Random inspection report
Care homes for adults (18-65 years)
Name: Address: Wrottesley Park House Nursing Home Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN three star excellent service 13/08/2009 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: Tina Smith Date: 0 3 0 9 2 0 1 0 Information about the care home
Name of care home: Address: Wrottesley Park House Nursing Home Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN 01902750040 01902755510 zoes@abbeyhealthcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Abbey Healthcare Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 63 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Conditions of registration: 20 58 The maximum number of service users who can be accommodated is: 63 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: Learning disability (LD) 20, Physical disability (PD) 58 Date of last inspection Brief description of the care home Wrottesley Park House is on the main A41 Wolverhampton/Telford road; the entrance is shared with a housing development. It is on a main bus route, and there is off-road
Care Homes for Adults (18-65 years) Page 2 of 19 1 3 0 8 2 0 0 9 Brief description of the care home car parking. The premises and grounds are accessible for wheelchairs. Offices are behind the signing in desk. The home is purpose built with four wings on two floors; each wing has communal areas. There is a main dining room, multi-sensory room, smoking room and laundry on the ground floor, and a pay telephone in the entrance hallway. There is a lift to the first floor where there is an exercise room with physiotherapy equipment. All bedrooms have en-suite facilities and a shower. There are additional assisted bathing rooms. Many of the ground floor bedrooms have french windows and the garden is not enclosed. A fee range is not published as this depends upon the nursing and care required, explained in the service user guide. Nursing care is funded by the national health service. There are standard terms and conditions that explain what is included and excluded from the fee. This information was correct at the time of our visit; for up to date information enquiries should be made to management. Care Homes for Adults (18-65 years) Page 3 of 19 What we found:
The home had a key inspection on 13/08/09 when their quality rating rose to Excellent and since then the home usually kept us well informed. This inspection followed five safeguarding concerns raised by relatives, a hospital and ambulance trust to CQC and councils after the management team and seven staff left in June and July 2010. The provider was not aware of the concerns until we made enquiries. Staff in charge could not answer our queries. We had not been notified as legally required about interim management arrangements. A temporary manager was then assigned from another home until vetting checks cleared for a new manager and deputy recruited. We were told that an assistant manager would not be replaced. People and families continued to be dissatisfied with staff response to their queries. They were not given access to the complaints procedure or a manager, and were told that people may need to stay in bed as there was not enough staff, particularly at weekends. The home continued to notify us about hospital admissions, infections, environmental breakdowns and a safeguarding report made by the home to protect a person. In June and July 2010 we were notified about leaks and breakdowns affecting hot water in parts of the building. New managers commenced on 02/08/10 along with a new nurse. They expected to find good systems in place but were faced with a range of urgent concerns. Additional permanent and temporary staff were then approved and arranged, as well as a recruitment drive. The new managers told us about steps they would take to ensure people have consistency. Permanent staff was to be rotad with temporary staff as they were more familiar with people and their needs. They were reviewing concerns we queried. They found care staff did not have access to cleaning materials in afternoons when domestic staff did not work. A key had been cut and we were told that domestic rotas would change. We advised the manager to request Abbey Healthcare lead an internal investigation about a particularly serious concern that arose prior to their employment, where the person had irreversible health consequences. We suggested that new managers concentrate on making the home and people safe. A random inspection was carried out over two days so that we could check progress. The home did not know we were going to visit on both days. One compliance inspector visited the home on 1st September 2010 to look at the environment and staffing. Two compliance inspectors visited on 3rd September 2010 to look at pressure area/wound care and medication. STAFFING, COMPLAINTS AND INCIDENTS We spoke with the new managers and staff to find out their views of working at the home and whether anything needed to be improved. All were positive and confident that things would be put right in time. Managers had been assured that resources would be made available to do what was necessary. Higher staffing levels have been maintained along with new rotas, and the managers continue to share weekends on duty. After our visit we were told that a nurse had resigned, so there is still instability. The new manager held meetings with people, relatives and staff. We were told that only
