CARE HOMES FOR OLDER PEOPLE
Washington Grange Burnhope Road Barmston Washington NE38 8HZ Lead Inspector
Mrs Elsie Allnutt Announced Inspection 27th September 2005 09:00 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 Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 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. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Washington Grange Address Burnhope Road Barmston Washington NE38 8HZ 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) 0191 419 1955 0191 417 0100 washingtongrange@barchester.com Barchester Healthcare Lynda Errington Care Home 40 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (19) of places Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 05/05/05 Brief Description of the Service: Washington Grange owned by Barchester Healthcare Limited is a purpose built care home situated on the edge of Barmston housing estate in Washington. The home is close to a local health centre, pharmacy and social club. A short walk to the nearest bus stop provides access to the Galleries shopping centre and all its amenities, Sunderland City centre and to other parts of the surrounding areas. The home is a two-storey building offering single bedrooms with en-suite facilities that are easily accessed by a passenger lift and stairways. There are 19 bedrooms for older people on the ground floor and 21 bedrooms for older people with dementia care needs on the first floor. There is a range of bathrooms and showers, WCs, lounges and dining rooms on both floors. All parts of the building are easily accessible. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 7 hours during one day in September 2005. The view of service users and relatives were sought prior the inspection and the overall view found was that the care and support provided in the home was satisfactory. However 8 out 24 service users thought there were not enough activities going on, and 16 out of 27 relatives who visit the home felt that there were not always enough staff on duty. When interacting with the service users many made complimentary comments about the staff and their attitudes. They said; “they are kind,” “lovely people,” “they will do anything.” One of the relatives spoken to commented that they had no complaints and were happy with the service provided, another discussed issues, all of which had been noted prior to the conversation and will be addressed in this report in a constructive way. A tour of the building was made as well as an examination of a number of records. Six of the ten staff on duty during the day and twelve of the thirty-six service users and three visitors were spoken to. The Registered Manager of the home was not available on the day of the inspection so the Deputy Manager, the Administrator and the Clinical Nurse Manager accommodated the inspection process. What the service does well: What has improved since the last inspection?
Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 6 All of the Requirements and Recommendations of the last report had been addressed and although one was not fully addressed, some improvements to the service had been made as a result. More staff now are qualified in NVQ and as a result carry out their role effectively, this includes 75 of staff. Since the last inspection the home has aimed at improving the care plans. Of the care documents examined these demonstrated that the home has accessed general guidelines in relation to dealing with individual medical conditions, for example information in relation to diabetes was available in one person’s care plan with guidance on suitable foods to eat. Some senior staff confirmed that they had received training in relation to Diabetes, Parkinson’s disease and Dementia Care and as a result, feel better equipped to address individual needs relating to these conditions. A newly recruited Activities Coordinator now organises a range of activities to take place during the week both in the home and in the local community. This provides stimulation, exercise and interest for service users. She explained that she is aiming to develop further links in the local community and at the moment uses one of the local multi purpose community centres as one of their venues. At the time of the inspection a game of skittles was organised for the service users on the first floor and great excitement and enjoyment from the service users was observed. What they could do better:
So that the important information in relation to medical conditions is used appropriately and effectively, and meets the needs of the individual service user, specialist medical guidelines should be adapted to meet the service users’ individual needs. For example the appropriate foods to eat when experiencing diabetes should be related to the individual’s dietary care plan and their likes and dislikes, so that they eat appropriately and avoid the foods that may affect their condition and cause effect on their blood sugar levels. Care plans in relation to dietary need would help this and should be developed. So that staff are equipped to deal with such medical conditions all staff should receive awareness training in the medical conditions that affect the service users in their care. To avoid mistakes being made and the possibility of service users coming to harm when administering medication, all medicines must be labelled and named appropriately. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 7 So that service users have a comfortable and attractive environment in which to live, the home’s refurbishment programme should go ahead and the lack of facilities in one of the bathrooms should be addressed. Service users could be further protected and supported if reported complaints were more fully investigated and recorded and if the staffing numbers were reviewed effectively. The Registered Manager must ensure that staff receive planned supervision at least 6 times a year. 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. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,6 Service users are admitted to the home only after a comprehensive preadmission assessment, and so that the information is used effectively care plans are put in place. Although the care plan includes specialist information in relation to medical needs this is not always adapted for or relates to the individual. EVIDENCE: This home has been working hard to improve the content of the care plans. The person in charge of the home stated that all of the service users had a care plan and this was confirmed in the files sampled. Of the care files examined, all included relevant information in relation to the needs assessed prior to admission. However for one service user such information related to diabetes, and although the clinical information in relation to this condition was available, it did not refer to the individual needs of the service user. For example although the information referred to the general dietary needs of people with diabetes and foods that should be avoided, there was no individual dietary plan, with information in relation to the food likes and
Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 10 dislikes, or the balance of diet needed. Neither were there guidelines related to the steps to be taken in relation to the person’s blood sugar levels fluctuating or the possible reasons for this. This was discussed at length with the Clinical Nurse Manager. This home does not provide intermediate care. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Generally the healthcare needs of the service users are met while at the same time their dignity and rights are protected. However, further improvements can be made to ensure that staff understand how the information available, and the role they play in relation to medical issues, is related to the care of individual service user. Medication administration procedures generally ensure that the service users’ health care needs are addressed. EVIDENCE: Since the last inspection there have been some improvements in relation to addressing the medical needs of service users. Some staff have attended training in relation to Parkinson’s disease, Dementia Care and Diabetes and commented that their understanding of the problems experienced by service users with such medical conditions had improved, and they felt better equipped to deal with them. A discussion took place with the Clinical Nurse Manager who agreed that more awareness training is needed in relation to medical conditions so that all staff have a better understanding of service users needs. She confirmed that plans would be put forward for this to progress.
Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 12 The care of service users with diabetes was discussed with the Clinical Nurse Manager, and training information was shared, with the outcome that she would compile an information/training pack for staff to follow and refer to. Risk assessments were in place but the content of some could be improved so that they are more explicit and in relation to the service user’s individual need. The storage and recording of medication was examined. Both were satisfactory, except for one liquid medicine that the Pharmacist had failed to name. The deputy manager was advised of this. The administration of medication that was observed followed the appropriate procedures. All staff that administers medication have received appropriate training in relation to this. This home does not and is not equipped to deliver Intermediate Care. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 13 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 Service users are offered the opportunity of participating in a range of leisure and social activities enabling them to lead active and fulfilled lives, and are offered a choice of nutritious meals, to help promote their health and general well being. EVIDENCE: A new activities coordinator has been employed on a part time basis since the last inspection. This has reflected in the activity opportunities for the service users and one service user commented that, “there is always something going on if you want to join in.” Other service users commented on the range of activities they enjoyed, some had visited the theatre while others had enjoyed a trip out in the mini bus to a local venue. However some service users commented in their pre inspection comment cards that they felt that there was not always enough activities going on. The activity organiser explained that she has plans to develop the programme further and at the moment feels that she is getting to know the service users in relation to their needs and preferences. Records were available in relation to what activities service users have enjoyed and prefer. Service users confirmed that they make choices in relation to their lives. They also confirmed that they can manage their own finances if they wish, and there is a locked facility in their room if they chose to do this, or they can keep their
Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 14 money in the home’s safe and withdraw it when necessary. The administrator confirmed this and demonstrated how appropriate accounts of financial transactions were satisfactorily kept. Service users confirmed that there is flexibility in relation to getting up and going to bed and generally with daily routines, and always a choice at meal times. Although the kitchen staff and care staff confirmed that there were different choices for people with special dietary needs, one relative felt that what their relative was served did not always reflect this. So that service users have an opportunity to access support with decisions in their lives information in relation to an independent Advocacy Service is available. This was advertised on a notice board in the entrance hallway. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 15 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 The home has a satisfactory complaints procedure; however there was evidence that not all complaints are handled appropriately, service users could therefore be at risk. Service users are protected by the home’s Protection of Vulnerable Adults (POVA) procedures. EVIDENCE: The home has a procedure to record complaints. However when examining the records two complaints were recorded in the Complaints File Index but only one of these had a written account of the complaint made, the outcome of which was still pending. There was no written account for the other in relation to its content and how it was addressed and its outcome. This must be addressed. Records examined demonstrated that some staff have attended training in relation to the local authority’s procedures on the Protection of Vulnerable Adults. A copy of the procedures was evident in the home and staff were able to refer appropriately to them. It was advised that training arrangements must be made for those staff who still need to attend. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 16 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 So that the quality of the original high standards of the environment is maintained, and the service users enjoy comfortable and safe surroundings that promotes their dignity and self esteem, the home is in need of redecorating and refurbishment. The current bathroom facilities do not meet the full needs of the people using the service. EVIDENCE: Staff, both care and ancillary, confirmed that they had attended training in relation to infection control. The person in charge confirmed that a new laundry system has recently been implemented which protects service users and staff from the possibility of cross infection. The areas of the home inspected were clean and tidy and discussions with the handyperson confirmed that day-to-day maintenance issues were being addressed appropriately. However as found at previous inspections the original high standard of décor and furnishings is now showing signs of wear and tear. The easy chairs in the lounge on the ground floor are particularly in poor
Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 17 condition and do not provide comfort for service users. The person in charge stated that new chairs had been ordered. One area of the home has had a carpet replaced in response to a health and safety issue. This carpet does not blend in with other carpets or matches the current décor. In discussions with service users, their relatives and staff, concerns were raised in relation to one of the bathrooms on the ground floor that does not provide lifting equipment to assist service users in or out of the bath. As all service users using this service now need this facility there is now no choice of bathing facilities on this floor. This was discussed with the person in charge. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 18 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): 27,28,30 The staff team are qualified to meet the needs of the service users and are competent to carry out their role effectively, however the staffing levels remain inadequate therefore there is a risk that service users needs will not be fully met and that they may not be in safe hands at all times. EVIDENCE: There are 75 of staff now qualified in NVQ. This is a good achievement. In addition to this, records and staff confirmed that some staff have received training in relation to different medical conditions including Parkinson’s disease and Dementia. Senior staff confirmed that they have also received training in relation to Diabetes, however during discussion with senior staff it was agreed that all staff should receive training in relation to diabetes and an information pack for staff to refer to should be compiled. Information in relation to this was given to the Clinical Nurse Manager. The handyperson confirmed that she attends training in relation to her role and this recently has included training in relation to dementia. This she feels has been of great value particularly in relation to her interaction with service users. Staffing ratios remain a concern and as a result of observations made and comments received from service users and their relatives, this was confirmed. Staff and records confirmed that there is one senior member of staff and four carers on duty in the home during the day. The Activity Organiser and the Support Worker, working on a Reminiscing project, work part time hours and therefore are available only at certain hours and days.
Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 19 Time was spent observing activity on the Dementia Care Unit where, at the time, two members of staff were on duty in this area. Although it was evident that one member of staff was engaging with service users who were agitated or disoriented, while the second member of staff was assisting a service user with their personal needs, this was a difficult task for the member of staff to carry out effectively single handed. Although staff were working hard to address the needs of the service users and the senior member of staff on duty was working between both floors carrying out her senior role, for example administering medication, addressing GP and district nurse visits, as well as supervising staff, it was evident that the full needs of the service users were not being met. In addition to this records and staff confirmed that two senior members of staff are working long hours to accommodate a senior staff vacancy. So that senior staff can carry out their role effectively within reasonable hours, the staff vacancy must be addressed. These issues were discussed with the person in charge. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 20 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): 31,33,35,36,38 The manager is supported in her role by a supportive senior management team, effective administrative staff and systems, and a well-equipped staff team, all of which promotes the health, safety and welfare of the service users. EVIDENCE: In the absence of the manager, the Deputy Manager and the Clinical Nurse Manager effectively, accommodated the inspection process. Staff and service users were aware of who was in charge and staff were observed to be attending to their work competently. The home’s administrator demonstrated that the finances of the home and all financial transactions of individual service users are appropriately recorded in separate accounts, and of the records sampled, the signed and dated receipts reflected the balance recorded and the money present. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 21 The formal supervision of staff has been an issue and requirement of the last two inspection reports. Unfortunately, in the absence of the manager, the documents that record and confirm the planned supervision of staff were not available, neither was the matrix that records supervision sessions. There were no health and safety issues evident on this visit while inspecting the premises, however the health safety and welfare of service users are compromised in relation to the staffing numbers not meeting the full needs of the service users. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 22 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 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x 2 x x x x x STAFFING Standard No Score 27 2 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 1 x 2 Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 23 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 OP7OP& 4 Regulation 15 Requirement Specialist information in relation to medical needs, in this instance particularly diabetes, must be adapted to the individual service users’ needs. Service users with special dietary needs must have a care plan related to these and all care plans should include a list of food likes and dislikes. Care must be taken so that staff serve service users the food that reflects their special dietary need. All individual medicines must be labelled with the individual service user’s name and the date it was issued. The Registered Manager must ensure that all complaints are fully investigated and recorded appropriate to the homes Complaints Procedure. Training arrangements must be made for those staff who have not attended training in relation to the local authority’s Protection of Vulnerable Adult (POVA) procedures.
DS0000054917.V250606.R01.S.doc Timescale for action 30/11/05 2 OP15OP4 12 & 15 & 16(2)(i ) 30/11/05 3 OP9 13(2) 30/11/05 4 OP16 22 30/11/05 5 OP18 13(6) 30/11/05 Washington Grange Version 5.0 Page 24 6 OP19 23(2) So that the quality of the original high standards of the environment is maintained, and the service users enjoy comfortable and safe surroundings that promote their dignity and self-esteem, the redecorating and refurbishment programme must continue. So that senior staff can carry out their role effectively within reasonable hours, the senior staff vacancy must be addressed. The manager must achieve the Registered Managers Award and NVQ 4 by December 2005. So that the needs of the service users are effectively met the staffing ratios and the allocation of staff in the home must be reviewed.(Timescale of 29.07.05 not met ) The manager must ensure that staff receive planned, formal supervision at least 6 times a year covering all aspects of practice, the philosophy of the home and career development needs. ( Timescales of 30.11.04 and 29.07.05 not met.) 31/03/06 7 OP27 18 (1)(a) 30/11/05 8 9 OP31 OP38OP28 OP27 9(2)(i ) 18(1)(a) 31/12/05 30/11/05 10 OP36 18(2) 30/11/05 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 OP7 Good Practice Recommendations Risk assessments relating to medical needs should be improved so that they are more explicit and in relation to
DS0000054917.V250606.R01.S.doc Version 5.0 Page 25 Washington Grange 2 OP21 the service user’s individual need. Consideration should be given to how the current bathroom facilities can meet the full needs of the service users on the ground floor. Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Washington Grange DS0000054917.V250606.R01.S.doc Version 5.0 Page 27 - 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!
