Inspection on 16/09/08 for Werrington Lodge

This is the latest available inspection report for this service, carried out on 16th September 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Werrington Lodge Baron Court Werrington Meadows Peterborough PE4 7ZE Lead Inspector Elaine Boismier Unannounced Inspection 16th September 2008 09:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Werrington Lodge Address Baron Court Werrington Meadows Peterborough PE4 7ZE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01733 324252 01733 321717 www.barchester.com Barchester Healthcare Homes Ltd Shelagh Kathleen Simpson Care Home 82 Category(ies) of Dementia (82), Mental disorder, excluding registration, with number learning disability or dementia (82), Old age, of places not falling within any other category (82), Physical disability (82) Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 Dementia - Code DE Mental Disorder, excluding learning disability or dementia - Code MD Physical Disability - Code PD The maximum number of service users who can be accommodated is: 82 NONE 2. Date of last inspection Brief Description of the Service: Werrington Lodge, owned by Barchester Healthcare Homes Limited, is a care home, registered to provide up to 82 places for people assessed to have personal care, including nursing care needs and some of who may have mental health care needs. The majority of people who live at the home are over 65 years of age. The home, situated approximately four miles from the city centre of Peterborough, is a single storey, purpose built home divided into three units; two of these are for people with mental health needs the other is for people with a physical disability. Enclosed gardens are to the rear of the building. A mini-bus is available for transport purposes. Current fees range from £516.39 to £900. Further information about fees can be obtained from the home. A copy of the inspection report is available on request from the home or via our website at www.csci.org.uk Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We have assessed this quality rating to be 2 star as we have confidence that action will be taken by the management of the home in response to our findings of the inspection. Last key unannounced inspection-October 2006 Since our last inspection of the home in October 2006 the home has had a change of registered owner and therefore any requirements made, for the then registered owner to take action, can no longer be considered in this inspection of September 2008. Annual Service Review-October 2007 In October 2007 we carried out an annual service review (ASR) of the home. We were satisfied with the information that we had received and we concluded that the people who lived at the home, during the time we carried out the ASR, were receiving good quality and safe care. Key unannounced inspection-September 2008 We, The Commission for Social Care Inspection, carried out this inspection, between 9:00 and 15:30, by two Inspectors, taking 6 hours to complete. We spoke with some of the people, some visitors to the home, some of the staff, including the Deputy Manager, and we observed activities in the home, including staff working. We also looked at documentation and had a look around the premises. Some of the people living at Werrington Lodge are not able to say what it is like living there so an Inspector spent two hours observing and recording the experience of some of the people using the service. This inspection activity is called the short observational framework for inspection (SOFI). Before the inspection we received some surveys back from visitors/relatives and staff although we did not receive any surveys that we had sent out, from people who live at the home. We also received, before the inspection, an Annual Quality Assurance Assessment (AQAA) completed by the Manager. We have also looked at information about the home since the ASR and some of the information from these sources has been referred to in this inspection report. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 6 For the purpose of the report people who live at Werrington Lodge are referred to as “people”, “person” or “resident/s”. What the service does well: What has improved since the last inspection? What they could do better: Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 7 Care plan documentation needs to be person centred, accurately reflect the assessed needs of the person, care carried out in accordance to the care plan and the care plan is drawn up in consultation with the person, whenever possible to do so. We expect the home to manage this rather than we make a requirement on this occasion. Care records i.e. repositioning charts and personal care records should be clear and accurate to demonstrate when care has been provided. The recording and safe storage of medication must be better to ensure the safety of the residents. We expect the home to manage this rather than we make a requirement on this occasion. Individual assessed needs of people should be considered more, when helping people with their food and drink. Full and satisfactory information about staff must be obtained before the person is allowed to work at the home. We expect the home to manage this rather than we make a requirement on this occasion. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. There are good systems in place to ensure the home can meet the needs of prospective residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA told us “Pre-admission information from Hospital staff is not always accurate” but “Comprehensive pre-admission assessments are undertaken to ensure that the Home is able to meet individual Residents’ needs. Information is made available on the Unit prior to admission.” Examination of some of the people’s care records indicated that a preadmission assessment had been carried out by the home before the person moved in. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. People are safe as they receive generally a good standard of healthcare although the quality of personal care and support could be better. Medication and care records also could be better to ensure people receive person centred and safer care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined a number of care records and compared our findings with observation and discussion with the staff and with some of the people. Evidence suggests that the care plans are sufficient in detail although there were some discrepancies: one person was provided with assistance to change their position in bed, to relieve pressure, although this guidance was not included in the care plan; for another person there was no guidance for staff in how to interact with a person with mental health needs when they were showing physical signs that they wished to be left alone and, following Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 11 discussion with a person, we found their care plan for bowel care was inaccurate. We found the care records were not person centred. The Deputy Manager informed us that this has been recognised by Barchester Healthcare and training and action is in progress to improve this area. Discussion with people indicated that they were unaware of their care plan and considered that there was not active consultation with them about their health and social care needs. We showed one person their care file and they said that they had never seen this file before. The 5 surveys we received from relatives told us that the person considered the home gave the support or care to, and always/usually met the needs of the resident they were linked with. One of these surveys said, “The care home is hands on they couldn’t do enough, it is definitely a place I would recommend to anyone who needed looking after.” Another of these surveys said that the home does well because “All care, attention and everything else is excellent.” The AQAA told us how people access external healthcare professionals because there are “Established links with external agencies e.g. Continence Advisor, Tissue Viability Specialist Nurse, MacMillan Nurse…Visits by professional Health Support e.g. Optician, Chiropodist.” Examination of people’s care records confirmed that people have access to a wide range of healthcare professionals, as detailed in the AQAA. In addition we noted that in one of the people’s care records that they had visited a dentist. In October 2007 we received a formal notification to tell us that there had been an outbreak of diarrhoea and vomiting amongst some of the residents and action had been taken, by the home and the GP in contacting the public health infection control nurse. In May 2008 we received information from an external agency telling us how a person admitted to the home with pressure sores was being cared for and “Werrington Lodge have noted the wounds, reported these, continued to seek advice from the tissue viability nurse and dressed the wounds …” We examined this person’s care records and spoke with the person: evidence suggests that the person has received a good standard of healthcare and that their deep pressure sores were actively healing. According to the AQAA 10 people have acquired a pressure sore whilst living at the home. We sought clarification on this number and we were told that within the last 12 months, 6 people have actually required pressure sores whilst living at the home. Of these 6 people there is evidence that action has been taken to Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 12 monitor and treat their pressure sores, to include dressings, ongoing assessments and the provision of pressure-relieving equipment. Repositioning charts were also introduced although the standard of the recording of these was variable in the two units we visited: in the dementia care unit the repositioning chart demonstrated that the person had a change of their position every 2 to 3 hours whereas the other person, living on the nursing unit, had assistance to change their position up to an interval of 6 hours. The record provided poor evidence of how this person was lying in bed when the record said “back to bed”. In addition there was one entry that was undecipherable to read, due to the standard of writing. We observed the person lying in their bed although the repositioning chart was not updated to accurately reflect that they had their position changed since the last entry. We expect the home to improve the standard of the record keeping, rather than we make a requirement on this occasion. Comparing information in the care records with the care provided, there was not always sufficient evidence to suggest the care plan was followed: for example a person’s care records said that the person was to be helped with going to the toilet every two hours: this care was not provided and the person required assistance following two episodes of becoming incontinent of urine; for another person their care plan stated that the person was to be offered a shower or bath daily although the person said that they could not recall when they were offered such care. We looked at the personal care records for another person and the records last entry indicated that the person had a shower on the 30th August 2008 and none since. They said that wanted to have a shower most days, although this was not offered to them. The Deputy Manager disputed this finding as she considered this might be an issue with the standard of record keeping. We expect the home to take action to improve the standard of record keeping rather than we make a requirement on this occasion, as we found the standard of people’s personal care was generally of an acceptable level. The SOFI observation indicated that one of the members of staff provided a good standard of interaction with the residents in an inclusive manner by involving a number of residents in conversation. It was noted for some other members of staff that opportunities to interact with people in an inclusive and warm manner were lost. For example we saw a resident speaking to a member of staff ,who was at the time, walking by the resident- the person was ignored; out of 24 episodes another person had 15 episodes only of interaction with staff; when people were given their food or a drink there was limited engagement for at least one person who sat alone at the breakfast table; the staff were seen to remove the crockery and then the table cloth with no word to the resident sitting there. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 13 On the nursing unit we observed staff talking to a person, when they were being helped with their breakfast and there was a good social interaction from the staff to the person. During a telephone call to the home, the day after our inspection, the Deputy Manager told us that staff were aware of our SOFI observation and that they felt under the “spot-light”. The staff felt that they were unable to respond in a warm, inclusive and spontaneous manner because of this feeling. Whilst we recognise that this could be the case we observed, when staff were not aware of our observation, of a member of staff ignoring a resident when walking by them, as detailed above. We looked at the storage, stock levels and medication records on the nursing unit and observed one of the medication administration rounds on the dementia care unit. The storage of medication on the nursing unit was satisfactory; temperatures of the room and the drug fridge were recorded daily and these were within the acceptable limits. Staff told us that there had been some difficulty with a local dispensing pharmacy as the amount of medication dispensed was less than prescribed. We were told, and records showed that, the person was without their prescribed medication for 3 consecutive days. The member of staff told us that the management of the home was aware of this issue. Other than this we found that stock levels were satisfactory, indicating that there is a control of medication coming into the home. The controlled drug register was satisfactory as it had the name and address of the dispensing pharmacy. Controlled drug medication was counted and the amount reconciled with the recorded balance. There was a record of medication audits, including the twice daily checking of the controlled drugs that were currently in use. For one of the residents the medication administration records (MARs) were confusing as these were in duplicate. A member of staff explained that the (blank) printed MARs would be used for the next cycle of medication, although the dates on this blank record correlated with the current cycle. There were some omissions in people’s MARS where creams and emollients had been prescribed, such as dermol lotion and epaderm emollient. In addition there was no record of when a person had been offered their prescribed food supplements. A record for the giving of alendronic acid indicated that this was given at the same time as the other medication although the manufacturer’s instructions state that this medication should be administered prior to any food or other medication is given and not within 30 minutes. We spoke with a member of staff who had given this medication and they told us, without solicitation, that they gave this medication, 30 minutes before the other medication was given, although this was not evident within the MARs. The records of medication must be maintained to an acceptable and legal standard. We expect the home to manage this issue, rather than we make a Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 14 requirement on this occasion. Medication administration and recording procedures were observed on the dementia care unit. Medication was administered to people in a hygienic, dignified and sensitive manner and MARs were recorded following the administration of the medication. The medication trolley was left unattended, on 4 separate occasions whilst it was unlocked and unobserved by other members of staff. We noted that some of the residents were walking around within the area where the unattended and unlocked trolley was left. According to the Deputy Manager there is no current resident able to take their own medication. We asked a resident if they had been asked if they wanted to take their own medication as part of a self-care task; the person said that no member of staff had asked them this question. We expect the home to consider people’s choice, in a person centred way and based within the framework of risk assessment. We saw staff knock on people’s doors before they entered and we noted people were spoken to in a respectful manner. Both residents and visitors we spoke with had praise for the staff, telling us that the staff were “very good”. For some of the residents they had access to a telephone in their own room. We observed however that this was not always the case: a resident was holding a private telephone conversation by the staff workstation, which was in public view. The staff told us that the Manager is making arrangements for people to have access to a hands free telephone set, to improve such situations that we observed. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is good. People have opportunities to live generally a good quality of life although there are some areas that this could be better. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA said that within the last 12 months the home has improved because of “Changes to Activities based on feedback”. One of the relatives’ surveys said that the home does well because it “Arranges events and trips on a reasonably regular basis, to try and cater for a diverse range of needs and abilities.” We saw photographs on display in the main foyer of the home and these were of a trip to a butterfly farm and entertainment provided by visiting musicians. One person we spoke with told us about their art interests and how they had been encouraged, and enabled, to continue with this interest. Their care records also demonstrated the home’s activities with this person. The 4 of the 5 relatives’ surveys that had been completed told us that the home allows the residents to live the life they chose. People we spoke with Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 16 