Inspection on 24/02/09 for Wilsmere House

This is the latest available inspection report for this service, carried out on 24th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Wilsmere House Wilsmere Drive Harrow Weald Middx HA3 6BJ two star good service The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ram Sooriah Date: 2 4 0 2 2 0 0 9 Information about the care home Name of care home: Address: Wilsmere House Wilsmere Drive Harrow Weald Middx HA3 6BJ 02084207337 02084207496 diana.parry@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 94 Number of places (if applicable): Under 65 Over 65 94 0 old age, not falling within any other category physical disability Conditions of registration: 0 94 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 Physical disability - Code PD The maximum number of service users who can be accommodated is: 94 Date of last inspection Brief description of the care home Wilsmere House is owned and operated by Barchester Healthcare, a national provider of care homes across the country. It is situated in a quiet cul-de-sac in a residential area of Harrow Weald. It is accessible by car and there is a large car park for in excess of twenty cars in the grounds of the home. Buses served the Uxbridge Road which is about ten minutes walk away. Underground and railway links are an approximate tenminute bus ride away. The home is located in pleasant grounds with lawns on the side Care Homes for Older People Page 2 of 13 Brief description of the care home and the back. The home itself is a large detached building spread over three floors: the basement, ground and first floors. Residents are accommodated in four units. There are two units on the ground floor and two units on the first floor. Each unit is run semiindependently with its own team of staff, a kitchenette and communal areas. There is a physiotherapy room on the ground floor in one of the units, and a computer training room in another unit. The kitchen, laundry, hotel managers office and psychologists office are located in the basement. Access to each floor is via lifts and stairs. Bedrooms are mostly single and en-suite. They are of varying sizes. There are a few double bedrooms but these are currently used mostly as single rooms. Showers and bathrooms are for communal use. The home accommodates a majority of younger adults with some older people. The younger adults are admitted with a variety of needs as a result of neurological conditions and brain and spinal injuries. To meet their needs the home benefits from a multi-disciplinary team, which consists of a physiotherapist, occupational therapist, dietician and a psychologist. The registered manager is Diana Parry. The fees range from 1100 to 3200 pounds weekly depending on the complexity and level of residents needs. There were 81 residents in the home during the inspection. Care Homes for Older People Page 3 of 13 What we found: This report contains the findings of a random inspection that took place on the 24th February 2009 from about 10:15 to about 16:45. The inspection was carried out by Claire Henderson Roe and Ram Sooriah, both regulation inspectors. We last inspected the home on the 31st January 2008 when the home was rated good. We carried out this random inspection to look at issues around care planning, the management of medicines, staffing levels and to check for compliance with an action plan that has been drawn up by the home, to address some shortfalls that had been identified following a safeguarding adult investigation by Harrow Social Services. As part of the inspection we looked at the care records of a sample of residents, inspected the management of medication in wings 1 and 2, talked to at least six residents and eight members of staff. We were also able to speak with the registered manager of the home and the operations manager. We would like to thank all residents who talked to us to tell us about their experiences of living in the home and the manager and all her staff for their support and cooperation during the inspection. PERSONAL AND HEALTHCARE. Toward the end of last year concerns were raised by social care practitioners about care planning. The concerns were whether care plans reflected the needs of residents, were detailed enough and updated when required, and written/reviewed with the involvement of residents or of their representatives. We found that care plans were in place for all identified needs of residents. Risk assessments had been carried out for falls and for all other identified areas of risk, for example, when residents are unable to use call bell and when residents are at risk of choking and aspiration. There was evidence of care documentation being reviewed monthly and that on the whole this was kept updated with the changing needs of residents. However, for one resident who had returned from hospital, the majority of the documentation had still not been updated 12 days after their return to the home. For another resident who had returned from hospital, the documentation had been updated within 24 hours. Evidence of input from residents or their representatives was seen in the majority of care plans that were inspected. Among the care records that were sampled, one residents risk assessment documentation had not been signed by the resident or their representative. We were informed that this would be addressed as soon as possible. On another occasion a resident was identified with a need with regards to communication. Their care plan did not fully address this need. The deputy manager said that she would explore what could be done to address this. We noted that pre-use checklists were completed prior to the use of bed rails and that monthly inspections were carried out and documented to make sure that the use of bed rails remain safe for the individual resident. We viewed wound care documentation. This was thorough and clearly identified each Care Homes for Older People Page 4 of 13 wound and the dressing regime to be followed as well as the progress of each wound. Pressure sore risk assessments had been carried out and the type of pressure relieving mattress in use for each resident is recorded in their care plan. There was evidence of input from the Tissue Viability Nurse Specialist. Continence assessments had been carried out and records were maintained when any relevant procedures were carried out for example, the changing of a catheter. Moving