Inspection on 14/09/09 for Wyatt House

This is the latest available inspection report for this service, carried out on 14th September 2009.

CQC found this care home to be providing an Excellent 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.

Other inspections for this house

Wyatt House 29/11/05

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Wyatt House Lower Farmhill Stroud Gloucestershire GL5 4EE Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 13:00 14th & 15 September 2009 th DS0000064585.V377152.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wyatt House Address Lower Farmhill Stroud Gloucestershire GL5 4EE 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) 01453 764194 01453 765153 manager.wyatt@osjctglos.co.uk The Orders of St John Care Trust Mrs Maureen Ann Crocker Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate two named service users under the age of 65 years. This condition will be removed when the named service users reach the age of 65 or no longer reside at the home. 19th September 2006 Date of last inspection Brief Description of the Service: Wyatt House is a purpose built care home providing personal and nursing care to thirty residents requiring dementia care. The home also offers day care facilities, and is situated in a large housing estate close to local shops and other amenities. The accommodation has thirty single rooms, is on two floors and has been fitted with a shaft lift to provide access to both floors. Although none of the rooms have en suite facilities, there are several assisted bathrooms and separate toilet facilities throughout the home. There are three lounges within the home plus two dining rooms and a number of smaller sitting areas for residents’ use. The enclosed gardens are maintained to a good standard. Information about the home is available in the Service User Guide (Information Brochure), which is issued to prospective residents, and a copy of the most recent inspection report is available in the home for anyone to read, along with the home’s Statement of Purpose. The charge at Wyatt House for the private nursing rate is £833.53. The home also provides care at the local authority rates where applicable. Hairdressing, Chiropody, Newspapers and Toiletries are charged at individual extra costs. Wyatt House DS0000064585.V377152.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 3 star. This means the people who use this service experience Excellent quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One Regulatory Inspector carried out this inspection on two days in September 2009. Care records were inspected, with the care of three residents being closely looked at in particular. The arrangements to manage residents’ medications were inspected. A number of residents, and their relative where possible, were spoken to directly in order to gauge their views and experiences of the services and care provided at Wyatt House. Some of the staff were interviewed. Survey forms were also issued to a number of residents, staff and visiting health care professionals to complete and return to us if they wished. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 6 What the service does well: Wyatt House is a well managed home. It provides a welcoming atmosphere for visitors, and there is a good amount of information about the home, its services and facilities to assist residents and their families. Residents are admitted here on the basis of an assessment of their individual needs. There is a good standard of care planning, with arrangements in place to meet residents’ personal, physical and mental health needs. There is a very strong focus towards a person-centred approach here, with staff understanding the residents and displaying respect towards each person as an individual. Residents appeared contented and at ease with staff, as did staff with residents. Life in the home was flexible in order to meet the changing needs, demeanour, behaviour and choices of the residents. Residents had regular opportunities to become socially engaged and stimulated, and to be meaningfully occupied. Staff were encouraging, enabling and supportive towards residents. One visiting relative described the staff and the home to us as ‘Top of the Tree’. A visiting healthcare professional also described the home in very positive terms to us. The quality and choice of food served to residents is good, with residents’ particular dietary needs and choices catered for. Meals are fortified where needed, and snack foods are readily available. There is a good system for addressing any complaints or concerns that arise, and there are sound policies and procedures in place for the protection of the vulnerable residents. Staff manage risks well, and the necessary protective measures are taken in cases where there are risks that might impinge on residents’ liberty and freedoms. Sound staff recruitment practices are observed here, and there are good opportunities for staff training, development and supervision. Staff worked well together, and displayed a mutual respect towards each other and towards the residents. There are good arrangements for monitoring the quality of the service provided to residents. The AQAA was very well completed and provided us with the information we required. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Wyatt House DS0000064585.V377152.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 Wyatt House DS0000064585.V377152.