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Inspection on 05/05/10 for Wordsworth House

Also see our care home review for Wordsworth House for more information

This is the latest available inspection report for this service, carried out on 5th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Wordsworth House has a calm atmosphere and staff interact well with people using the service, each other and visitors. People looked well care for and families were very positive about the care and support their relatives receive. Good assessment of need is completed prior to admission and social work assessments were also available in the file. These assessments are comprehensive and cover all aspects of need, including residents wishes around practical issues such as specific likes/dislikes and including sensitive issues about their wishes about their death. Various assessment tools are completed that inform the care planning process and include, falls assessments, pressure care, moving and handling, nutritional risk assessment. Sample of care plans showed that people are treated as individuals and give examples and explanations within the plan to help staff develop empathy of the persons situation, their needs and experience. The records showed good assessments and guidance for staff about how to recognise symptoms such as assessing peoples mood. This included observing for non verbal signs and behaviour for example, withdrawal from contact, not smiling, occasional weariness, poor concentration or throwing things. There were other good examples in plans around pain management and communication. For example, where a person can only answer yes or no the plan said that questions should be short and closed. Evaluations of care are routinely carried out every month with some evidence of very detailed information but some entries record, no problems or no change, which doesn`t provide a full and proper evaluation of a residents care, progress or deterioration. Reviews of care are held with the service user and, or their relative. One relative described the care given to their relative as being "second to none" and that the "staff are caring and provide very good clinical support". Records show very good multi-agency involvement in some areas of care such as psychology, psychiatry, Community Learning Disability team (CLDT), Speech and Language team (SALT) team and other specialist staff. There were examples of personal history, which gave staff insight into who the individual was before they came to Wordsworth and highlighted the things that are important to them. Staff were modest about the standard of planning they produce and the deputy commented that they are currently being developed. Weights are recorded dependent upon what is identified within the MUST assessment of nutrition and this varies if people have specific needs, for example, difficulty swallowing or little appetite. Staff support people very well as part of carefully a planned end of life strategy, workingclosely with the GPs and palliative care specialist nurses. This was evident when someone died during the visit and staff managed the situation very well. Medications were given out during the meal although this is not currently Southern Cross policy. People using the service had stated they preferred to take their tablets when they eat their meals. The nurse dispensing medications wore a red tabard so that they people can distinguish what she is doing and not disturb her while dispensing medication. A meal was shared with people on the ground floor, which was unhurried and staff were attentive. A couple of residents didn`t want what was on offer and were given a few alternatives to the menu. The choice for the lunchtime was mushroom soup followed by chicken pie or, cauliflower and broccoli bake, and then home made rice pudding. The rice pudding was very popular with people. The quality of the food was good and the meal was tasty, hot and nicely presented. One lady said really we get too much to eat, I have quite a small appetite and find two cooked meals a day too much. Another lady said she had enjoyed the chicken pie, while another who had eaten sandwiches said, they were nice but rather like doorstep sandwiches. The cook is knowledgeable about the way that the food can be fortified to increase the calorific content of the food and is kept informed of those residents who are at risk of weight loss or who had already lost weight. During the meal the chef visited the dining rooms, the residents confirmed that this is usual practice so that he can ask them about the food and it was usual for them to comment of the food. On the day of the visit there was sufficient staff to provide person centred and sensitive care. During the day one person took ill and another died, yet the atmosphere remained calm. The home has a Dignity Champion in line with the Department of Health project to raise the concept of dignity in care for all people. Notices are displayed to inform people who he is but the general culture within the home is that peoples dignity is respected. Staff are polite and respectful, offer choice and give explanations to people. There has not been a registered as manager in the home since in March 2009. However, it is to the credit of the deputy and the staff team that they have continued to deliver a high standard of care, particularly given the high level of need of some people living in the home. In addition, a support manager has been conducting quality audits and Regulation 26 visits and the Deputy has concentrated on supporting very good clinical support to nursing and care staff. Recruitment of a new manager is currently taking place.

