CARE HOMES FOR OLDER PEOPLE
Warwick Park Nursing Home 55 Warwick Park Tunbridge Wells Kent TN2 5EJ Lead Inspector
Justine Williams Key Unannounced Inspection 12th September 2006 09:30 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.V309825.R01.S.doc Version 5.2 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.V309825.R01.S.doc Version 5.2 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.V309825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Of the 25 beds 20 are registered for Nursing Care and 5 for Terminally Ill. Care of one service user is restricted to one person whose date of birth is 29/12/1953. One service user under 65 years whose date of birth is 15/6/1941. Date of last inspection 10th January 2006 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, further on street parking is available. 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 needs and choices of each service user. The current fees range from £575.00 to £700.00 per week. Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An announced inspection was carried out on 12th September 2006 between 9.30 am and 2.30pm by regulatory inspector Justine Williams. During that time a number of residents, relatives, staff, the registered manager and responsible individual agreed to speak with the inspector both in public and privately. Feedback was given to the manager during and at the end of the inspection. This report contains assessments made from observation, conversation and records. What the service does well: What has improved since the last inspection?
The manager has recruited a private consultant to provide advice and support around fire safety, equipment provision and risk assessment. The infection control issues found at the last inspection have been resolved with the purchase of a washable seat pad for the bath hoist, and advice sought and followed from the infection control team. the laundry walls and floor were painted with impermeable washable paint. The sink is used for hand washing only.
Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 6 The manager is undertaking the Registered Manager’s Award and expects to complete it within the year. The boiler has been replaced which has resolved the issues around heating in some parts of the home, due to it being somewhat temperamental. The hours worked by the activities co-ordinator have increased from part time to full time, providing greater access to the co-ordinator for those residents unable to participate in activities and the greater provision of activities. 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.V309825.R01.S.doc Version 5.2 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.V309825.R01.S.doc Version 5.2 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): 3,6 Quality on this outcome area is good. This has been made using available evidence including a visit to the service. Residents are confident their needs can be met in the home through good admission procedures. Intermediate care is not provided. EVIDENCE: The admission records and assessments for 3 residents were seen. Each contained a thorough assessment carried out by the manager. In the event that the manager is unavailable a registered nurse from the home or the deputy manager may carry out the assessment. The service considers carefully the needs assessment for each prospective resident before agreeing admission to the home. One resident spoken with who had recently moved to the home spoke of how the manager had come out to carry out the assessment, explained about the home although she was already familiar with it and given her written information about the home. The joint assessment is requested by the home for residents who have care managers from social services.
Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 9 All residents are assessed for their nursing care needs contribution from the NHS in accordance with guidelines from the Department of Health. Intermediate care is not provided at Warwick Park. Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 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 Quality on this outcome area is good. This has been made using available evidence including a visit to the service. Residents’ health and personal care needs are well managed and residents are treated with dignity and respect. EVIDENCE: The care plans are written in plain language, are easy to understand and consider all areas of the individual’s life including health, personal and social care needs. The plan also includes a risk assessment for falls, nutritional status, moving and handling, and continence. More able residents are involved in the drawing up of their care plans, the relatives of less able residents are encouraged to become involved where appropriate and with due regard to confidentiality. Risk assessments for specific activities the resident undertakes were not seen on the files, and these should be developed to provide a more comprehensive management plan. The home ensures that each resident’s plan is reviewed regularly. The manager and trained nursing staff are aware of current policy issues and topical reviews of care for older people, and the home works to transfer this into the daily work with residents.
Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 11 The health care needs of those residents too frail to leave the home are managed by visits from local health care services, for more able residents staff and family support them to access healthcare in the community as needed. Residents’ personal aids are well maintained. The home continues to work closely with the tissue viability and elderly care nurse specialist, and continues to have a good track record in the prevention and healing of pressure sores. The medication policy and practices followed at the home are robust. It was identified at the last inspection that due to lack of storage for controlled drugs additional storage was needed, this is not an issue at present, and so should be reviewed as and when necessary. None of the residents are self administering medicines at present though each resident has lockable storage in their rooms. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity and these values are fundamental to the philosophy of care at Warwick Park. A concerted effort is needed to record the wishes of all residents upon death, whilst this information is sought for terminally ill residents, should a resident die unexpectedly or deteriorate suddenly their wishes may not be known. The staff have robust policies for care of dying residents to follow. Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 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 Quality on this outcome area is excellent. This has been made using available evidence including a visit to the service. The range of activities and lifestyle experienced at the home surpasses most residents’ and relatives’ expectations. Residents are encouraged to make choices about aspects of their daily lives EVIDENCE: Residents are able to enjoy a full and stimulating life style at Warwick Park. The home has sought the views of residents and considered their varied interests and abilities when planning the routines of daily living and arranging activities. Routines are very flexible and residents can make choices in all areas of their life. The routines and activities at the home are resident focussed, regularly reviewed, and can be quickly changed to meet individual residents needs. Relatives are encouraged to be involved with the activities and are invited to trips out. The residents have recently enjoyed a trip to the Hawkenbury show and many including some residents with very complex needs recently went to Burrs wood for the afternoon and for cream teas. Residents have also been to the theatre, to a local garden centre and the home recently held its annual summer fete. The activities co-ordinator has recently had her hours increased to full time and residents and relatives spoken with were very happy with this and continue to speak very highly of her.
Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 13 Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them to have a drink or a meal with the resident. Residents can choose to entertain visitors in their own rooms or any other part of the home where they choose. Relatives spoken with said they felt very welcome at the home and that they were offered support and care at difficult times. The home would record and actions any restrictions, which the resident may make on who they wish to visit them. The importance of meal times and an interesting and nutritious diet is understood by the cooks, kitchen assistants, manager and indeed all the staff. Relatives spoken with said the residents are assisted with meals and drinks sensitively and discreetly. The menu is varied, balanced and nutritious, it is displayed daily in the lobby next to the dining room. It is recommended that menus be made available elsewhere as well and that the choices also be displayed, as it is not immediately obvious that there is a choice available. Residents who miss a meal are cooked something of their choice fresh, and if a resident felt unwell, then wanted to eat outside of the “meal time” whatever they wanted within reason is cooked for them. Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 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 Quality on this outcome area is good. This has been made using available evidence including a visit to the service. Residents can express their views and be listened to. They are protected from the risks of abuse as far as is possible. EVIDENCE: Residents and relatives spoken with could not think of anything at the home that might give them cause to complain. When encouraged however they said understood who they could make a complaint to, and that the home’s complaints policy was displayed and available for them to use. The home has had 2 complaints since the last inspection, both of which were dealt with by the manager swiftly and to the satisfaction of the complainants. A good standard of recordkeeping is held in respect to complaints and action / investigations undertaken. Policies, procedures and the home’s documentation reflect the rights of the individual. The home safeguards its vulnerable residents as far as possible through its policies, procedures and working practices, and also its supervision of staff and robust recruitment procedures. Staff have received training in adult protection and receive planned updates to refresh their skills and knowledge. Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 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): 19,26 Quality on this outcome area is adequate. This has been made using available evidence including a visit to the service. Residents live in what they describe as a homely and clean environment, which would benefit from some refurbishment, and renewal of some furnishings etc. EVIDENCE: Warwick parks garden continues to be well maintained and attractive, and residents have enjoyed the garden over the summer months. Carpets have been replaced in a couple of areas and carpet and non-slip flooring has been purchased for other areas in need of renewal. The manager said some areas will be refitted with carpet next month. The home does not have a documented programme for renewal and maintenance, this is recommended. The manager has employed the services of a maintenance company to help with updating fire risk assessments, checking of equipment, etc. The home has recently had a new boiler fitted, and the manager does not anticipate any issues with heating the home over the coming months.
Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 16 Some beds are not adjustable height, this was identified at the last inspection and no further beds have been purchased since then. Whilst the manager carefully considers who she is able to admit based upon this and other factors, the lack of adjustable beds could present a significant health and safety issue for staff and residents, and therefore must be addressed urgently. Some items of furniture, chest of drawers and wardrobes are in need of renewal as they do not close properly and are becoming tatty. A toilet frame in one of the toilets should either be fixed to the ground or grab rails fitted. Bathrooms and toilets and other hand washing areas were stocked with liquid soap and disposable hand towels in line with good practice, however the hand towels do not fit in the dispensers and thus were left on top of the dispenser this could present an infection control hazard. The laundry walls have been painted with impermeable, washable paint, but the floor needs re painting as several areas have become worn or damaged. The sluice flooring needs replacing with flooring that is continuous to reduce the risk of cross infection. Whilst the home was mostly free from offensive odours, 2 bedrooms had a strong odour, the manager assured the inspector that the carpets are cleaned frequently in these bedrooms, the manager and inspector discussed other flooring options which may reduce the odour. The number of beds and bathrooms in use was also discussed, in view of the homes lack of handy storage. Residents and relatives said the home is always kept very clean. Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 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 Quality on this outcome area is good. This has been made using available evidence including a visit to the service. Residents are cared for by a high level of competent, trained and experienced staff. EVIDENCE: The number of staff on duty frequently exceed that which was required by the registering body. The home has a written staff roster. The manager increases staffing levels in accordance with the needs of the residents. A Registered General Nurse (RGN) is on every shift and frequently an additional RGN is on during the day. For the majority of time residents do not have to wait long for assistance when they ring their buzzers. Warwick Park has a bank of casual staff to call on if needed to cover sickness and annual leave etc, and has not employed any agency staff for some years. Residents are protected by the robust recruitment policy and procedure followed by the home. A variety of in house and external training is available for staff and regular updates are provided in mandatory training. 59 of care staff have attained NVQ training at level 2 and many are now undertaking level 3 training. Residents report that staff working with them are very skilled in their role, and are consistently able to meet their needs. Ancillary staff employed include house keeping, cleaning, laundry, maintenance, kitchen assistants and an activity co-ordinator, who together with the carers and RGNs ensure the smooth running of the home.
Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 18 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): 31,33,35,38 Quality on this outcome area is good. This has been made using available evidence including a visit to the service. Residents are confident that the home is well managed and safe. EVIDENCE: The manager is an RGN, with many years management experience. She has been running the home for several years, has a nursing degree and is part way through the registered managers award. The manager is highly competent to run the home and meet its stated aims and objectives. The manager is an excellent role model for staff and her leadership skills foster a caring fun and motivated staff team. The manager ensures she undertakes periodic training to update her knowledge and skills. Some quality assurance systems are in place, such as tracking of accidents and complaints to look for trends, annual quality assurance questionnaires, and some documentation audits.
Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 19 The service will benefit from formalising some of the systems and by pulling together the information into a report, showing where the service is now, and what the manager and staff hope and wish to accomplish at the home in the future. 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. Occasionally for some residents a small amount of cash is held, this is kept separately and with balance sheets and receipts kept. Those records required by regulation are up to date, accurate and kept securely. It is recommended that all policies be dated and signed by the author or ratified by the manager, and that reviews of policies are evidenced by dating and signing when this has taken place. Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 20 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 3 X 2 X 3 X X 3 Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? no 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 OP26 Regulation 13 (3) Timescale for action The registered person shall make 28/10/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home in that: Laundry floor must be readily cleanable with a finish that reduces the risks of cross infection. The flooring in the sluice should be replaced to provide a continuous surface to reduce the risk of infection. Requirement 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 Refer to Standard OP7 OP15 Good Practice Recommendations It is recommended that all entries in the daily events of the care plan be timed, currently staff put AM PM etc. It is recommended that alternative choices be displayed on
DS0000026212.V309825.R01.S.doc Version 5.2 Page 22 Warwick Park Nursing Home 3 OP19 4 OP19 5 OP24 the menu and that menus be more widely available in residents rooms for instance. It is recommended that a written plan for renewal be produced and that planned refurbishment to bathrooms replacement of carpets in hallways and bedrooms etc be undertaken as soon as possible. It is recommended that complete refurbishment of the bathroom is undertaken as soon as possible. This recommendation is repeated from the last inspection and is ongoing 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 6 OP38 It is recommended that policies be signed and dated by the author and ratified by the manager and signed and dated when reviewed. Warwick Park Nursing Home DS0000026212.V309825.R01.S.doc Version 5.2 Page 23 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
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