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to information and a comprehensive pre-admission process gives prospective residents and their families an assurance that their needs can be met here. EVIDENCE: The home had an up to date Statement of Purpose, which was readily available to both residents and their representatives. The home’s information brochure was also made available to all prospective residents, and could be provided in alternative formats if necessary. All prospective residents were assessed prior to being given a place at the home. We inspected an example of a pre-admission assessment, which was for a resident more recently admitted to the home. The assessment had been Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 10 carried out prior to admission being agreed and had been comprehensively and fully recorded on the home’s designated tool for the purpose. The assessment had been signed and dated, with the location where it was conducted identified. The assessment took account of the prospective resident’s personal details and their past medical history; their health and care needs; their medications; their socialisation and cultural needs; their understanding and legal status. There was also a moving and handling assessment, a pressure sore vulnerability and overall skin assessment, a nutritional and a falls risk assessment. An assessment from the placing authority and information from other health care professionals previously involved in the person’s care was also obtained. Confirmation letters regarding residents’ admission to the home had been issued. The home’s AQAA stated that all prospective residents and their representatives were encouraged to make preliminary visits to the home, and to have trial visits before making a decision about coming in here. Evidently not many had taken advantage of this opportunity for reasons particular to them. The manager told us that admissions sometimes came from people who had previously used the adjacent day centre or had been in the home for respite care. Wyatt House does not provide intermediate care. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have their health and personal care needs met through good care delivery that is mindful of their privacy and dignity, and through a generally safe system for administering their medications. EVIDENCE: Residents had their own regularly reviewed care plan that had been drafted on the basis of an assessment of their health and personal needs, and also a ‘Strengths Based’ assessment. Three care plans were selected for case tracking. Each was written in an appropriately detailed way, and provided some excellent guidance for staff. As well as the person’s physical and mental health needs and personal needs, care planning in each case took account of their levels of ability and independence, choice and dignity. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 12 The ‘Strengths Based’ assessment took account of the person’s values, beliefs and feelings; thinking and communication; contact and activity; ability to maintain control; their environment and physical health. A ‘Whole Person Picture’ had then been compiled, which showed the person’s strengths and abilities; those which could be built on or maintained, and where a high level of support was needed. Recorded risk assessments in each case included personal safety, pressure sore vulnerability, falls, nutrition, and moving and handling. There was clear planning to address the risk factors in each case and promote improved health and welfare. Acute bouts of ill health and chronic conditions were being addressed through the care arrangements in the home and the collaborative working with external health care services in the community. The psychiatric services were regularly involved in the care of the residents, with necessary interventions, therapies and monitoring arrangements in place. The home’s AQAA stated that the commencement of a programme to compile residents’ life histories was supporting staff to care for people as individuals. We saw some very good examples of this work. Those residents, who were helped to respond to our survey, confirmed that they were satisfied with their care. We met many of the residents during the course of our visit, some of whom appeared comfortable and settled in communal areas, whilst others who were physically poorly were being nursed in their rooms. Where applicable, staff were performing regular care tasks in these cases, and there were care monitoring charts regularly maintained. Some residents were able to walk and wander freely in the safety of the home as was their habit or behaviour. Staff were very sensitive and mindful towards the particular mental health needs of residents, with support and respect given towards the variety of ways in which issues associated with their mental health manifested. One resident told us ‘staff look after us very well’. A visitor told us that the care at Wyatt House was ‘top of the tree’. She said that staff ‘looked after her relative so well, and had a very good approach with him’. Staff who responded to our survey told us that they had access to good information about residents’ needs. A staff member told us that they had ‘regular handovers of information, were kept well informed about residents’ needs, and had access to the care plans’. A visiting healthcare professional told us that Wyatt House’s team ‘frequently go the extra mile’. He said that staff ‘regularly discussed residents’ issues’ with him and ‘tried to resolve problems’. The person went on to report good communication between staff and residents, and that staff ‘sought his input and support to provide advice and training in all aspects of dementia care’. It Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 13 was his view that, during his contacts with residents he had found them ‘very contented overall’. He said that the home was ‘respectful towards residents, and was very strong on dignity’. He also reported that ‘staff reacted well to any directives and promoting residents’ safety’. All of the residents’ medications were managed by the nursing team. The registered nurse was observed returning to complete the 8am medication round late into the morning. The majority of the medications had been administered earlier, but there remained some which were outstanding. This was due to medication rounds needing to be flexible to suit the needs and challenges of the residents. A good amount of time was being devoted to ensuring that residents were taking their medications as prescribed. The