CARE HOMES FOR OLDER PEOPLE
Warwick House Bonsall Avenue Littleover Derby DE23 6JW Lead Inspector
Janet Morrow Unannounced 18th May 2005 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 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 House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Warwick House Address Bonsall Avenue Littleover Derby DE23 6JW 01332 718720 01332 718720 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Derby City Council Caroline Brighouse Care Home with personal care 28 Category(ies) of Old Age registration, with number of places Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 22ND November 2004 Brief Description of the Service: Warwick House is a 28 bedded home for older people situated in Littleover, a suburb of the city of Derby. The home has been refurbished to provide six places for intermediate care and will provided twenty two places for respite care over a phased period. The property was purpose built and is owned by the local authority, Derby City Council. Service users’ bedrooms are situated on the first floor, which is accessed by stair lift and passenger shaft lift. The intermediate care bedrooms are situated on the ground floor and are en suite. All bedrooms are attractively decorated and personalised. Communal areas are bright and décor is of a good standard. There is a garden area with patio and outdoor seating. Support services are in place with a choice of General Practitioners, and visiting district nurses, chiropodist, dentist and optician. Community psychiatric nurse, occupational therapist, physiotherapist and dietician are accessed as required. Staff training takes place to inform and enable staff to care for service users appropriately. Transport is arranged for those service users wishing to go out and in house entertainment is arranged. Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over 7.3 hours, with follow up telephone calls being made to relatives and visiting professionals. Care records were examined and documents and policies were read. A tour of the building was undertaken. Five members of staff, nine of twenty-three service users, two relatives and three professionals were spoken with. One relative and two visiting professionals were contacted by telephone following the inspection visit. What the service does well: What has improved since the last inspection? Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 6 The access to the building and garden area had improved with the provision of new doors and ramps. The information provided in the statement of purpose had improved and now meets all the requirements of the Care Homes Regulations 2001. The adult protection policy had improved and a new employee handbook was being printed which contained details of how staff should report any concerns (whistle blowing). 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 House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3 and 6 The home provides clear information, which enables prospective service users to make am informed choice about the home. The care provided is relevant and maximises service users independence. EVIDENCE: The home had developed a comprehensive statement of purpose and service user guide that could be produced in large print if required. Terms and conditions of residence (contract) were examined and set out the obligations of both the Local Authority and the service user. Three service users’ files were examined and all had an assessment in place that provided the basis for a comprehensive care plan. The home had dedicated space with rehabilitation facilities. Specialist input from occupational therapists and physiotherapists was available and they had provided the training for care staff. One member of care staff per shift was deployed in the unit. The manager explained that additional staff, including staff from the Health Authority, were brought in as required and that better systems of working together were being developed, which included assessment staff working alongside care staff.
Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, and 10 Health care needs were generally met. However, lack of clarity and consistency in relation to risk assessment and care planning documentation could result in key areas of care being missed. EVIDENCE: Care plans were available on the three files examined. However, risk assessments were not always completed. For example on one file, a tissue viability assessment was not completed properly and on two other files a general risk assessment had not been completed. On one file a nutritional assessment had not been completed and on another it was only partially completed. It was therefore unclear whether or not a risk was present. There was no evidence of consultation with the service user on one of the files examined. These issues were raised previously at the inspection in November 2004. Service users’ interviewed stated that their privacy and dignity was respected and it was observed during the inspection that relationships between staff and service users were warm and friendly. Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 10 Service users interviewed stated that staff were ‘very kind’ and written feedback received by the home from a relative described the care as ‘outstanding’. Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 15 Social activities and meals are both well managed and provided daily variation and interest for people living in the home. EVIDENCE: Service users were spoken to during lunch-time and a meal was sampled. Everyone asked stated that the food was good and they enjoyed it. Mealtimes were flexible enough to accommodate individual preferences. Menus and recipes were examined and showed a good variety of meals were available. Written feedback received by the home from a relative described the food as ‘to a really exceptional standard’. Activities such as videos, quizzes and movement to music were detailed on a board in the corridor of the Cherry Tree Unit and service users were observed to be pursuing their own interests such as reading. Visitors were able to visit when they liked and stated that they were made to feel welcome at the home. Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 18 The home had a clear adult protection policy that operated in accordance with Derby and Derbyshire Local Authority Social Services procedures to ensure a proper response and protection to any suspicions of abuse. EVIDENCE: There had been no allegations of abuse since the last inspection in November 2004. The adult protection policy was comprehensive with clear procedures on what to do in the case of a suspicion of abuse. The policy stated that the procedure for whistle blowing was detailed in the Employee Handbook, but this was not available for inspection. The manager stated that it was currently being printed. Training records showed that staff had received training in adult protection. Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 20, 21, 22, 23, 24 and 26 The home was well maintained and provided safe, comfortable and homely accommodation for service users EVIDENCE: Bedrooms were personalised and comfortable. There were sufficient toilets and bathrooms with relevant equipment to assist those with disabilities. A new loop system had been fitted in the television lounge, clinic and dining room and three portable units were available for individual use. Communal areas were spacious and bright and had access to the pleasant garden area. Access to the patio area and at all the entrances had been improved by the provision of new doors and ramps. Furnishings and fittings were of good quality. The home was clean, tidy and odour free. Staff had received training in infection control and an outbreak of infectious disease in January 2005 had been dealt with appropriately, with the involvement of the Environmental Health Department.
Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Sufficient staffing and training is available to ensure staff are competent in their job and able to meet service users’ needs. EVIDENCE: There were sufficient staff on duty to meet service users’ needs but discussion with the manager highlighted recruitment of new staff as a problem. Agency staff were used to ensure staffing levels were maintained and the deployment of health staff and community staff to the intermediate care unit was reported as beneficial. Staff training certificates confirmed that they had undertaken training in moving and handling, fire safety, adult protection and infection control. Staff also confirmed that fire training was undertaken regularly. Those staff interviewed confirmed that there was good access to a range of relevant training courses. Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 37 and 38 The manager showed leadership and direction to staff to ensure that service users received consistent care. Quality assurance systems were inadequate to ensure that the home was run in the best interests of service users. EVIDENCE: The manager had completed the Registered Managers award and had many years experience in running the home. The management structure was well defined and lines of accountability were clear. A relative described the home as having a ‘pleasant feel’ about it. The atmosphere in the home was observed to be relaxed and informal and visitors described it as welcoming. There had been no progress on quality assurance issues other than a regular questionnaire to service users. There was no coherent plan of how the
Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 16 standard of care would be improved and no mechanism for obtaining the views of visiting professionals. Informal feedback received from ‘thank you’ cards and letters was positive with the home being described as ‘most impressive’ and ‘superb’. Relevant records were in place, including a valid registration certificate and insurance certificate. Care records required some improvement, as detailed earlier in the report. Health and safety issues were addressed with staff having undertaken relevant training in health and safety areas. Maintenance checks on equipment such as fire extinguishers, portable appliances and hoists were up to date. Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 2 x x x 3 3 Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 18 YES 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. 1. Standard op7 Regulation 15 (1) Requirement Risk assessments must contain specific information, particularly in relation to falls. Previous timescale of 1.5.04 not met although improvements made Information required by Schedule 2 of the Care Homes Regulations 2001 must be included in staff files. This requirement was not assessed on this occasion A quality assurance plan must be in place.The views of visiting professionals and other relevant parties must be obtained. Previous timescale of 1/8/04 not met The results of assessments must be followed through with appropriate interventions. Previous timescale of 1/4/05 not met All service users must have risk assessments proprerly completed and appropriate interventiopns detailed Service users must be consulted about their care. Timescale for action 1.8.05 2. op29 19 (1) (ac) & (4) (a-c) 1.8.05 3. op33 24 (1) 1.8.05 4. op8 15(1) Schedule 3 (3) (m)) 12 (1) (a) (b) & 13 (4) (c)) 15 (1) 1..8.05 5. OP8 1.8.05 6. op7 1.8.05 Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 19 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 op27 op33 Good Practice Recommendations Consideration should be given to specifying more domestic staff hours for tasks such as laundry. Informal views about the home should be collated to assist with quality assurance. Warwick House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection South Point, Cardinal Square Nottingham Road Derby DE1 3QT 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 House C02 C52 S35936 Warwick House V229061 180505 Stage 4.doc Version 1.30 Page 21 - 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!