Care Homes for Adults (18-65 years) Page 4 of 19 minor requests were made, which are being dealt with, and they are planning to write to all relatives to introduce the management team. This is good practice. We checked complaint and incident logs and saw no new complaints, which is positive. Most incidents over the past year concern falls, and quality monitoring confirmed that risks for people were reviewed. Monthly audits by managers will resume, which are checked on most provider visits. The manager wants the logs to reflect actions and outcomes, which would be an improvement. The manager said that the complaints log had not been updated yet with concerns reported by CQC on behalf of people and relatives. We were satisfied that actions taken had resolved some concerns. We were also told about medication concerns which should have been recorded as incidents and CQC notified, such as sharing prescribed medication between people when one persons ran out. This is poor practice, is unsafe and contravenes the Medicines Act 1968. ENVIRONMENT The premises and furnishings deteriorated since our last inspection; recommendations we made about the environment and infection control had not been acted upon. On this visit we found hazards and system deficits placing people and staff at risk of trips, slips, falls and the spread of infection. Our first impression of the home was a skip full of cardboard , a garden tool left outside, and a smell of urine before we entered the home. We queried these and cleaning arrangements. Deep cleansing of the carpets has been planned since May 2010. A quote was authorised in-between our two visits so this will be arranged shortly. We looked at communal areas of the building with the manager, particularly bathrooms and toilets and pointed out empty hand-soap and bacterial gel dispensers. This meant that people, visitors and staff could not maintain basic hygiene. Each wing had open soiled laundry trolleys with no lids, which remain in communal lounges all day due to lack of storage. This is not homely, may contribute to malodour and poses contamination risk. The laundry door is propped open due to a broken security pad. Clean laundry is now put away immediately, which was an improvement. We were told about a Primary Care Trust (PCT) infection control audit on 16/08/10 which found deterioration and standards non-compliant with Department of Health guidance. Various orders had been placed including new soap dispensers and hand-washing supplies. We were concerned that insufficient interim action had been taken since the PCT visit to improve basic hygiene and domestic rotas, that hand hygiene had further deteriorated, and that no one was overseeing current cleaning schedules. Medical devices, a contaminated suction machine and transport containers had not been cleaned and chlorine based disinfectant was not available. By 03/09/10 malodour had improved but was still evident at the entrance. All but one bathroom had liquid soap. There was only one bottle of bacterial gel for the entire home, apart from those kept on medication trolleys. Staff need ready access to the appropriate hand-cleaner when delivering personal care or changing dressings. Two people currently in hospital have acquired contagious infections; one acquired in the home and one in hospital and managers were not up to date about this. One bedroom was locked but managers were not aware if it had been appropriately cleaned. Instructions, materials and oversight were not in place to prevent the spread of infection. There was a minor
Care Homes for Adults (18-65 years) Page 5 of 19 outbreak of norovirus earlier this year and a recent hospital admission of a similar nature. The providers quality monitoring reports since January 2010 were not in the home as legally required and the manager had not seen them. Most were sent to us after our visit. These noted periodic malodour on various units, spills not cleaned up and deep cleaning needed in the kitchen as well as carpets. We echoed provider concerns about continence management which we raised with the managers on our visit. We noted that in August 2010 the manager had been instructed to do an infection control audit. On our visits there was access to cleaning materials and no spills. On 03/09/10 there was a lot of cleaning activity evident in the morning. We asked staff to empty an assisted bathtub that wasnt draining and we queried two leaking taps. One needed repair, the other was left on by staff. A leaking roof caused electrical damage to isolated parts of the building. Expenditure was authorised on 02/09/10 so that the source of the problem can be resolved, but we had an unclear response to our query about which task should be undertaken first. Re-decoration was also authorised, although the manager had conflicting instructions from two managers about this and could not commence phased planning to limit disruption. Repairs and refurbishment have been arranged piecemeal and are not timely. Since the last inspection no system was arranged for forward planning of essential contractor maintenance or a rolling refurbishment programme. This makes breakdowns more likely, which has affected the running of the home and the experience of people and staff. An Operations Director was recently appointed to address environments and quality standards at the providers homes. This home lacks a health and safety culture. For example we noted buckled flooring needing replacement outside the