and handling assessments clearly identified the specific equipment to use for each resident. Nutritional assessments were carried out and clear documentation was in place for each residents nutritional needs, to include specialist needs such as for those who receive their nutrition via a percutaneous endoscopic gastrostomy (PEG) tube. There is a record kept of when the PEG tube was changed. If medications are administered via the PEG tube, then a risk assessment for this is in place, which clearly identifies that the medication and method of administration have been fully discussed and agreed. The assessment is signed by both the GP and the dispensing pharmacist. In one instance there appeared to be a marked change in a residents weight within a 2 day period. This was reviewed at the time of inspection and an up to date weight recording made. Appropriate equipment for checking each residents weight is available. The home has contracted input from the dieticians, physiotherapists and GP services. Healthcare professionals spoken with during the inspection, expressed their satisfaction with the way that the staff manage the residents often complex healthcare needs. We also noted that members of the multi-disciplinary team were involved in the care planning process to ensure continuity and consistency of care. We were pleased to note progress in this area. Residents cultural care needs were clearly recorded in their care records. For example, gender issues about care and dietary needs were addressed. There had been a concern recently as to whether a residents cultural needs with regards to their diet were being met. We found that this concern had been addressed and that the resident was on the whole pleased with the meals that they were receiving in the home at the time of the inspection. Part of the action plan of the home includes the auditing of care plans to make sure that these were comprehensive and up to date. We found that a thorough audit had recently been carried out on the care records of several residents and prompt action had been taken to update the documentation and address the shortfalls, where these were identified. MANAGEMENT OF MEDICINES. We carried a brief inspection of the management of medicines on wing 1 and 2 by sampling the medicines administration records (MAR) charts and checking some medicines at random. We found that the amount of medicines were appropriately recorded when received in the home and that on most occasions there were no empty spaces to suggest that staff had not sign the medicines charts or recorded a code if a medicine had not been given. One resident however, who was on a liquid medicine had empty spaces in their MAR chart and the amount of medicine left in the bottle and the date of opening of the bottle suggested that the resident had not always been getting that medicine. Care Homes for Older People Page 5 of 13 Controlled medicines in the home were appropriately managed with all records kept as required. Those residents who were on rectal diazepam because they have epilepsy had protocols in place to manage epileptic seizures. The protocols had been agreed by the GP. We found that items of equipment to be used in an emergency were not always prepared and ready to be used. For example suction equipment did not have tubing and catheters attached and the batteries were not charged. Staff were not also quite sure where to get the equipment if that was required in an emergency and what equipment to use for the ventilation of someone who was not breathing. STAFFING. There has been concerns about staffing levels in the home a few months prior to the inspection. The situation had been complicated by the number of vacant care staff posts and the number of nursing staff that were on leave. There were 19 care assistants vacancies in November. Since then there has been significant progress in this area as there were only 5 care assistants vacancies at the time of the inspection and we were informed that interviews have been arranged to recruit staff in these positions. We were told during the inspection that there were four nurses who were on leave and that the shifts were mostly covered with in-house staff. The manager stated that agency staff were used when required and that staff that were on leave were starting to return back to work. On the day of the the inspection the home was fully staffed according to the usual staffing levels. We spoke to some members of staff and we noted that some of them have been working in Wilsmere house for a relatively long time. One member of staff has been in post since the home first opened about 12 years ago. A few have been in post for 7-8 years. We therefore think that some members of staff are satisfied with the terms and conditions of employment and do get a job satisfaction with caring and supporting the residents that are accommodated in the home. Three residents were worried about the consistency of staff and said that new members of staff do not know how to care for them. Residents were however, on the whole satisfied with the attitudes of staff and with the way that they were cared for. We think that the staffing issues were getting back to normal after a period when there was a difficulty with regards to maintaining consistency and quality of care because of the shortage of staff who knew the home and who were familiar with the needs of the residents. During our feedback to management, we discussed the current staffing levels on wing 2 of the home, with regards to nursing staff. This unit tends to accommodate the residents with high dependencies, and complex nursing and care needs. Whilst the number of care staff seems to be very good during the day and at night, there is currently one trained nurse on each shift. Feedback from staff and some residents suggests that the nurses are very busy with providing nursing care and maintaining good records and that the unit would benefit from more nursing input. The manager and the operations manager stated that they were in the process of reviewing the number of nursing hours that are required for that unit in line with the dependencies and needs of residents that are accommodated on that unit. Care Homes for Older People Page 6 of 13 OTHER ISSUES. There was a relatives and residents meeting in the home on the day of the inspection that was attended by the operations manager and the registered manager of the