What the care home could do better:

On arrival at the home, the grass was overgrown giving the building a rather unkempt feel. There is ample parking space and a sheltered area over the door enables people to stay dry if they are gaining access into the home and have to wait to get in. The decor generally is looking tired and worn, with paint flaking from gloss work and wallpaper either marked or peeling off some of the corridor walls. Bathrooms are stark and where repairs have been made to WCs or showers and tiles have been replaced, these were not flush with other tiles. The showers themselves are operated by a timed push switch, which stops after a short period of time and makes enjoying a shower difficult. The entrance to one shower room on the ground floor has a lip before negotiating the ramp, which needs to be leveled to prevent discomfort for people using wheelchairs. Handtowels are sited in WCs well out of reach of people using wheelchairs and bins are sometimes located in wheelchair turning spaces. Bedrooms were personalised but again are in need of redecoration. A painter and decorator was in the building, painting the corridor walls during the visit. Although the carpet had been replaced as required at the last inspection, other carpets throughout the home were worn and stained in places and need to be replaced overtime. Externally, there are areas where people can sit and enjoy the nice weather but garden maintenance needs to improve to ensure these are nice areas to sit. Some of the living room furniture on all floors were also worn, with stuffing coming out of a couple of chairs and sofas. These rooms have a homely feel but need to be refurbished. A full plan of refurbishment with detailed timescales needs to be shared with residents and their families as residents meetings have highlighted this as a particular concern. CQC should also have a copy of this. Although food choices were offered by staff, the organisation of the meal could be improved on the ground floor so that people`s experience is more positive for people with more complex needs. At least four people were sat on tables by themselves with no one to talk to. One lady does prefer to eat alone but for others the experience was not stimulating. Other people were sat together, where staff sat and helped people to eat their meal. This was conducted in a respectful way but one member of staff referred to people as feeders and this term is not a dignified way to refer to people. Plastic glasses were used to serve cold drinks and while some of them were new, others were scratched after being in the dishwasher. Again, people should be offered glasses rather than plastic glasses or beakers, which are childish and unpleasant to drink from. the deputy commented that they used them as staff had broken the glasses and not residents. Routine training has not been planned for or provided routinely for staff, this has been picked up with the Quality Assurance and Reg 26 processes and some training around clinical aspects such as catheter care have been arranged. Safeguarding training was particularly low and statistics from May show that only 6 per cent of staff have updated their training this year. In addition, Infection control, 23 per cent, COSHH 10 per cent, food hygiene 59 per cent, nutrition 19 per cent, moving and handling 77 per cent and medication update 27 percent and safe handling of medication at 27 per cent. The same statistical sheet showed that no training has been given for health and safety, pressure care, customer care, care planning, challenging behavior, dementia training, and safer use of bed rails in the last 12 months.

Random inspection report Care homes for older people Name: Address: Wordsworth House Clayton Road Jesmond Newcastle Upon Tyne Tyne & Wear NE2 1TL 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Suzanne McKean Date: 0 5 0 5 2 0 1 0 Information about the care home Name of care home: Address: Wordsworth House Clayton Road Jesmond Newcastle Upon Tyne Tyne & Wear NE2 1TL 01912121888 01912813764 wordsworthhousenewcastle@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross BC OpCo Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 78 Number of places (if applicable): Under 65 Over 65 0 78 learning disability old age, not falling within any other category Conditions of registration: 4 0 The maximum number of service users who can be accommodated is: 78 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 - maximum number of places 78 Learning Disability - Code LD, maximum number of places 4 Date of last inspection Care Homes for Older People Page 2 of 10 Brief description of the care home Wordsworth House is a purpose built care home situated in Jesmond, a residential suburb of Newcastle. It opened in 1989 and is now owned by Southern Cross. The home has seventy-eight beds and offers both nursing and residential care. All bedrooms are single and are spread over three floors. There are 19 bedrooms with en-suite facilities. There are large lounges and dining rooms on each floor plus assisted bathing and toilet facilities. There is a private chapel, hairdressing and activities room. A passenger lift accesses all resident areas. There are extensive landscaped gardens with patio and decking areas that are easily accessible. Car parking is available at the front of the building and the home is close to main bus routes and a Metro Station. The fees for the home are £383 to £647 per week. Further information about the home is available in the service user guide, which contains the statement of purpose and previous inspection