lift on the first floor. On 03/09/10 this had torn and posed a trip risk we reported. An order for new flooring was authorised on 02/09/10 but no action was taken to make the corridor safe until we queried this again. There was no sign about the lack of a light in the visitors toilet on both days we visited, and staff did not warn us. A persons wheelchair was missing a footplate, which we queried to prevent injury. We were told that the lift had been repaired, however the door sticks open on the first floor. We checked the lift and there was no risk of people falling down the lift shaft, which a relative had been concerned about. Most communal assisted baths were not in working order as well as two hoists. Staff and people told us some baths were too low for the hoist. No action had been taken to repair a broken waste pipe since the last inspection. The PCT noted bathroom flooring needs attention. The toilets were not accessible to people as aids had been left in the way, which restricts independence and continence management. These bathrooms did not have door locks as the knobs were missing parts and the internal mechanism was exposed. This means people did not have privacy, could hurt themselves getting out of the room, and the internal mechanism cannot be easily cleaned. We hand-tested the water, spoke to people about bathing and checked the water temperatures with the handyperson. People use their en-suite showers, but one person who used a communal bath was satisfied it was hot enough. Temperatures were in the safe range apart from 6 en-suite showers recorded at 44 degrees C, but we heard that these had been adjusted to be safe. We fedback that records need to show the action and when it is taken if the safe range is exceeded to prevent scalds. Records also showed one
Care Homes for Adults (18-65 years) Page 6 of 19 bathroom sink had no hot water with no action taken. Contractor maintenance certificates were not all available during or after our visit. The manager found no servicing contract for the heating system or hoists and during our visit asked the new handyperson to search for contractors after we fedback that this posed health and safety risks to people and staff. The handyperson is working through the repair book. Two broken security pads were on order. In response to reports from relatives that they sometimes wait too long for staff to let them in, we were asked to advise on a proposed plan. The needs of people requiring protection had not been considered, including a person who is the subject of a court order and we were told the plan would be reviewed. The manager said they had level 2 health and safety training but they need to use this effectively through health and safety risk assessment to arrive at and document solutions. PRESSURE AREA CARE The care and health records, and bedrooms of three out of five people needing pressure area prevention and/or wound care were examined. We spoke with staff about their knowledge of peoples needs and care plans, about their clinical skills and advice from health specialists. Care and nursing records are kept separately in the home. We found all three peoples plans insufficient to guide staff, and specialist health advice was not fully detailed. Nursing plans did not match best practice guidance as they lacked information about positioning and frequency of turning, bedrest and nutritional supplements, pressure relieving aids and how to use them, mattresses and settings. Daily records about fluid intake and output were insufficient; nutritional supplement frequency was not noted, nor was re-positioning. There were no measurement records and no photographs to evaluate healing. This did not meet professional standards of nursing practice. When queried we learned that the homes camera had been lost and was not yet replaced, so nurses do not have a basic tool for their use. Staff changes and instability meant it was not yet possible to assign named nurses and keyworkers for individuals. The managers had not yet reviewed and updated peoples care plans but this was planned. People had poor if any evaluation of their treatment and healing, which is poor practice in a nursing home. We could not confirm that health specialist advice was sought early enough when there was deterioration or that their advice was followed. Two weeks of a persons treatment for necrotic pressure sores could not be accounted for in June and July, nor could records explain the point of and cause of deterioration which had resulted in irreversible health consequences. Records showed that essential prescribed dressings, creams and gels had run out on two occasions, for up to six days. People were not consistently weighed and action had not yet been taken, although this has been known since August. Two people had not been weighed since April and May 2010 respectively. Waterlow risk assessments were not regularly reviewed, or pressure relieving aids and mobilising especially after specialist health advice. Managers and provider were aware that the record format in use needed improvement so that staff demonstrate plans are followed, but no action had been taken yet to improve or follow up recording gaps. The home could not demonstrate that care and treatment meets peoples health needs. At the time of our visit there was a lack of accountability for vulnerable individuals
