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Preston Private Requires improvement

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Inspection report

Date of Inspection: 30 June 2014
Date of Publication: 9 August 2014
Inspection Report published 09 August 2014 PDF

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Not met this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 30 June 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, talked with commissioners of services and were accompanied by a specialist advisor.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

Where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements.

Reasons for our judgement

The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS provide legal safeguards for people who may be unable to make decisions about their care.

We spoke with staff to check their understanding of MCA and DoLS. Staff demonstrated an awareness of the code of practice and confirmed they had received training in these areas. This meant procedures were in place to enable staff to assess peoples' mental capacity, should there be concerns about their ability to make decisions for themselves, or to support those who lacked capacity to manage risk.

We looked at the care records of ten people who lived at the home. Each of the records showed that people who lived at the home or their representative, had consented to a photograph being taken for care and medication records. There was also a consent form for people to have annual health vaccinations.

It is the home’s policy that people should have a capacity assessment on admission. We found that majority of the records we viewed, did not have a capacity assessment on file.

We found good examples of where capacity assessments had been completed following a change in a person’s care or health needs. For example one person had been reluctant to be treated for a pressure ulcer. A capacity assessment and best interest decision had been taken to ensure the person received an appropriate level of care. This had been recorded in line with the requirements of the MCA code of practice.

However during our visit we were approached by a family member who informed us of their concerns that a decision had been taken by the home without their consent. The family member explained they held a ‘Lasting Power of Attorney’ for care and welfare for their relative. A lasting power of attorney is a legal document which gives a person the legal right to make decisions about a person’s care and welfare where the person in question lacks the mental capacity to make such decisions.

The family member told us, “My relative has been here a long time and they have always had excellent care. We have never had any complaints, until now.” They told us bed wedges had been used as a safety measure to protect their relative from falling out of bed. However a decision had been taken by the provider to remove the bed wedges. The family member told us, “I got a phone call to say my relative had fallen out of bed. This was the first I knew about the wedges being removed. They should have consulted me.” This was a breach of the MCA code of practice.

We spent time in each of the four units of the home. This helped us to observe the daily routines and gain an insight into how people's care and support was managed. We observed staff communicated with people by their preferred method and people were engaged in making choices about their daily routine, for example what time they got up and dressed in the morning. We saw that if people had chosen to stay in their rooms, their wishes were respected.

We looked at care records to review how people’s advanced wishes were being managed by the home. We saw a number of care records included notices which would tell an emergency crew not to attempt to cardiopulmonary resuscitation. These are known as Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. We found one person had a DNACPR form which had not been completed. We asked a senior member of staff to remove the document as it could have been taken accidentally as a DNACPR in an emergency situation. The document was removed immediately.

Another person’s care records held two DNARCPR forms. Neither were completed fully and there was no record of capacity assessments or consultation with relatives. This meant people’s dignity, quality of care and choice could be compromised because best practice was not followed.

We spoke with the registered manager and operations director about our concerns. They confirmed that MCA and best inte