home. There had not been a residents and relatives meeting since August 2008. The home was on the whole clean and there were no odours. It has been recently refurbished as per its redecoration and refurbishment plan. The main dining area that used to be in the basement, is now a gym with a number of other facilities. There are now dining areas and kitchenettes on each unit. A conservatory has also been added to the basement of the home that now provides a quality communal space for residents and their visitors to enjoy. The home has a new call bell system and there were times when this had not worked, as it should have done. A few residents told us that they were concerned that staff would not know when they required help and support. There was evidence that when the call bell system did not work, there were systems in place to check on residents. The manager said that she had also contacted the contractors for them to look at the call bell system when that was required. Lunch on the day of the inspection consisted of tomato soup, bacon and potato wedges, lamb curry, haddock, stuffed peppers, rice and potatoes. There was rhubarb and madeira crumble with custard, and ice cream for desert. Most residents were pleased with the meals but a minority thought that the variety was good and that the food did not taste very good. The complaints register showed that there had been 17 complaints in 2008 and two for 2009. Complaints were generally appropriately dealt with in terms of acknowledgment, investigation and response. There had been at least one complaint that had not been fully investigated at the time. However, this issue has now been addressed and the manager is aware of the need to conduct thorough investigations of complaints. We looked at the accidents/incidents records for the period from January 2009 to the date of the inspection. There were about 30 entries. Examination of these suggests that in most cases the home has made attempts to find a cause for the accidents/incidents in view of preventing similar accidents/incidents from happening and to rule out any suspicions of abuse. In four cases the cause of the accidents/incidents were not clearly documented on the accident/incident forms. However, the manager was able to provide information that explained the accidents/incidents, when we asked for more information about these. What the care home does well: The home accommodates a number of residents with complex care needs and the home has been able to demonstrate that the residents are on the whole cared for and supported appropriately. The care and nursing staff team are familiar with looking after the residents that are accommodated in the home and they are supported by a number of healthcare professionals whose input has in some cases been contracted into the home, to ensure that this support is available, as and when needed. Care Homes for Older People Page 7 of 13 Residents and their representatives tend to be involved in drawing up and reviewing care plans and risk assessments. Their cultural and spiritual care needs are also addressed appropriately in the care records. The management of pressure ulcers in the home seems to be of a good standard and records that are kept about wound care are also of a good standard. What they could do better: 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 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 5 5(1)(b)(c) The responsible individual 31/05/2008 must ensure that all residents receive a copy of the contract/terms and conditions of the home to ensure that the residents are aware of their obligations and of their rights while living in the home. 2 6 15(1,2) Care plans must be drawn up 31/03/2008 to reflect all the needs of residents and must be kept updated as and when changes occur. That residents or their relatives be involved not only when the care plans are reviewed but also when they are drawn up. 3 9 13(4) To make sure that residents are safe when they are seated in wheelchairs with the seatbelts on, risk assessments must be drawn up to address this issue. 31/03/2008 4 20 13(2) That medicines are recorded accurately throughout the home when administered. If not administered the correct endorsement must be used. 21/05/2008 Care Homes for Older People Page 9 of 13 Changes in dosages must be clearly re-written. 5 20 13(2) That the homes reviews and 01/07/2008 tightens up on its procedures for the safe handling of warfarin 6 35 18(1)(c) The home must have 50 of 31/12/2008 its care staff trained to NVQ level 2 as soon as possible, to make sure that they are fully competent to care for the residents. 7 42 24 There must be monthly 31/03/2008 emergency lights test to make sure that the system is working properly and at least quarterly fire drills, including one at night to make sure that all staff are aware of the action to take if there is a fire. That the devices to keep bedrooms doors open (particularly wooden wedges) be subject to a risk assessment to make sure residents safety is being maintained at all times. Consideration must be given to the use of automatic self closing devices, such as electro-magnetic door holders and door guards, to close the doors should the fire alarm be activated Care Homes for Older People Page 10 of 13 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 1 7 15 Care plans must be kept updated when the needs of residents change. To make sure that the care plans fully reflects the needs of the residents 25/05/2009 2 8 13 There must be a review of the availability of equipment to use in an emergency, including equipment to use for resuscitation, to make sure that these are easily available and ready to use in an emergency. To provide effective first aid. 25/05/2009 3 9 13 All medicines must be administered as prescribed. If a medicine is not administered then a code must be used to describe the reason for not administering the medicine. To ensure the safety of residents at all times. 25/05/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 11 of 13 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 38 That the cause of each accident/incident is recorded in the relevant section on the accident/incident report. This will provide information to manage accidents/incidents and may help in preventing further accidents/incidents in the future. Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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