Care Homes for Adults (18-65 years) Page 7 of 19 health. Insufficient priority had been given to establishing and meeting high priority health needs. We noted people with sores who did not have all the aids they needed and we established that their needs were not fully assessed or met. Managers were aware that clinical skills in wound care needed development. A quality monitoring report in the home dated January 2010 showed us that pressure care had been reviewed at that time and approval had been given for two staff to attend tissue viability training. The provider could not tell us whether this training took place and it was likely that both nurses had left the home. There is an ongoing safeguarding concern which involves clinical skills in a variety of respects. On our visit we found that the deputy had booked appropriate clinical training so that skills can be updated however this will need repeating if professional staff change. People were at risk of deterioration and of developing sores, particularly as we noted people with insufficient pressure relieving aids. The home agreed to do an immediate audit of Waterlow scores, pressure mattresses and aids to provide CQC and the home with a view of the extent of risk to everyone in the home. New pressure mattresses delivered were put in place during our visit. This avoided need for an immediate requirement. Sufficient information was provided on the date agreed to indicate a problem needing urgent attention and we advised that up to 27 people needed pressure cushions of varying types. We were provided with waterlow scores for 37 out of 52 people living in the home, so there may be people who have not been risk assessed or who have not had this regularly reviewed. The home will also need to check assessments for people who use the home regularly for respite as one person developed red areas unnecessarily recently when there were insufficient staff. DYSPHASIA AND PEG FEEDING We checked how the dietary needs were met for people with additional needs due to swallowing difficulties or peg feeding, following a concern that staff had not been using current specialist health advice. Concerns arose at a time when temporary staff had been left in charge of the home. There were insufficient details in nursing plans particularly, to guide staff unfamiliar with people. Communication with a new cook had broken down and food had been prepared which the person could have choked on. The dietary needs and plan for one person with dysphasia had been resolved. Relatives raised another incident to the manager in the recent meeting. This was not in the homes incident log, may have occurred in the past. Another relative raised a concern about peg feeding supplies which we were told had been ordered. The home had advocated well for one person unable to communicate and peg fed to be re-admitted to hospital for tests and we praised good practice. We were not confident that all dysphasia plans had been updated, and the home did not have sterile suction equipment in case of emergency. At least one person in the home needs frequent suction. The managers were working through a list of relatives concerns and updating peoples records but we were not confident about timeliness for peoples safety, or that nurses had safe equipment or prescribed supplies available when needed. MEDICATION The medication system places peoples health and wellbeing at risk and we were told it
Care Homes for Adults (18-65 years) Page 8 of 19 was a big mess. Managers were aware of the problems and discussed them openly, but they were uncertain how to address them all as well as other competing demands. The deputy was delegated the role of improving all clinical areas but also felt she needed to work the floor, which was unachievable. Dedicated managerial time was needed to make immediate changes. Care and medication records were not yet audited. We were told that the system was not auditable. There were missing photos of people but no camera so temporary and new staff could not check that medication was given to the right person. Medication records were not accurate. There were too many gaps in administration records or lack of carried forward data for stocks to be reconciled. The medication round can take two hours and some people did not have medication on time - records are not accurate. As a result no one can determine if people have essential medication for their health as prescribed by doctors. During our visit we gave advice on how to put the system back on track quickly and suggested that managers share the tasks. In the longer term the manager is planning to train senior care staff to administer medication which will release nurse time for clinical tasks. Managers need to establish a safe system and stocks of medication, creams, gels and dressings urgently so that they are available when needed. Peoples records evidenced two occasions recently when they ran out. There were unsafe practices, such as sharing medication and sharps boxes had been used inappropriately in the absence of a disposal system. A night nurse was assigned to undertake ordering. The homes medication systems must be resolved strategically in a timely way to protect health, with accountable oversight. We are aware, for instance that the home has experienced prescribing difficulty in the past with GPs from three counties, which complicates the task of ordering. Quality monitoring reports showed anomalies in the medication system for many months, apart from controlled drugs when the previous manager ran the home. Weekly