considered that they had to “fit” in with the routine of the home, such as when they got up out of bed. We asked people, who needed help with their personal care, if they were able to choose their clothes, but they were unable to tell us, due to their mental health condition. We saw and spoke with residents’ guests and they told us that they visited as many times as they wished to. Care records, and discussion with the staff, indicated that people have contact with their families and friends. The AQAA said that there have been “Changes to dining experience. Only fresh produce is used”. People we spoke with said that the food was good and there was a choice. We saw people were offered toast, cereal, and a cooked breakfast. The two week menu that we saw indicated that there is a variety of menu including choices of a main meal and deserts. On the dementia care unit a person had a care plan that noted on the 18th August 2008, the person was having difficulty feeding them self. The care plan guidance was for staff to sit near the person and assist them with their food. No member of staff was seen to sit with the person on a 1:1 individual basis when assisting them to eat. Some staff went off with no explanation and a different carer came and sat with the person awhile later, to continue with assisting the person with their meal. On the nursing unit we saw people were assisted with their food, in their own rooms, with 1:1 attention and the staff were sitting down, on the level of the person they were helping. For one person’s care records it was noted that the person was to be provided with finger foods between meals although none of these were made available to them. On the dementia care unit we saw that during the mid morning people were given, and had drunk, their drinks before they were given a biscuit (none was available on the unit at the same time as the drinks were offered). It was noted that due to this people were eating dry biscuits and having difficulty in doing so. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. People are listened to and are safe from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since our Annual Service Review of Werrington Lodge, in October 2007, we have received no complaints about the home. The AQAA told us that within the last 12 months there have been 5 complaints made against the home; all of these complaints were responded to within the required 28-day time period and none of these complaints were proven. We saw the record of complaints and this was satisfactory. Four of the 5 surveys from relatives told us that the person knew how to make a complaint and of those surveys that were completed the person was satisfied with the home’s response to any concerns that they had made known. All of the 5 surveys from staff said that the person knew what to do if any person visiting, or living at, the home, had concerns about the place. We spoke with some of the residents and some of the staff and we were informed that there is knowledge of the complaints procedure. Since October 2007 we have received notification of three safeguarding alerts and we were satisfied that the home followed correct reporting procedures to ensure that the risk of abuse was reduced. The AQAA told us that of the 4 Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 18 safeguarding referrals made only one has resulted in a safeguarding investigation. (Safeguarding was previously referred to as protection of vulnerable adults against abuse or POVA). We asked some of the staff what they would do if they witnessed or suspected abuse against a resident and we were satisfied that the staff were aware of the correct safeguarding procedures. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. People live in a well maintained, safe and clean home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since our last inspection of the home, in 2006, there has been a reconfiguration of the building to increase the number of places for people with mental health needs and for the provision of care for people with such conditions to be divided into two units. Which unit they live in is based on the person’s abilities and level of needs. In a copy of a report, from a representative of Barchester Healthcare, dated January 2008, we read “Head of dementia care considered that reconfiguration of dementia care unit has “provided improvements to quality of care for residents with a sensory unit and memory lane for more active residents”. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 20 The AQAA said that the home has “Developed a sensory lounge for Residents in later stages of Dementia” and we found this to be the case. We also found that there has been an improvement in the sensory aids on the walls of the dementia care unit and ornaments, stylish furniture, old pieces of equipment such as a typewriter and a sewing machine. The enclosed garden was provided with pictures/designs of butterflies and the flowerbeds and lawns were reasonably maintained. We saw a person sitting in this garden, with their guests whilst (seemingly) enjoying smoking a cigarette. On first entry to the dementia care unit we noted a smell of urine. However, due to the standard of cleaning practices this smell had cleared by the early afternoon. Other areas of the home were clean and fresh smelling. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. People can be confident that they receive care from well trained and generally well recruited staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the relative’s surveys said, “Everyone in the home is very helpful and professional.” Four of the 5 staff surveys said that there was always/usually enough staff on duty to meet the needs of the people; the remaining staff survey said that “sometimes” there was a sufficient number of staff on duty. One of these surveys said, “If there is any shortage due to illness etc staff know how to cover to ensure (the) smooth running of (the) unit and provide care.” Staff we spoke with considered that there was always enough staff on duty to meet the needs of the people. People we spoke with considered that this was not always the case. We discussed this issue with the Deputy Manager and we considered that although there are enough staff on duty it might be the organisation of how staff work. This would include, for example providing 1:1 attention at meal times; offering showers/baths according to people’s choices. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 22 We found the atmosphere of the home to be friendly and happy and this was also recorded in the reports, from a representative of Barchester Healthcare, for June and August 2008:”There is a good team spirit” and “Staff morale is high….Good team work was evident.” The staff we spoke with said that they enjoyed working at the home. The AQAA told us that within the last 12 months 6 full time care/nursing staff and 6 care/nursing part time staff have left their employment. According to the AQAA there are 44 care staff working at the home and there are 21 of these with a National Vocational Qualification (NVQ) level 2, or above, in care i.e. 47.7 with other care staff working towards this NVQ certification. Information provided by the Deputy Manager indicated that some of the staff working towards the NVQ level 2 in care have a nursing qualification, acquired before the member of staff started working at Werrington Lodge, as a member of care staff. Therefore the home has above 50 of care staff with NVQ level 2, or equivalent, in care. Three staff recruitment files were examined and full and satisfactory information was available in two of the three files. For the third file there was a reference from a friend (such a reference poses a risk of subjectivity) and for the second reference there was no information provided about the suitability/experience/ skills/attitude of the person. In addition there was an unexplained gap in employment history between December 2006 and March 2007. We expect the home to manage this issue, rather than we make a requirement on this occasion. The surveys from relatives of residents said that the staff had the right skills and experience to look after people properly. The AQAA informed us that 100 of care /nursing staff have attended training in preventing and managing infection and staff we spoke with confirmed that they had attended such training. Other staff training attended included customer care, care of people with dementia, dealing with challenging behaviour, care of a person with difficulties with continence and administration of medication. The 5 surveys we received from staff told us that the staff considered the induction training covered everything very well/mostly for the person to do the job when they started and had received relevant and ongoing training to be able to meet the needs of the people they were looking after. Within the staff surveys we were told the home does well because “People are given opportunities to develop themselves through learning & development” and “Excellent learning programmes for staff.” Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. People benefit from a well managed and generally safe home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the staff training records indicated that the Registered Manager has attended refresher training in administration of medication and fire safety. We have received required notifications of any untoward incidents, such as outbreak of infection and of any person admitted to the home with deep pressure sores. On the day of the inspection the Registered Manager was on leave and the Deputy Manager was managing the home. The running of the home, in the absence of the Registered Manager, was smooth and this is also indicative of the standard of the management of the home. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 24 The AQAA was completed in a satisfactory manner and it told us what the home does well in, what areas have improved within the last 12 months and areas that the home intends to improve in. The AQAA told us that the management team of the home “Undertake monthly audits as directed by Director of Care & Quality”. We saw that audits are carried out for medication and people with pressure sores. We saw the daily kitchen audit for the kitchen that includes cleaning routines and the delivery and storage of food and according to the Deputy Manager there other audits, including a recent one with regards to care plans, by one of the Barchester Healthcare clinical development nurse. The home does not currently hold any resident’s personal monies for safekeeping. According to the AQAA 100 of catering staff and 100 of care staff have attended training in safe food handling. The AQAA also told us that safety checks are in date for portable electrical equipment, hoists and fire detection and fire fighting equipment and the records for this confirmed what the AQAA told us. Checks for emergency lighting, fire alarms and temperatures of hot water accessed in baths and from showers were satisfactory. In response to a report of an inspection, carried out in February 2008 by the environmental health officer, the Deputy Manager informed us that two food refrigerators have been replaced. Records for staff training in fire drills and moving and handling were seen and the majority of staff have attended this training within the last 6 months. According to the Deputy Manager the home’s policy is that staff should attend such refresher training every 6 months. We were told that where staff have not attended this training, within such a period of time, action is in progress to make sure all the staff have up-to date refresher training. Staff we spoke with said that they had attended training in fire safety and moving and handling and we saw that staff used the appropriate equipment and safe techniques when helping a person to transfer. Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x N/A x x 3 Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Werrington Lodge DS0000069322.V371126.R01.S.doc Version 5.2 Page 28 - 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!