reports. This is kept in the reception area of the home. Care Homes for Older People Page 3 of 10 What we found: An unannounced visit was carried out by a regulatory inspector and a Local Area Manager on 1st June 2010, the visit was started at 9.45 and was completed by 16.30. During the visit we looked around the home, spoke to the residents and their visitors and spoke to the manager. We also looked at some of the records being kept including care plans and the Quality Assurance records. The requirements made at the last inspection on and none were identified as a result of this visit. What the care home does well: Wordsworth House has a calm atmosphere and staff interact well with people using the service, each other and visitors. People looked well care for and families were very positive about the care and support their relatives receive. Good assessment of need is completed prior to admission and social work assessments were also available in the file. These assessments are comprehensive and cover all aspects of need, including residents wishes around practical issues such as specific likes/dislikes and including sensitive issues about their wishes about their death. Various assessment tools are completed that inform the care planning process and include, falls assessments, pressure care, moving and handling, nutritional risk assessment. Sample of care plans showed that people are treated as individuals and give examples and explanations within the plan to help staff develop empathy of the persons situation, their needs and experience. The records showed good assessments and guidance for staff about how to recognise symptoms such as assessing peoples mood. This included observing for non verbal signs and behaviour for example, withdrawal from contact, not smiling, occasional weariness, poor concentration or throwing things. There were other good examples in plans around pain management and communication. For example, where a person can only answer yes or no the plan said that questions should be short and closed. Evaluations of care are routinely carried out every month with some evidence of very detailed information but some entries record, no problems or no change, which doesnt provide a full and proper evaluation of a residents care, progress or deterioration. Reviews of care are held with the service user and, or their relative. One relative described the care given to their relative as being second to none and that the staff are caring and provide very good clinical support. Records show very good multi-agency involvement in some areas of care such as psychology, psychiatry, Community Learning Disability team (CLDT), Speech and Language team (SALT) team and other specialist staff. There were examples of personal history, which gave staff insight into who the individual was before they came to Wordsworth and highlighted the things that are important to them. Staff were modest about the standard of planning they produce and the deputy commented that they are currently being developed. Weights are recorded dependent upon what is identified within the MUST assessment of nutrition and this varies if people have specific needs, for example, difficulty swallowing or little appetite. Staff support people very well as part of carefully a planned end of life strategy, working Care Homes for Older People Page 4 of 10 closely with the GPs and palliative care specialist nurses. This was evident when someone died during the visit and staff managed the situation very well. Medications were given out during the meal although this is not currently Southern Cross policy. People using the service had stated they preferred to take their tablets when they eat their meals. The nurse dispensing medications wore a red tabard so that they people can distinguish what she is doing and not disturb her while dispensing medication. A meal was shared with people on the ground floor, which was unhurried and staff were attentive. A couple of residents didnt want what was on offer and were given a few alternatives to the menu. The choice for the lunchtime was mushroom soup followed by chicken pie or, cauliflower and broccoli bake, and then home made rice pudding. The rice pudding was very popular with people. The quality of the food was good and the meal was tasty, hot and nicely presented. One lady said really we get too much to eat, I have quite a small appetite and find two cooked meals a day too much. Another lady said she had enjoyed the chicken pie, while another who had eaten sandwiches said, they were nice but rather like doorstep sandwiches. The cook is knowledgeable about the way that the food can be fortified to increase the calorific content of the food and is kept informed of those residents who are at risk of weight loss or who had already lost weight. During the meal the chef visited the dining rooms, the residents confirmed that this is usual practice so that he can ask them about the food and it was usual for them to comment of the food. On the day of the visit there was sufficient staff to provide person centred and sensitive care. During the day one person took ill and another died, yet the atmosphere remained calm. The home has a Dignity Champion in line with the Department of Health project to raise the concept of dignity in care for all people. Notices are displayed to inform people who he is but the general culture within the home is that peoples dignity is respected. Staff are polite and respectful, offer choice and give explanations to people. There has not been a registered as manager in the home since in March 2009. However, it