audits were requested but there was no evidence they have taken place since May 2010. New managers found thorough controlled drug checks and ways in which the efficiency of checks can be improved. The manager was waiting for an audit form which the regional manager wanted them to use. In August managers identified that agency nurses were leaving gaps in medication records and on at least one occasion had not administered medication because they thought stocks had run out. They had not known where additional stocks were kept. There were several examples where temporary staff did not have sufficient briefing. They are in the process of getting nurses to address gaps if they occur. A system to regularly appraise staff competence with medication is needed. The Primary Care Trust found the medication room cluttered and advised that the medication system and dressing trolleys need better infection controls. Nebulisers could not be found and pathology specimens could become contaminated. Staff were not inducted about infection control. There are new staff and the manager had just found the homes induction programme. We therefore were unable to confirm that peoples health and wellbeing is protected or that the medication system is safe. We were able to confirm that there was a positive outcome for a person who was not having their medication at the right time. They now store and manage medication by themselves, following an appropriate risk assessment, so they have more independence. MANAGEMENT
Care Homes for Adults (18-65 years) Page 9 of 19 An excellent service should have responsive and effective quality monitoring and contingency systems to manage unexpected situations, but this is not what we found. We queried what the interim manager did as staff managed the rotas themselves, hygiene standards fell, medication and more serious health concerns arose. Regulation 26 quality monitoring reports were not on the premises as required and the new manager had not seen them although they were briefed. Some were sent to us within 48 hours. Although we had been told in June that regional managers were sharing oversight of the home, no monitoring took place during July 2010 when the home was in crisis. People and commissioners had no one to turn to within the company; they were not informed about interim arrangements. We could see that quality monitoring is comprehensive about compliance, and that high standards are promoted, which we fedback to the regional manager after our visit. We were told about obstacles to environmental improvements which had been removed, but timely action did not then take place. The same was true of medication anomalies since May 2010. Instructions to managers were not actioned or followed up. The managers development plan showed intention to personalise care and bedrooms, improve the environment, activities and staff training. Staff do not have practical training in moving and handling but see a DVD which they had identified as insufficient; training is booked for early September 2010. Other mandatory and clinical skills training has been booked to take place between September 2010 and February 2011 including wound care and challenging behaviour. The development plan did not fully address health and safety or problems with medication and infection control systems posing risks to people, so we had cause to query priorities and there were no timescales to ensure compliance with care regulations. There was no copy of Essential HSCA Standards in the home, although we saw the KLORA on display, both of which should currently guide compliance. Managers were frequently interrupted. We saw that managers were tired from their efforts to manage the staffing situation. They appeared overwhelmed by all that needing doing at once. There was pressure to raise occupancy but no clear guidance on the fee structure. Each had management induction folders but did not feel they had sufficient induction yet or clarity on line management. The manager did not have a job description. The regional manager impressed us but has insufficient time to support and induct the new managers. IT is under-developed as technology could improve responsive decisionmaking and order approvals. There are no head office services that assist with human resource or other functions. The home is now run with reduced management capacity as a third manager will not be replaced. Managers were under pressure and needed support and resources in the short term to achieve rapid change. At all levels managers were aware of the problems and discussed them openly with us, but there were competing demands. They have successfully quelled the tide of concerns, and are making progress but need to be clear on priorities and timescales. Managers are qualified and experienced and during our visit demonstrated skills in instructing and guiding staff. The manager is a learning disability nurse who has experience running small residential homes which value people. The manager said she
Care Homes for Adults (18-65 years) Page 10 of 19 needs to update her general nursing skills. The deputy is a registered general nurse with good clinical skills, previously worked at the home and demonstrated knowledge of good nursing standards. She has assistant manager experience at a smaller home. Both managers are rapidly gaining experience in running a large and busy nursing home which has frequent admissions and discharges, and offers regular respite care. Two concerns arose affecting people during respite stays. We advised introducing surveys after each respite stay for people and relatives to improve their outcomes and working together for peoples benefit. We also advised reviewing policies, procedures and care plans to ensure all their needs and ways to meet them are sufficient and known to staff. What the care home does well:
Since the last inspection the home improved signage so that the public can find the home. An atrium was repaired following a storm, a new boiler was installed and an underground leak repaired. People continue to have a range of activities and outings and are currently involved in improving the garden. Recently a part-time worker was appointed to stimulate people needing individual support. Physiotherapy exercise continues to be provided. The home was used as a polling station for the community in May, which also helped people to exercise their rights to vote. Managers are welcoming and held a number of meetings to quickly get to know everyone. They are responsive to people, relatives and staff views and are trying to maintain an open door, although this constrains their time for essential tasks. People we spoke to are very happy in the home, and relatives were reassured. There have been no further complaints and requests are being addressed. There is a development plan to improve individualised care and non-confrontational management of behaviour. The manager and university intend to re-establish their link with the home when there are sufficient nurses to supervise students, which will help nurses keep up to date and is a means of recruiting professional staff. Training has been booked over the next half year which will update clinical skills and mandatory training, including moving and handling. Staff supervision and appraisal has re-commenced. During our visit the managers responded to our queries by addressing some immediate health and safety risks (had a toilet cleaned, a broken radiator cover repaired, removed a garden tool and continence aids inappropriately stored, taped up ripped flooring). After our visit the deputy prepared a report and provided this within the time requested, which helped the home and CQC to assess risk to people. Some essential repairs have been authorised so that contractors can resolve environmental problems at source. There is a new handyperson who is working through the repair book, obtains quotes and since our inspection has been seeking contractors so that servicing and maintenance contracts can be arranged. Water temperatures in the home are within the safe range. The home has a four star award from environmental health about food safety and people liked the food. There is a new cook and a new freezer. Care Homes for Adults (18-65 years) Page 11 of 19 Re-decoration and deep cleaning of the home has been approved and the manager will be planning how this can be achieved with least disruption to people. It is intended that people are involved in plans to personalise and upgrade their rooms and furnishings. Recruitment of staff is ongoing and rotas now ensure people have consistent staff who understand their needs. People now have higher staffing levels. Permanent staff told us they like working at the home; some have been there for several years and get on well with people. The new manager and deputy are qualified and experienced in providing care and nursing and have complimentary experience that will bring new developments in the longer term for people using the service. They intend updating their own clinical skills and demonstrated knowledge of good nursing standards and leadership skills. Areas needing improvement were known. They formed and prioritised a development plan. The provider usually conducts monthly quality monitoring visits. Their reports demonstrate comprehensive checks and promote high standards, give managers positive feedback and clear direction to improve and maintain those standards. The provider nationally is progressing a plan to improve the fabric of their homes as well as care standards. Wrottesley Park House is the providers highest rated home and has a recent history of high standards to draw upon. We were assured that there will be immediate investment to protect health and safety and to improve the environment. There is commitment to achieve compliance and we have confidence that the home can achieve this within the next few months due to the number and nature of tasks, if management capacity and staffing stability is effectively achieved. What they could do better:
Nursing and care plans lacked sufficient detail to guide staff. There is insufficient evaluation and oversight of pressure area and dysphasia care and treatment. Health specialist advice was not always followed and clinical skills need updating. Risk assessment, weighing and evaluation of treatment has not been regular or to a sufficient professional standard. Essential dressings, medication and pressure relief for people, and tools for nurses are urgently needed to promote and protect health. Infection controls are poor making the spread of infection more likely. There will be another inspection by the Primary Care Trust to check that changes have been made. People have been harmed as a result of insufficient contingencies for oversight and accountability at the home during a management and staffing crisis. On our visit we found insufficient action to prevent deterioration in health or about environmental risks posed to people. Essential repairs, equipment and refurbishment is not timely and needs a rolling programme. The building and premises deteriorated since our last inspection and the home has been difficult to run smoothly as a result of frequent breakdowns. Communication between staff can improve, as well as the briefing of temporary staff and induction of new staff. A range of systems, documentation, forward planning and audit for health and safety needs development, along with timely investment proportionate to peoples needs. Practice and records must demonstrate compliance with current and new care regulations
