrals were made on behalf of people when needed. Staff were kind and caring towards people. People knew how to complain and felt confident complaints would be dealt with.

People enjoyed the food and the choices that were available to them. People made decisions about how to spend their day and felt they were treated in a dignified way. People’s privacy was upheld and they were happy with the activities that were available for them to participate in. Relatives were free to visit anytime and they felt welcomed by staff.

Quality monitoring was completed by the provider and was used to make improvements to the home. The opinions of people who used the service were sought and this information used to bring about changes. Staff felt supported and were given the opportunity to raise concerns. People told us the home was well managed and the provider understood their responsibly around registration with us.

At the time of the inspection there were 38 people living at the home. During this inspection we spoke with people who lived at the home, visitors, staff members and the registered manager. The people we spoke with on the day of the inspection were generally complimentary about the staff and the care provided.

Improvements to documentation were evident and systems were in place for monitoring care delivery. However we did not find that the delivery of care always reflected the care planning and risk assessments which were identified during the assessment of individual care needs. This is particularly important as occasionally the home employed agency staff to support people with their care and welfare.

We involve people in our inspections that have knowledge and experience of using social care services; we call them experts by experience. During the inspection, together with the expert by experience, we spoke with people living at the home, visitors to the service, staff members and the manager.

We asked people living at the home if they were treated with dignity and respect. One person told us: 'When people come to get me up they knock on the door and wait until I shout them to come in'. Another person said: 'When staff are washing me they are courteous asking me if I'm alright and what do I want doing'.

The care planning, risk assessments and documentation in relation to people's care needs did not give sufficient information and detail to ensure care was being delivered in a safe and consistent manner.

We saw that people who used the service were provided with a choice of suitable and nutritious food and drink. People we spoke with said the food was good and choices of meals were available. One person said: 'Staff always ask me what I would like to eat'.

We looked at how medicines were managed in the home. We found systems were in place for storing, recording and handling medicines.

There was an effective complaints system available to enable people to raise concerns.

On the day of the visit there were 41 living at the home. We observed that staff were courteous and polite and treated people with dignity and respect. The staff we spoke with were knowledgeable about the care requirements for people. Plans of care for people were available and the information was reviewed monthly.

We asked staff about their understanding of safeguarding (protecting vulnerable adults). The staff we spoke with said they had received training as part of their mandatory training programme and were able to tell us how they would report concerns.

The home had a robust induction programme to ensure all new staff employed at the home were supported within their role. Staff told us they had training provided by the home and had one to one meetings with the manager.

There was a process for the on going quality monitoring of the service provided at Prestwood House. The current systems were being reviewed and updated to ensure the organisation continued to gather feedback on the quality of the service it provided.