Inspection on 10/01/06 for Warwick Park Nursing Home

This inspection was carried out on 10th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Warwick Park Nursing Home 12/09/06

Warwick Park Nursing Home 27/06/05

Warwick Park Nursing Home 06/10/04

Warwick Park Nursing Home 19/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Warwick Park Nursing Home 55 Warwick Park Tunbridge Wells Kent TN2 5EJ Lead Inspector Justine Williams Announced Inspection 10th January 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Warwick Park Nursing Home Address 55 Warwick Park Tunbridge Wells Kent TN2 5EJ 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) 01892 541434 01892 549991 Up-Beat Enterprises Limited Miss Karen Lesley Pratt Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 25 beds 20 are registered for Nursing Care and 5 for Terminally Ill. 27th June 2005 Date of last inspection Brief Description of the Service: Warwick Park Nursing and Residential Home is a large detached house set in its own grounds close to the centre of Tunbridge Wells. The Home has been adapted to provide accommodation for older people who require nursing and residential care. The accommodation consists of 15 single and 6 double rooms, however 2 of the double rooms are used as single rooms, which takes the occupancy to 23 residents. The home has three floors and access to the various floors is provided by a shaft lift. There are some rooms that are only accessible via a short flight of stairs equipped with a stair lift. There is a large, very well maintained garden to the rear of the building and limited parking to the front. The Home employs care staff that work a roster that gives 24-hour cover with a qualified member of staff on duty at all times. The Home also employs other staff for activities, catering, domestic and maintenance tasks. The aim of Warwick Park is to provide a home from home that caters as far as reasonably possible for the individual need and choice of each service user. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An announced inspection was carried out on 10th January 2006 between 9.50 am and 3.30pm by regulatory inspector Justine Williams. During that time a number of residents, staff, the registered manager and responsible individual agreed to speak with the inspector both in public and privately. Feedback was given to the manager and responsible individual during and at the end of the inspection. This report contains assessments made from observation, conversation and records. As part of the inspection process comment cards were received from residents, relatives and professionals. Comments made included: “the Primary Care Trust have confidence that any resident placed at Warwick Park will receive the best possible care” “the Matron clearly has the total well being of the service users at heart” “Warwick Park has a lovely atmosphere, and I am always impressed by its cleanliness” “My (relative) is not able to leave her room and staff are very good at chatting to her” What the service does well: What has improved since the last inspection? Residents’ dignity is better protected now that linen storage has been moved to accessible yet discrete areas. The risk of cross infection has been reduced by the purchase of a shower chair which is washable. The manager has Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 6 continued to work on the quality assurance tools in the home to promote good practice and identify any shortfalls. The home has begun to purchase adjustable beds and two have been purchased since the last inspection. Adjustable beds make caring easier for residents who have complex needs. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 7 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 Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,6 Residents are confident their needs can be met in the home through good admission procedures. EVIDENCE: The manager or another senior member of trained nursing staff assesses potential residents using a pre admission assessment form. These residents are assessed in their own home or hospital, the manager also requests copies of assessments undertaken by social services. All residents are reassessed on admission to the home and this information is recorded and forms the basis of the care plan. Each resident will be assessed by the relevant health care professionals for free nursing care. The manager ensures that the complex nursing needs of residents at Warwick Park can be met. A resident spoken with said the manager had met him in hospital and although he was unable to visit the home, his family had visited on his behalf. He had received written information about the home which he found useful. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 9 The home does not provide intermediate care. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Residents are treated with respect and dignity by all staff. Individual health and social care needs are managed well. EVIDENCE: Each resident has a plan of care which includes nutrition, skin integrity, continence and moving and handling assessments. The care plans were up to date, regularly reviewed and sufficiently detailed to enable staff to provide the care the resident needs. Resident’s files included risk assessments for falls and other specific activities the resident may engage in. The daily record contained reasonable detail and the Registered General Nurse countersigned all entries. A record of all visits by healthcare professionals is kept in each file and this showed good access to a variety of professionals including chiropody, speech and language therapists, and dieticians. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 11 The home has purchased several pressure relieving mattresses which it uses for prevention of pressure sores, indeed only one resident has a pressure sore which she was unfortunately admitted with, and which is now improving. Qualified nursing staff administer medication. The medication was stored appropriately and the administration records were completed correctly. The controlled drug cupboard is very small, it is recommended that consideration be given to the purchase of a larger one. Staff said at times it is very difficult to fit all the medication in the cupboard especially when residents are terminally ill, and on several controlled drugs. Lockable facilities are provided in rooms should residents choose to self-administer their medication. Residents confirmed that they were called by their preferred name. Throughout the inspection, staff were seen and heard to treat residents with dignity and respect. Shared rooms have privacy screening fitted, rooms on the ground floor have net curtains. Residents wishes regarding terminal care were not recorded on all the files seen, however the manager said for those residents who are terminally ill this is always recorded and they are in the process of gathering all residents views and wishes. Staff understand the special needs of residents who are dying and also the needs of their families and they endeavour to provide all the support they can. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents are encouraged to make choices about aspects of their daily lives. The range of activities and lifestyle experienced at the home meets residents’ expectations. EVIDENCE: Residents are asked their preferences regarding routines of daily living such as times they like to rise and go to bed, every effort to meet these is undertaken. Some residents chose not to participate in planned activities and the activity coordinator respects this and will spend time with individual residents according to their wishes. Resident’s arts and crafts are on display around the home, with photographs of events such as Christmas parties, summer ‘Pimms’ parties, and the recent trip to Howletts zoo. During the inspection several residents were playing croquet in the lounge with the activities coordinator. The activities coordinator keeps records of activities planned and participated in, residents spoke highly of her. Visitors said they are always welcomed to the home and are able to visit when they wish. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 13 Most residents chose to have their relatives manage their finances. Those who wish to and are able to have lockable space in their rooms and are encouraged to maintain their financial independence. Residents’ rooms contained their own items of furniture and personal possessions which they are entitled to bring in with them. Residents were very satisfied with the food, saying “the food is excellent”, “very tasty” and “cooked well” they also said that alternatives were cooked for them if they did not like what was on the menu. Many residents choose to eat in the dining room, which is pleasantly furnished with lovely views over the garden. Those residents who prefer to eat in their rooms may do so. Residents are offered a glass of wine with their lunch. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents’ rights to receive a safe and satisfactory service are protected. EVIDENCE: Residents and relatives said they had never had cause to complain, they were aware of the complaint policy which is in the residents guide and on display around the home. The policy contains all the necessary information with correct contact detail. The record of complaints has provision to detail information of investigations undertaken, outcomes and any correspondence. Residents said that whilst they had no cause to complain they felt confident that if they had to make one they would be listened to, and that “the matron would bend over backwards to make things right”. All staff have received recent adult protection training by the NHS Elderly Care Nurse Specialist. Staff had a good knowledge of adult protection issues and the homes procedure. Staff also understood whistle blowing. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24,25,26 Residents live in comfortable pleasant surroundings which would be improved by resolving infection control issues, some refurbishment and ensuring risk assessments are updated. EVIDENCE: Warwick Park has a very well maintained and attractive garden that the residents have full access to. Some areas inside the home however would benefit from refurbishment in particular one of the bathrooms, and some corridors where the carpet is frayed and baggy and could present trip hazards. Many residents’ bedroom doors, which the manager said were fire doors, are being propped open by systems not agreed with the fire safety officer. Urgent advice should be sought from the local fire officer regarding this practice and the fire risk assessment updated. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 16 One area of the home (which includes some bedrooms) was markedly colder than the rest of the home. The manager said there were ongoing problems with the boiler, the home had purchased fan heaters in the interim which were fitted to the wall in one corridor and one bedroom but not in all the areas affected. Some beds are not adjustable height, this was identified at the last inspection and two further beds have been purchased since then. The Manager said this is on the refurbishment plan and they are gradually replacing divans with adjustable beds. Skandia toilet frames have been removed since the last inspection and have been replace with fixed grab rails. The risks of cross infection have been reduced as the storage of linen has been reviewed and washable bathroom chairs have been purchased. The home was clean on the day of inspection however some infection control issues were identified. The use of foam padding on the bath hoist must cease unless it is for a named resident or for single use only, the manager said a washable cushion is on order. The bath on the middle floor is damaged and may present a risk of cross infection as it cannot be adequately cleaned. The laundry does not have a separate hand wash basin and the floor and walls are not impermeable or readily cleanable. It was recommended that the manager seek advice from the NHS infection control team. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Residents are cared for by a high level of competent, trained and experienced staff. EVIDENCE: Residents said staff were “like friends”, “very caring” and “can’t do enough for you”. There are high levels of staff and residents said they rarely have to wait when they ring for assistance. A Registered General Nurse (RGN) is on every shift and frequently an additional RGN is on during the day. The staff team are supported by the manager who is on site for management days as well as for shifts doing “hands on” care. The home employs staff for twilight shifts to assist with suppers and helping residents to bed. Other staff employed include house keeping, laundry, maintenance, kitchen assistants and an activity coordinator, who together ensure the smooth running of the home. The home has not employed any agency staff in several years and has its own bank of staff to fill in for sickness and annual leave. Residents are protected by the robust recruitment policy and procedure followed by the home. Two files seen contained all the information required by regulation. The home does not have any volunteers working at present. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 18 Staff said there is plenty of training offered, much of it in house, some provided by the Elderly Care Nurse Specialist. Other external training is available. Files showed that all staff receive training in “core areas” such as fire, manual handling etc, as well as more specialist training. Over 50 of care staff have achieved NVQ 2 or 3. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38 Residents are confident that the home is well managed and safe. EVIDENCE: The manager is still waiting for a start date for the Registered Managers Award. She is a qualified nurse with a degree in nursing and has kept up to date by further study. There are clear lines of accountability in the home which are understood by staff and residents. Residents clearly benefit from the open, friendly, inclusive atmosphere of the home and the manager’s approach. The manager’s open door policy and frequent chats with residents and relatives also benefit the running of the home. Residents and staff meetings offer formal strategies for feedback and having a say in how the home is run. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 20 The manager has been working closely with the Elderly Care Nurse Specialist on the homes quality assurance processes and they have audited many areas of practice the most recent being adult protection, using a formal audit tool. Residents control their own finances for as long as they wish and are able. The home does not manage the finances of any residents. A system for payment for services such as chiropody hairdressing and newspapers has been developed where the owner of the home pays for the services, then invoices the resident or their relatives. Residents and relatives are happy with this arrangement. Those records required by regulation are up to date, accurate and kept securely. The fire risk assessment was out of date and must be reviewed urgently. The manager conducts regular environmental risk assessments where she walks the building looking for potential problems. The current record does not record what action was taken where a problem was seen. A file of servicing and maintenance of equipment indicates that safety of supplies and equipment is maintained. An accident book is held which complies with Data Protection. Staff have policy documents, including health and safety, to refer to. Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 3 X 2 2 2 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 2 4 3 X 3 X 3 2 Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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. 1 Standard OP38OP19 Regulation 13 (4)(a) Requirement The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety in that: • Timescale for action 28/02/06 2 OP26 13 (3) Advice from the fire officer must be sought regarding suitable fire safety precautions, including suitable door closures • The fire risk assessment must be updated • Action must be taken to reduce risk of falls on loose and frayed carpeting. The registered person shall make 28/02/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home in that: • The use of foam padding on the bath hoist must cease unless it can be evidenced that is it used for a named resident or single use only. The bath on the middle Version 5.1 Page 23 • Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc 3 OP31 9 (1) (2) (i) floor must be repaired or replaced. • A separate hand washbasin must be provided in the laundry. • Laundry floor and walls must be readily cleanable with a finish that reduces the risks of cross infection. A person shall not manage a 30/03/06 care home unless he has the qualifications necessary to do so in that: He has a qualification at the NVQ level 4 or equivalent. This requirement is repeated from the last inspection and is ongoing 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 2. 3. Refer to Standard OP9 OP19 OP24 Good Practice Recommendations Consideration should be given to providing additional storage for controlled medication to ensure there is adequate space available at all times. It is recommended that complete refurbishment of the bathroom is undertaken as soon as possible. It is recommended that adjustable beds be provided for service users who request or require them, or as identified for health and safety reasons. This recommendation is repeated from the last inspection and is ongoing It is recommended that the problems with the boiler be resolved as soon as possible and environmental temperature be recorded. Alternative methods of heating should be used to ensure residents are warm enough. 4. OP25 Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Warwick Park Nursing Home DS0000026212.V263349.R01.S.doc Version 5.1 Page 25 - 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. 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