is to the credit of the deputy and the staff team that they have continued to deliver a high standard of care, particularly given the high level of need of some people living in the home. In addition, a support manager has been conducting quality audits and Regulation 26 visits and the Deputy has concentrated on supporting very good clinical support to nursing and care staff. Recruitment of a new manager is currently taking place. What they could do better: On arrival at the home, the grass was overgrown giving the building a rather unkempt feel. There is ample parking space and a sheltered area over the door enables people to stay dry if they are gaining access into the home and have to wait to get in. The decor generally is looking tired and worn, with paint flaking from gloss work and wallpaper either marked or peeling off some of the corridor walls. Bathrooms are stark and where repairs have been made to WCs or showers and tiles have been replaced, these were not flush with other tiles. The showers themselves are operated by a timed push switch, which stops after a short period of time and makes enjoying a shower difficult. The entrance to one shower room on the ground floor has a lip before negotiating the ramp, which needs to be leveled to prevent discomfort for people using wheelchairs. Hand Care Homes for Older People Page 5 of 10 towels are sited in WCs well out of reach of people using wheelchairs and bins are sometimes located in wheelchair turning spaces. Bedrooms were personalised but again are in need of redecoration. A painter and decorator was in the building, painting the corridor walls during the visit. Although the carpet had been replaced as required at the last inspection, other carpets throughout the home were worn and stained in places and need to be replaced overtime. Externally, there are areas where people can sit and enjoy the nice weather but garden maintenance needs to improve to ensure these are nice areas to sit. Some of the living room furniture on all floors were also worn, with stuffing coming out of a couple of chairs and sofas. These rooms have a homely feel but need to be refurbished. A full plan of refurbishment with detailed timescales needs to be shared with residents and their families as residents meetings have highlighted this as a particular concern. CQC should also have a copy of this. Although food choices were offered by staff, the organisation of the meal could be improved on the ground floor so that peoples experience is more positive for people with more complex needs. At least four people were sat on tables by themselves with no one to talk to. One lady does prefer to eat alone but for others the experience was not stimulating. Other people were sat together, where staff sat and helped people to eat their meal. This was conducted in a respectful way but one member of staff referred to people as feeders and this term is not a dignified way to refer to people. Plastic glasses were used to serve cold drinks and while some of them were new, others were scratched after being in the dishwasher. Again, people should be offered glasses rather than plastic glasses or beakers, which are childish and unpleasant to drink from. the deputy commented that they used them as staff had broken the glasses and not residents. Routine training has not been planned for or provided routinely for staff, this has been picked up with the Quality Assurance and Reg 26 processes and some training around clinical aspects such as catheter care have been arranged. Safeguarding training was particularly low and statistics from May show that only 6 per cent of staff have updated their training this year. In addition, Infection control, 23 per cent, COSHH 10 per cent, food hygiene 59 per cent, nutrition 19 per cent, moving and handling 77 per cent and medication update 27 percent and safe handling of medication at 27 per cent. The same statistical sheet showed that no training has been given for health and safety, pressure care, customer care, care planning, challenging behavior, dementia training, and safer use of bed rails in the last 12 months. 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 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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, 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 19 23 Replace worn and stained carpets and soft furnishings throughout the building. This will ensure people live in convivial surroundings. 31/08/2010 2 19 23 Physical barriers to independence must be addressed. This will ensure that people are encouraged to be as independent as possible. 31/08/2010 3 30 18 Staff must regularly receive training appropriate to the role they perform. This will ensure that staff are skilled and competent to do their job, using the most up to date practice. 31/08/2010 Care Homes for Older People Page 8 of 10 Recommendations These recommendations are taken from the best practice described in the National 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 7 Care plans must consistently contain detailed evaluations to ensure that they accurately reflect peoples current needs and staff are aware of changes. The organisation of mealtimes on the ground floor should be reviewed to ensure that people have a positive experience. A suitably qualified and experienced manager should be appointed to provide leadership to the staff team and make sure the service is run in the best interests of the people living there. 2 15 3 31 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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