Care Homes for Adults (18-65 years) Page 12 of 19 which come into force on 1st October 2010. Managers need to review priorities and accountability, delegation of tasks and staff at all levels need clear understanding of roles. Sustaining compliance, high standards and continuous improvement will depend upon responsive staffing ratios to match peoples changing needs, follow through from audits, quality monitoring and staff appraisal. Contingencies are needed to manage staff turnover as well as strategies for staff retention and teamwork. An ongoing safeguarding investigation is likely to result in further lessons to be learned. 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 Adults (18-65 years) Page 13 of 19 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 Adults (18-65 years) Page 14 of 19 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 12 12(1): Robust systems must 03/10/2010 be in place and demonstrate effective wound care, repositioning and fluid monitoring, and that current health specialist advice is followed to minimise pressure sores and promote healing and about dysphasia. Care and nursing plans must have sufficient instruction for staff about pressure relieving aids, settings as well as monitoring. Health must be promoted and protected. 2 20 13 13(2): A robust review of the 03/10/2010 systems to order, store, dispose of, administer and record medication must make the system safe and auditable. The medication system must protect peoples health and wellbeing and demonstrate they have medication, creams, gels and dressings when needed and as Care Homes for Adults (18-65 years) Page 15 of 19 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 prescribed. 3 30 13 13(3): Action must be taken 03/10/2010 in line with the Wolverhampton City Primary Care Trust infection control audit 16/08/10 to minimise risk of infection spreading. Periodic audits must demonstrate that hygiene standards are maintained. Health must be promoted and protected from contagion. 4 38 13 13(4)(c), 23(1)(2): A robust 03/10/2010 health and safety risk assessment must be undertaken about the home, and actions taken proportionate to the degree of risk posed to people using and visiting the service. Environmental hazards must be removed, appropriate storage found; essential building repairs, refurbishment of equipment and essential contractor servicing must be maintained. Communal facilities, equipment and the premises should be accessible, in working order, hygienic and suitable to meet peoples needs safely. 5 39 26 Reg 26 Thorough periodic 03/11/2010 audits should demonstrate management accountability and duty of care is exercised
Page 16 of 19 Care Homes for Adults (18-65 years) 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 to meet peoples health needs in accordance with best practice and professional standards, with appropriate actions taken. Peoples health must be promoted and protected through evaluation; clinical skills must be regularly updated and essential nursing equipment must be available. 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 19 People should be regularly and consistently weighed for early recognition and intervention with inter-related risks (malnutrition, pressure sores, falls). The manager should ensure that nursing and care plans are evaluated at appropriate times, particularly in the absence of a system to assign permanent named nurses and key workers. Communal assisted bathing facilities and hoists should be suitable to meet peoples needs, accessible and in working order. Briefing and induction should ensure temporary and new staff understand the homes systems, drug storage, infection control, policies and procedures. Management roles need clarification. An application should be made to register a suitable manager. Surveys for service users and families are suggested following each respite stay to develop respite services to improve peoples outcomes. Records should demonstrate that care and nursing plans
Page 17 of 19 2 19 3 24 4 35 5 6 37 39 7 41 Care Homes for Adults (18-65 years) 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 are carried out in full at the frequency people are assessed to need. 8 41 Care and medication administration records should all have photographs so that permanent and temporary staff can identify the correct person. The Commission must be notified if management and staffing arrangements change and affect the running of the home. Strategies to retain and motivate staff should be employed which promote effective teamwork and best practice. 9 42 10 43 Care Homes for Adults (18-65 years) Page 18 of 19 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 Adults (18-65 years) 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 19 of 19 - 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!
