Inspection on 08/12/05 for Warwick Nursing Home

This inspection was carried out on 8th December 2005.

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

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

Other inspections for this house

Warwick Nursing Home 14/12/06

Warwick Nursing Home 21/03/06

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 John McGarva Unannounced Inspection 8th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Warwick Nursing Home DS0000027949.V273479.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. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 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.V273479.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range 60 upwards Date of last inspection 10th March 2005 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 with a four person vertical lift providing level access to the first floor. It 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. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection, which took place on Thursday 8th December 2005, and the Provider / Manager Mrs Celina Jowett was available to assist with the process throughout. The inspection commenced at 10.00hrs until 15.00 hrs, 5 hours in total. There were 16 residents in the home, all receiving nursing care. The inspection focused on all the key standards, which CSCI have identified as important issues for the inspections during 2005 / 2006. An inspection of some of the resident’s rooms, lounge, bathrooms and medication storage area was also undertaken. Discussions took place with the manager, nurses and carers. The residents were able to give a coherent account of their experiences and these were very positive. They looked well cared for, appeared content and were most complimentary about the quality of the staff and the meals provided. What the service does well: The staff provides a good quality of nursing care, which is delivered in a professional and friendly manner The residents were particularly appreciative that, being a small home they were able to relate to all the staff in a more personal and companionable way when compared with larger homes of which they had previous knowledge. The residents are pleased with the quality and variety of meals, appreciating that fresh vegetables etc were available each day. Conversation with the cook confirmed that the resident’s wishes and preferences are taken into account with her seeking their dietary preferences the day before. There is a physiotherapist who comes to the home once per week and the residents and care staff alike appreciates this service. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 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. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 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.V273479.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 6. The residents’ needs are assessed and met in a professionally planned and programmed manner. EVIDENCE: The manager or one of the senior staff visits prospective residents in their own home or hospital to assess them prior to admission. Individual ring folders are available for each of the home’s residents and into which all information pertaining to them is kept. These are kept in a locked filing cabinet close to the nurse station. The information includes admission details, assessment of general risk, continence, Pressure Sore risk, Social history, Physiotherapy visits, Chiropody, Weight, Moving & Handling, Professional visits and records are also made of made of conversations with relatives. The assessment documentation inspected was good and included sufficient detail so that needs are identified and upon which information the care plans are developed. The home does not provide intermediate care. (Standard 6) Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 10. The physical and health needs of the residents are identified and appropriate care plans are created to ensure they are met. EVIDENCE: The residents looked well cared for with clean and well-pressed clothes and appeared content with the care they were receiving. The care plans inspected demonstrated that suitable records are being kept of the residents needs and upon which information they can be addressed. There is a place for the resident or relative to sign to evidence that they have seen and been consulted about the care plan. The daily reports are undertaken twice per day usually at 0.7.00 hrs and 20.00 hrs and a mix of 24 and 12 hr clock were used to record the timings these records are made. Ideally the timings should be recorded routinely utilising the 24 hr clock and this was discussed with the manager. Pressure relieving mattresses are provided when required by either the local Primary Care Trust (PCT) or the home. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 10 Although there is a resident receiving feeding by tube directly into the stomach (PEG) there is no suction machine available should it be required. This was discussed with the manager who agreed to source this in the near future. A physiotherapist comes to the home once per week and assists with the risk assessments in relation to the ambulation and moving and handling of the residents. The care staffs were observed to knock on individual room doors prior to entering thereby respecting the resident’s dignity and privacy. The Main drug storage cupboard is located in the entrance hallway above the nurse station desk and the drug trolley is located in a small room nearby. Although not an ideal location for safe storage of drugs, the system appears to work well. There is a 28-day blister pack system in use and this is well established and is satisfactory. The controlled medication stock of one resident was checked against the records and found to be correct. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 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 the following standard(s): 12 and 15. The resident’s wishes are respected and contact with relatives and friends is encouraged. The dietary needs of users of the service are met with a varied menu being offered that satisfied service users tastes and choices. EVIDENCE: The resident’s routines of daily living are tailored to their expressed or perceived needs and choice. There is an activities organiser who works two days (12 hrs) per week and this can be either group activities or individual sessions and may also include visits to the town shopping etc. Staff spoken to thought the residents needs in regard to activities are addressed and help enable them to keep active. Visitors can attend the home at any time they choose, day or night, with drinks provided for them routinely. The meals are of good quality and the inspector confirmed that fresh vegetables are used at all times. Full cream milk and butter is always provided. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 12 There is a choice of two main courses at lunchtime and the cook visits the residents the previous day to find out what their wishes are. Alternatives are also available should the set menu not be to the personal liking of anyone. The timings of the meals have recently been changed after consultation with the residents and staff to Breakfast 7 to 9am, Lunch 12.15, Tea 5 pm. Individual teapots, milk and sugar bowls are deployed whenever it is felt the resident can cope with them, thereby helping maintain their independence and dignity. A recent environmental Health inspection identified minor issues pertaining to the kitchen environment, which has been satisfactorily attended to. Routine monitoring and recording of the refrigerator and freezer temperatures are now undertaken. The community dietician attends the home on an irregular basis when advice is required. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 13 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 and 18. The home has appropriate complaints and adult protection procedures that help safeguard residents from abuse. EVIDENCE: The home has a complaints policy with time-scales for the resolution of these. There have been no complaints received regarding this home in the past year. There are Adult Protection and Whistle Blowing procedures available to protect the residents and a copy of the North Yorkshire County Council ‘No Secrets’ is available in the home to see. A carer confirmed that training about abuse issues was also part of her NVQ Level 2 training Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 14 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, 22 and 26. The environmental standards of homes registered prior to 2002 are met. EVIDENCE: As it is a converted Edwardian house there are some constraints in general layout, access and communal room provision that would be difficult to change without significant alteration. There is a handyman who works at the home for a day per week attending to routine maintenance and he was present at the home on the day of inspection. There are twelve single, and three shared rooms. Three of the single rooms have en-suite toilet facilities. Only two of the shared rooms have more than one resident in at the present time. There has been some replacement of carpeting to the corridors and general decoration taken place as part of the continuing refurbishment programme. Although the lounge / dining areas are limited there was no impression of congestion as there were few residents sitting in the lounge, most preferring to remain in their own rooms. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 15 The bathrooms are provided with basic manual ‘wind up’ hoists and more upto-date power assisted hoists would provide a more satisfactory arrangement for residents and staff alike. Although there is a sluice room located on the first floor there is no sluicing slop hopper sink or commode pan / urinal disinfector provided to help ensure safe practice. It would be possible for these to be accommodated within the sluice room. We have asked the provider to look into providing these important pieces of equipment, as their provision will help ensure a safer environment in relation to infection control. Sanitizer and bleach are used for the commode containers and appropriate gloves and aprons are available to use. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 16 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 and 30. The residents receive a good standard of care from sufficient staff that are appropriately trained and supervised. Further NVQ training is required for the recommended standard so trained to be achieved EVIDENCE: The home complies with the staffing letter of the previous regulatory authority and the staff spoken to confirm that they have sufficient staff to provide the care required. The home have managed to access free NVQ training through the Care Skills Council for the care staff over 26yrs, which in the past has only been available for those younger than this. Three of the care staff has achieved NVQ Level 2 training standard and a further two have commenced this training. One carer has commenced NVQ Level 3 training. The percentage of the care staff so trained is therefore 25 and when those currently in training have completed, and no one leaves, then the 50 minimum standard will be achieved. The recruitment procedures at the home meet the required standard and all Criminal Record Bureau (CRB) checks have been completed for all staff. There is a training programme in place for the care staff, which meets the National Training Organisation (NTO) standards. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 17 The manager undertakes formal supervision of the care staff and nursing staff and the records of these episodes was discussed. A physiotherapist assists in an informal capacity with advice on moving and handling for the care staff. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 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 and 38. The home is well managed with staff that is kept informed and consulted on developments in the home. There are systems in place to ensure that the Health & Safety of the residents and staff are protected. EVIDENCE: The manager is a First level nurse who has had many years in caring for the elderly and has also gained the NVQ Level 4 in management. She enjoys the respect and support of the staff and regular meetings with the staff are held to keep them involved and consulted about the running of the home. There is no formal quality assurance system in place at present, however the manager has this in mind for the future. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 19 As the home is relatively small, it is thought that the views of the residents and their relatives and friends are easily communicated to the staff during routine contact and conversation. The residents or their relatives on their behalf arrange the management and control of the resident’s personal monies and in consequence there is no need for the home to be involved in these transactions. Routine statutory training in the areas of Heath & Safety, Moving & Handling and Fire safety are given at the recommended intervals. A member of the care staff said that training in First aid had been planned in the near future. Regular servicing and records of this are maintained of the gas boilers, lifts, hoists and other equipment. The wiring certificate for the home was provided on 9th November 2005 and is valid for five years. There are sufficient policies and procedures, compliance with which should ensure a safe environment for the vulnerable residents. A system of obtaining the signatures of the staff to evidence that they have seen and understood the homes policies and procedures was discussed with the manager. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 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 3 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 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X 2 X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 x x 3 Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 21 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 2 Standard OP8 OP26 Regulation 16 (1)(2) (c) 13(3) 16(2) Requirement A medical suction machine must be provided. Suitable sluicing facility and a sluicing disinfector must be provided. (Previous time-scale of 1-4-05 not met) A formal quality assurance system must be introduced. Timescale for action 01/01/06 01/03/06 3 OP33 24 (1)(a)(b) (2)(3) 01/04/06 Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP8 OP22 OP28 OP38 Good Practice Recommendations The timings of entries in the daily reports should be made Utilising the 24 hr clock. The provision of power-assisted hoists for the bathrooms should be considered The provider should endeavour to have 50 of care staff trained to NVQ Level 2 standard. All policies & procedures should be numbered, indexed and dated. Signatures of the staff should be obtained to evidence that they have seen and understood the home’s policies and procedures. Warwick Nursing Home DS0000027949.V273479.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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. 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