Inspection on 14/12/06 for Warwick Nursing Home

This inspection was carried out on 14th December 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 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

Warwick Nursing Home 21/03/06

Warwick Nursing Home 08/12/05

Warwick Nursing Home 10/03/05

Warwick Nursing Home 10/09/04

Warwick Nursing Home 24/02/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Warwick Nursing Home 10 Warwick Crescent Harrogate North Yorkshire HG2 8JA Lead Inspector Donna Burnett Key Unannounced Inspection 14th December 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 Nursing Home DS0000027949.V322746.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 Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warwick Nursing Home Address 10 Warwick Crescent Harrogate North Yorkshire HG2 8JA 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) 01423 560807 01423 500885 Mrs Celina Jowett Mrs Celina Jowett Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range 60 upwards Date of last inspection 21st March 2006 Brief Description of the Service: Warwick care home is owned and managed by Mrs Celina Jowett and provides nursing care for up to 17 residents. Previously an Edwardian private dwelling, circa 1908, it has been converted and extended for its present use. It is built with a mix of stone facing and white washed pebbledash and is on two floors, including ground. There is a four person vertical lift, as well as a staircase, providing level access to the first floor. The home is located in a quiet residential area close to open parkland and within reasonable walking distance of Harrogate town centre. The ethos of the home is to provide a family run establishment in a homely environment. The home charges between £500-£625 per week which includes physiotherapy. Additional charges are made for newspapers, hairdressing and chiropody. The manager states that prospective service users and their families are given written information about the service and facilities, which the home provides. Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager returned a ‘pre-inspection questionnaire’ before the inspection began. The information supplied was used to help plan the visit to the home. Five hours were spent preparing for the inspection. The time was spent sending out surveys and comment cards and looking at the feedback received. Comments were received from two service users, seven relatives and two GP’s. Details are included in the main body of the report. One inspector spent five hours inspecting the home. The manager/provider was available for the duration of the inspection. Time was spent talking with residents, visitors and staff on duty at the time. A tour of the premises was carried out and observations were made of the day-to-day running of the home to try and see what it was like to live there. A selection of resident’s and staff’s files were looked at. Some health and safety records were inspected to make sure that people were being properly and safely cared for. Verbal feedback was given to the manager at the end of the inspection. What the service does well: One family member commented that ‘this is an excellent nursing home’ and that their relative is ‘well cared for’. Residents and their relatives say that the environment is ‘homely’, ‘quiet and gentile’. The home is clean and dose not pose a health hazard to people who live in it. The registered provider, who is approachable, has a big presence in the home and knows the needs of the residents well. Residents enjoy good quality food of their choice, which is of a high standard. Residents are offered a reasonable choice of recreational activities and physiotherapy in order to maintain, and in some cases improve, levels of independence. The home has a history of providing good quality nursing care and residents very rarely have cause to complain. Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Warwick Nursing Home DS0000027949.V322746.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 Nursing Home DS0000027949.V322746.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. The manager ensures that people are only admitted to the home if their care needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective service users are assessed prior to moving into to the home so that the manager can make a decision about whether or not the home can meet their particular needs. Wherever possible the manager visits people either at home or in hospital before they are admitted. People are not admitted if the manager thinks that either the home cannot meet their needs or that the environment would be unsuitable. Other service users are considered so that minimum disruption is caused by new people coming to live at the home. Prospective service users and their families can spend time at the home talking to people who live there and meeting the staff. This allows them to make their own minds up about whether or not this is where they want to live. A fourweek trial period allows people to decide if the placement is to become permanent. Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 9 Each service user has a written assessment on their file. Staff are informed of any particular needs that they might have, and are told about what help to give, before they arrive at the home. The information available allows staff to understand the social, personal, emotional and health care needs of people they care for. Standard 6 was not looked at, as the home does not offer an intermediate care service. Warwick Nursing Home DS0000027949.V322746.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. Service users get the care they need and are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user’s health and social care needs are clearly written down in their own, individual care plans. The plans are easy to read and in enough detail for care staff reading then to know what help and support to give. The plans are regularly reviewed and updated to take into account any changes. The home communicates clearly, and works in partnership with, GP’s and other health professionals. This ensures that people living at the home get the specialist help and support that they need and are entitled to. Service users see their GP’s in the privacy of their own rooms. Physiotherapy is provided at the home, free of charge to the service users. Service users spoken with felt they benefited greatly from this input and that it helped to keep their independence. The staff at the home understand the needs of the people they care for and are suitably skilled. When other professionals give specialist advise, the appropriate care is provided. Service users say they are cared for ‘perfectly’ and that the staff are ‘marvellous’. Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 11 Medications are stored securely in locked cupboards. A specific, qualified nurse takes responsibility for the ordering, receipt, and stock control of medicines and has an organised system, which minimises the chances of errors occurring. Records are kept which show what medication was given, to which person, by whom and at what time. Service users are treated respectfully and by the name they prefer. A telephone point in each bedroom allows service users to have their own private telephone if they wish. Screening ensures privacy for the service users in the bedroom which is occupied by two people. People living at Warwick House receive a high standard of care. Two family members commented that their relative’s mental and physical abilities have improved considerably whilst at the home. Service users and relatives who returned comment cards, and those spoken with during the inspection, all expressed complete satisfaction with the overall care provided at the home and said they would ‘recommend it to anyone’. Warwick Nursing Home DS0000027949.V322746.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. Service users enjoy meals that are nutritious and varied. They are encouraged to maintain close contact with family and friends who are welcome at any time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home choose how and where to spend their time. There is opportunity for social stimulation and interaction for those wishing to engage in either 1:1 or group activities. Service users have access to a visiting hairdresser, reflexologist, library, occupational therapist and physiotherapist. Information about what is on offer is advertised on a notice board in the entrance hall. Service users can greet their visitors in private who are more than welcome at any time. Refreshments are offered and visitors are invited to stay for meals if they wish. Service users are very much supported and encouraged to maintain contacts and relationships with family members. Service users bedrooms are individual and personal possessions are permitted. Safes are provided in each room so that service users who choose to look after Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 13 small amounts of money can do so safely. People choose when to get up and go to bed, where to eat their meals and when they want to bathe. Service users are extremely complimentary about the food. The cook knows the likes and dislikes of the people she caters for and is aware of the allergies/dietary needs that some service users have. Service users are asked about their preferences on a daily basis and have a genuine choice of ‘sometimes six or seven things to choose from’, according to one service user who was spoken with. There is a good supply of hot and cold drinks and snacks available throughout the days so that service users do not go for long periods of time without food or drink. Service users who require help are provided with the help they need, but still encouraged to be as independent as possible. Warwick Nursing Home DS0000027949.V322746.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. Service users feel safe, happy and well looked after. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is posted on a notice board in the entrance hall and assures complainants that any complaint made will be taken seriously and acted upon. Neither the manager nor The Commission for Social Care Inspection have received any complaints since the last inspection. Comments and discussions with relatives are recorded in individual service user’s files. Service users and their relatives find the manager approachable and do not hesitate to speak to her about any concerns they might have. When concerns are raised, the manager listens and takes the necessary action to deal with the problems. Discussions were had with the manager about how staff respond to service users that may display difficult or challenging behaviour. New staff receive induction training, which covers abuse awareness, but this training is not routinely repeated, formally. The manager says that she talks to staff about how to work with and care for service users in order to protect their own safety and the safety of the service user. The chances of service users coming to harm are minimal due to good communication and relationships between service users, the manager and staff within the home. Warwick Nursing Home DS0000027949.V322746.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. Service users live in a safe, comfortable home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives describe the home as ‘homely’ and caring. They describe the environment as ‘quiet and gentile’. Service users live in a home, which although not purpose built, is suitable for their needs. The manager complies with the requirements of the local fire service and makes sure that service users are protected against, and in the event of, fire. The home is kept clean and comfortable. Service users and family members spoken to say it never smells unpleasant. Bedding is laundered commercially, off the premises, as the home is not equipped to deal with large amounts of soiled laundry. This ensures that bedding is kept clean and the risks of infection reduced. The washing machine at the home operates at temperatures sufficient to control infection and is used mainly for service users clothing. Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 16 At the previous two inspections the provider was required to provide suitable sluicing facilities and a sluicing disinfector to improve infection control. Although this has been looked into, equipment has not been purchased. The manager has however, produced a written procedure for the cleaning of commodes and commode pots. This ensures that in the absence of more suitable equipment, service users are not at risk of infection. There have been no outbreaks of infection at the home and the current working practices seem good enough to keep service users safe and healthy. Warwick Nursing Home DS0000027949.V322746.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. Delayed checks on the suitability of new staff means that service users are not as well protected as they should be. The staff that have been confirmed as suitable to do the job, are competent and care for service users very well. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users and relatives say the staff are ‘committed to their job’, ‘very caring’ and ‘thoughtful’. One relative who was spoken with during the inspection commented that the staff team consisted of some of the ‘nicest bunch of women’ they had met. There is enough staff on duty at any given time to meet the needs of the service users who say that call bells are responded to promptly. There is always at least one qualified nurse on duty who is able to provide the specific nursing care that service users need. A number of care staff have achieved or are working towards a recognised qualification in care although the number is below the recommended ratio. This does not appear to have any negative impact on the care that the service users receive. The manager recruits staff who she genuinely feels are competent and able to provide the care the service users need. However, delays in satisfactory Criminal Records Bureau being obtained means that some staff are being deployed to provide care to service users before the manager can be certain that they do not have a criminal record or are not on the Protection of Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 18 Vulnerable Adults list. In some circumstances, verbal references are obtained and then backed up with two written references. Again, delays in obtaining the written references means that some care staff are providing care before satisfactory written references have been obtained. Whilst it is acknowledged that in order to keep service users safe, care staff may need to be recruited quickly, service users must not be placed at risk of being cared for people whose suitability has not been confirmed. The manager takes responsibility for the induction training of all new staff. Staff receive initial training which covers fire safety, abuse awareness and safe working practices. Several members of staff have recently attended fire lectures and training on infection control and moving and handling. Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. The manager is well respected and runs a safe home, in the best interest of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is run and managed by the registered provider who has a history of providing good quality nursing care to people living at the home. Service users, relatives and members of staff find her approachable and easy to talk to. Where shortfalls are identified that could impact on the safety of service users, necessary steps are taken to improve standards. The provider welcomes the opinion of service users and relatives and acts upon any comments or concerns that are raised. Records are kept of communications between family members, which shows that what they have to say is seen as important. Service users are surveyed formally approximately once a year. In between times, the provider regularly asks service users about Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 20 their satisfaction with the service. The cook speaks to service users on a daily basis to ask what they want to eat and to get feedback about the meals she prepares. Service users are encouraged to take responsibility for their own money and each room is equipped with its own safe so that money and valuables can be kept secure. The manager does not handle money on behalf of anyone living at the home. Staff are routinely observed providing care to make sure that their way of working is safe and does not harm service users. Formal 1:1 supervision is carried out on average twice a year and appraisals are performed annually. The manager encourages staff to approach her at any time should they have any queries or issues relating to their work with service users. Staff say they feel supported. Staff are trained and competent to provide care to service users, in a safe way. A selection of maintenance and health and safety records were looked at which show that equipment used by service users is regularly checked for its safe use. However, there was no evidence that bed rails were being checked to make sure they were being used safely, although the manager thought they were. The cook prepares food, which is safe to eat, in a kitchen that is clean and well organised. However, there is not a HACCP (Hazard Analysis Critical Control Points) plan, which looks at how food is handled to make sure the food produced is safe to eat. The provider needs to make sure that the cook has up to date information about the checks that have to be made, and the records that need to be kept, to make sure that food is stored, prepared and presented in a safe way. Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 22 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 OP29 Regulation 19(4b) Schedule 2 19(4c) Schedule 2 Requirement Timescale for action 14/01/07 2. OP29 3. OP38 13(4)(c) 4. OP38 13(4)(5) 23(2)(c) The registered provider must not employ anyone to work at the home until two satisfactory, written references have been received for that person. The registered provider must not 28/12/06 allow employees to deliver care, unsupervised, until an up to date, satisfactory, enhanced criminal record certificate has been received. The registered provider must 14/03/07 comply with the requirements of the current food safety legislation and seek further clarification from the environmental health department if unclear. Equipment used by service users 14/01/07 must be regularly checked, and a record kept to evidence the checks, to make sure that the equipment is safe to use. Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 23 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 OP18 Good Practice Recommendations The provider should arrange for all staff to attend up to date training in the prevention and reporting of abuse in care homes. The provider should consult with the infection control nurse to make sure that the system of maintaining hygiene, with regards to the cleaning of commodes and pans, is satisfactory. If recommended by the infection control nurse, installation of a sluice disinfector must be considered. The provider should continue to encourage care staff to undertake the National Qualification In Care. A 50 ratio of staff should be attained. A formal system of quality assurance should continue to be developed within the home. The provider may wish to consider refresher or more up to date training for the cook to ensure compliance with current food safety legislation. 2. OP26 3. OP28 4. 5. OP33 OP38 Warwick Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Nursing Home DS0000027949.V322746.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!