nurses ensured that subsequent administration times were adjusted to suit. Medications were stored safely and hygienically. Medication administration records were printed by the supplying pharmacist and were well maintained by the nurses. There were clear instructions for medication usage and clear records of administration. Medications prescribed for use ‘when needed’, either orally or topically featured in an associated plan of care which gave very clear indications for its usage. In one case covert administration was being practiced. This had been decided upon in a multidisciplinary way, with due consideration given towards the residents’ health, safety and wellbeing, and was supported by clear documentation. The doctor involved had signed the records for the covert administration in the resident’s food and drink, as ‘being in order to maintain wellbeing’. We conducted some random audits on medications, and these were generally in order, however we found a discrepancy in one case. Our audit revealed that there were seven tablets in excess of what there should have been in stock, taking account of the number signed out by staff. This could not be fully explained at the time, but the manager and deputy manager resolved to discuss and investigate the matter with the nursing team. Nursing staff had received updated training in medication management, and had access to the medication policies and procedures. Care was delivered to residents in the privacy of their own room, and all efforts were made by staff towards ensuring their dignity in communal areas. Staff were consistently respectful towards residents. The home has been part of a pilot scheme to focus more closely on developing a more individualised care planning system to understand and address residents’ particular advanced wishes in the event of their death. The home was endeavouring to involve families as well in this planning. We saw some examples where advanced care planning was in place. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 14 Death and bereavement training was planned for staff. The AQAA reported that ‘reflective meetings’ were held after a resident had died, in order to share memories and reflect on practices. One such meeting was being held in the home during the week of our visit; the deceased person’s next of kin had accepted the invitation to attend. Wyatt House DS0000064585.V377152.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are excellent arrangements to ensure that people living in this home can remain socially occupied according to their ability and choice, and also have a good diet that focuses on variety and nutritional content. EVIDENCE: The home had a designated social activities coordinator, who had undertaken specific training so that she could provide residents with dementia the appropriate social activity and occupation. She was well informed and equipped to meet the social and recreational needs of people with dementia. Full records of planned and past activities were kept, and these demonstrated the activity participants, the benefits and challenges with the activity that had been identified, and the levels of supervision required, and the choices that people had made. There were photographs of past events, with many seeming to enjoy the container gardening. A programme of activity included reminiscence, crafts, Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 16 musical entertainments, and exercise. There was a lot of equipment and accessories to support a varied activity programme. We saw examples of the residents’ life history books that had been started. These were highly informative about many aspects of the residents’ past life, helping staff to understand the residents better, and help residents with important reminiscences and memories. The AQAA stated the layout of the building and the restrictions upon space has meant that group activity can sometimes be compromised, but that staff had endeavoured to overcome this by organising and tailoring activity to suit smaller groups; we saw small group activity sessions taking place during the course of our visit. Residents were involved in craft work, and those with a past interest in baking were sitting with the coordinator looking at a cake-icing book with pictures, which was provoking some memories and discussion. The home had links within the local community, and the local church provided a monthly multi-denominational religious service for the residents in the home. A weekly ‘reflection group’ was also held during which residents could enjoy some quiet time, sing hymns and ‘reflect’. One person who responded to our survey said that they were given ‘plenty of choice in all matters, and enjoyed going to the day centre’. They also said that they would ‘like more trips out and a regular newspaper’. A member of staff commented that staff ‘could do with more one-to-one time with the residents, and that more trips out should be arranged’. We found that trips out involved a great deal of organisation and relied upon very high levels of supervision and one-to-one support from the staff in order for them to be successful for the residents. As a consequence of this, trips tended to be for very small numbers of people on a periodic basis. Visitors were welcomed into the life of the home. We met one visitor, who said that they were made to feel ‘very welcome here’, and could stay and have a meal with their relative if they wanted. They told us that the staff ‘shared in their husband’s sense of humour and allowed him to be himself’. The AQAA reported that the home aimed to make life as flexible as possible for residents, and to support them with meaningful activity and occupation. A visiting health care professional also commented on this as one of the things that the home did particularly well. We saw that this was the case, with staff consistently offering appropriate choices to people. They were very encouraging towards residents, and adapted flexibly to suit their changing demeanour, decisions and behaviours. Staff also interacted on a social level with residents as they carried out their duties. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 17 Residents were actively encouraged to personalise their bedroom, although some appeared less personalised than others. Those residents who were able were allowed to wander and move around freely within the safety of the home. The AQAA reported that residents’ meals were fortified to aid nutritional requirements, and that snacks were available between meals. Meal times were made flexible around the more organised timeframes, with residents supported to eat when and where they preferred. One lady was supported to finger-feed, as she disliked being fed. We discussed nutritional requirements for people with dementia with the cook. She had yet to complete training in this area, but was informed about the residents’ needs, and confirmed the fortification of meals that existed, and the ready supply of snacks available to residents, particularly for those for whom a higher calorie intake was important. Staff used a variety of ways to ensure that residents were enabled to make their choices from the menu. Staff said it was important to them to know the residents, so that they had a good understanding of people’s likes and dislikes. The cook regularly observed residents with their meals whilst she was serving, and got to know what was particularly appreciated by some and not others. There were a number of choices for breakfast, and we saw residents having a cooked breakfast, cereals or porridge, toast and preserves. There were two main choices for lunch, although we saw other choices being accommodated where necessary. Special diets were observed, and pureed foods were well presented. All food looked nutritious, well cooked, and well presented. Staff were assisting where it was needed, and were very patient, supportive and encouraging to people. Eating and drinking aids were provided. We saw at least one resident eating their cooked breakfast between 10am and 10.30am, who then went on to have a cooked lunch before 1pm. Despite this short time lapse the resident had no problem enjoying both meals in their entirety. However, staff should remain mindful of short time lapses between meals having the potential to impact on residents’ appetite under certain circumstances. The kitchen was clean and well organised. There were full stocks of food stuffs, and catering records were maintained. People generally responded favourably about the food. One person told us that their ‘needs were looked after well, but that they would like more healthy and whole foods, with more exercise’. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can be reassured by the homes complaints procedures and the very sound policies regarding the recognition and prevention of abuse. EVIDENCE: The home had a clear complaints’ policy, which was displayed in the entrance hall, and which was included in the information brochure issued to residents and their families. A record of any concerns and complaints that had been received was maintained. This showed a recent complaint, for which we saw full investigation notes and statements, plus all records of correspondence; the complaint had been robustly addressed. The complainant had been able to meet with the management of the home to discuss things as well. A monthly audit of complaints was being carried out. The home had policies and procedures in place to protect the vulnerable residents. The protection of vulnerable adults had a high profile in the home, with information and guidance readily available to all. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 19 The manager and the deputy manager had both undertaken specific training with the local authority in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff had received training in Abuse, MCA and DoLS. All staff were issued with an easy-read version of the MCA during their induction training. Sound care planning was in place to show that residents’ rights were upheld, and that robust multidisciplinary arrangements were in place for the protection of an individual where significant concerns existed over their safety, wellbeing and liberty. Since the last inspection the home has made isolated reports to us when any concerns about residents’ safety and welfare have arisen. One case was reported to the local safeguarding team for consideration, with certain elements transpiring to be without foundation. However, as a consequence of this we identified certain matters which could have been better addressed by staff in the home at the time, and we issued some statutory requirements for improvement, which had all been satisfactorily addressed. Residents appeared completely comfortable and at ease with the staff, as did the staff in response. A relative indicated their complete confidence in the staff and the home overall. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although certain aspects of this environment could be improved upon, people living in this home are generally provided with accommodation that is suitable and safe to meet their needs. EVIDENCE: Wyatt House was constructed some time ago, and as such parts of it appear well worn and basic. However, certain adaptations have been made to ensure its suitability to provide care for people with dementia, and there was an ongoing programme to redecorate and maintain it. Carpets had been replaced with alternative flooring to ensure good hygiene, although this had the potential to detract from a more homely feel, depending on what else was in the room. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 21 The dining room and lounges had been refurbished, although the windows in the dining room were in a very poor state of repair at the time of our visit. These were scheduled for replacement in the near future. Numerous parts of the corridors’ low ceilings were damaged, reportedly by water, which required attention; we were told that work to rectify this damage was in hand. There was an area of crumbling and peeling wall covering above some of the shelving in the dry food store that required attention. The cook said that ‘she thought this had been reported to the maintenance person’. When we pointed this out to the manager she took steps to ensure that the necessary action was being taken. There was an enclosed and well maintained garden, which was accessible to residents. The patio had been rebuilt so as to provide safer access for the residents. The home was clean throughout. We detected unpleasant odours in the environment at various times, although these tended to be reasonably transient, with the staff working to ensure that these were addressed appropriately. Residents were provided with a plastic water jug in their bedroom. Sticky labels had been attached to the jug lids, (some of which were remnants of old labels with new ones on top), which staff were dating when the water was refreshed. This practice conveyed a slightly ‘institutional’ impression, and also looked unsightly. The laundry was being well managed, with residents’ clothing and all other items segregated and laundered as part of infection control procedures. The sluice rooms were tidy and clean, with all grades of clinical waste correctly managed. There were disposable gloves and aprons, liquid hand washes, paper towels and sanitizers around all areas of the home. One person who responded to our survey commented that the home was ‘always clean and tidy’. Another said that their room was ‘always kept spotless’. A visitor commented to us that ‘the rooms were kept very clean’. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home receive care from a stable, competent and considerate work force, and are protected by a safe staff recruitment procedure. EVIDENCE: We discussed the staff rota with the manager. Routinely there was one qualified nurse and seven care staff on duty in the morning, and one nurse and six care staff during the afternoon and evening. The manager aimed to provide two qualified nurses on some mornings when possible. One nurse and three care staff worked at night. There was a good team of ancillary workers, which included catering, cleaning, laundry, maintenance and administrative personnel. The home had a stable and cohesive core group of staff, and in the main the use of agency staff was kept to a minimum. The manager was supernumerary to the care team numbers, and shared a positive working relationship with the home’s deputy manager, who was a Registered Mental Nurse (RMN), possessing good knowledge of the needs of the resident group. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 23 Staff demonstrated a calm and attentive approach and demeanour with residents. All whom we witnessed had an approach that displayed mutual respect with each other, as well as the residents. One of the visitors told us that ‘staff had a particularly good approach with their relative in the home’. One person who responded to our survey commented that the staff were ‘always available’. One person commented that the staff were ‘very kind, patient and helpful’. Two members of staff told us that ‘there was a good reliable team of people who worked exceptionally well together’. There was an expectation that care staff started a National Vocational Qualification in Care (NVQ). There was approximately 70 of care staff who were qualified to a level two standard. Some were qualified to level three. More staff were currently working on the award. We inspected recruitment files for two more recently appointed staff. Application forms provided a full and detailed employment history. Two references, one of which was from the previous employer had been obtained, and proof of identity had been confirmed. Verification of why the worker had left their last place of work had been sought when applying for references. Formal interviews had been conducted in each case. The correct Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks had been carried out. Medical fitness had been confirmed. Equal opportunities monitoring was being carried out, and job descriptions, offer letters and employment contracts had been issued. The home had a designated training coordinator, who worked in conjunction with the manager. Staff had individual development portfolios that contained their records of training and achievement. A training matrix was maintained for monitoring and planning the delivery of training to all staff. Records showed a wide range of training courses that were specific to each job role in the home. Given the particular needs of the residents living in Wyatt House all staff had received specific training in Dementia Care; five care staff were undertaking a more in-depth training course in this with the Care Home Support Team. Staff had received training in Person-Centred Care, in order to promote the delivery of a person-centred service to the residents. There were good induction training arrangements, with care staff receiving training in the Common Induction Standards for Care Workers. New staff worked under supervision during this period, and also undertook additional essential training in areas such moving and handling, recognition and prevention of abuse, infection control and fire safety. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 24 Staff who responded to our survey confirmed good induction and training arrangements. One carer wrote that ‘person-centred care was at the heart of Wyatt House’. One particular person told us that they did not receive adequate ongoing training for their needs, and that more relevant training should be provided for the nurses on the team. Nurses had attended a study day covering recordkeeping issues and certain clinical points, however the home’s AQAA acknowledged that this was an area for improvement. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems in place here ensure that the interests, and health and safety of the residents living in the home are safeguarded. EVIDENCE: The manager of Wyatt House is an experienced manager, who is a registered nurse with the Registered Manager Award. She has done some additional training in the care of people with dementia, as her original qualification was in general nursing only. She has been registered with us for her role. She was welcoming to us, and was helpful and cooperative with the inspection process. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 26 The home’s AQAA had been completed to a good standard, with information contained within it evidenced during the course of this inspection visit. There were a number of systems used to monitor and improve quality in the home. A major internal audit had been planned during the second day of our visit, but was postponed briefly to accommodate us. The manager used the home’s own auditing tools to monitor standards in a number of areas, such as care planning, medication management, complaints and the environment. An annual quality assurance survey was conducted with residents and their families and other stakeholders, the results of which were being collated ready for an action plan to be drawn up to address issues that were raised. The home’s Business Plan was on display for people to read, and there were feedback and suggestion forms also available. Residents and relatives were encouraged to give their views on the care they experienced, and to request any changes or additions that they would like made to the service during a six monthly review of their placement in the home; recorded examples of this were seen in residents’ care plans. The manager told us that she had plans to introduce a regular relatives’ meeting, but for the present time all were welcome to seek more informal meetings whenever they wished. Serious concerns about the safety and liberty of one particular resident had arisen. Staff had taken all the appropriate steps to protect this person in terms of their safety and wellbeing, whilst endeavouring to take the least restrictive option for them in order to afford protection. The home had consulted with the DoLS Authority, and a Mental Capacity Assessment and a Best Interests Assessment had been carried out, and an Independent Mental Capacity Advocate had been appointed. A DoLS had been authorised in this case, and was due for review in two months time. Some residents had chosen to place personal money in the home’s main safe for safe-keeping. Records were maintained in each individual case, which contained evidence of running balances and transactions. Some receipts were attached to account for financial transactions carried out by staff on the resident’s behalf, and two members of staff signed records in the absence of a resident being able to sign for themself. In certain cases, such as with the chiropodist, the hairdresser or the home’s own shop, there were no actual receipts as such. However, financial records could be checked against the associated registers maintained in each of these three circumstances to ensure accuracy and transparency. The chiropodist and hairdresser had signed their name on the individual’s record as well. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 27 There was a programme in place to deliver formal supervision to staff. A matrix was used to plan and deliver the programme, and this showed that staff were receiving it on a regular basis. One of the sessions for staff was an annual Performance Development Review. Those staff responsible for delivering the programme had received appropriate training. Staff confirmed to us that they received regular support and supervision. The home had written policies and procedures for the promotion of the health and safety of the residents, visitors and staff, and associated training was provided for staff. Immaculately kept maintenance and servicing records showed us that regular safety checks and planned maintenance visits had been carried out on the fire safety systems. Residents had an individual fire safety risk assessment in their care plan. Fire extinguishers around the home were guarded in order to protect residents and prevent the dangers of tampering with the equipment. Fire safety training had been delivered to staff, and this had incorporated theoretical and practical training, with instruction in evacuation procedures in the event of a fire. The home’s Fire Safety risk assessment had identified numerous areas of concern. A schedule of works had been drawn up in risk priority order to address each of the areas over the coming months. Automatic door closers had already been fitted to all bedroom doors as an additional safety feature in the event of fire. Hot water temperatures were being monitored for safe levels, and a Legionella risk assessment and appropriate control measures were in place. Timely and regular safety checks and maintenance had been carried out on utilities and equipment. First aid facilities were readily available and staff had received First Aid training. Accident records were maintained. The home provided a generally safe environment for the residents, however given the state of disrepair that the dining room windows were currently in, a risk to the security of the home existed, and needed attention. The manager had raised this concern about security, and the work to replace these windows was scheduled in the near future. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 28 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 3 X 4 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 2 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? 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. 1 Refer to Standard OP26 Good Practice Recommendations The home should replace the plastic water jugs in residents’ rooms, and consider alternative methods of ensuring that drinking water is refreshed to replace the current practice of applying a dated series of sticky labels. Wyatt House DS0000064585.V377152.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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