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Inspection on 19/07/06 for Bingley Wingfield Nursing Home

Also see our care home review for Bingley Wingfield Nursing Home for more information

This inspection was carried out on 19th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is comfortable and clean and the gardens are very well kept. Residents have access to the gardens by way of a ramp and a gazebo has been put up to provide a shady place for residents to sit. On both days of the inspection several residents were outside enjoying the nice weather. The home has a friendly atmosphere and staff treated residents with kindness and respect. Residents said staff were kind and they did not have to wait too long when they needed help. One relative said she found the staff extremely keen to help and said the nursing staff and manager were extremely approachable. The home welcomes visitors at any time and residents can see their visitors in private. People are encouraged to visit the home before making a decision about admission and residents are encouraged to bring some of their personal belongings with them when the move in. The inspection was carried out during the heat wave and it was good to see that staff were very attentive to making sure that people had lots of extra drinks.

What has improved since the last inspection?

There were seven requirements at the last inspection and the majority of these have been dealt with. The care records have continued to improve although there is still more work to be done to make sure that care needs are not overlooked. There has been very little change in the staff team since the last inspection and the home has made a lot of progress on staff training. Residents are benefiting from being cared for by a stable and well-trained staff team. Health care professionals who visit the home said they had seen an improvement in the past six months particularly in terms of how staff respond to residents needs. The owner has started to do regular visits to the home to audit all aspects of the service and speak to residents and staff. This will help the management team to identify areas for improvements and to plan further development of the service.

What the care home could do better:

The home must make sure that before new residents move in they are given clear information about the range of services that are to be provided, the fees for these services and the arrangements for payment of fees. Despite the fact there have been improvements in the care records more work is needed to make sure that staff are provided with detailed information about residents abilities and needs. Residents` views on the food varied, some said it was very good, others thought the choices were limited, and at least one person thought the portions were too small. The management team must address this, they must also make sure that people who are nutritionally at risk are identified, and appropriate action is taken. The activities programme must be reviewed in consultation with residents to make sure it reflects the preferences and abilities of the people living in the home. The management team must review the refurbishment programme and the systems in place for dealing with day-to-day maintenance. They must make sure that equipment and installations are maintained and checked at the required intervals in order to protect the health and safety of residents and staff. Staff have some awareness of equality and diversity but it tends to be limited to the area of religion. This needs to be developed to promote a greater awareness of how to address residents` needs in the areas of race, ethnicity, age, sexuality, gender, and disability. Requirements and recommendations have been made and are detailed at the end of this report.

CARE HOMES FOR OLDER PEOPLE Bingley Wingfield Nursing Home Oakridge Court Off Priesthorpe Road Bingley West Yorkshire BD16 4ED Lead Inspector Mary Bentley Key Unannounced Inspection 19th July 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 Bingley Wingfield Nursing Home DS0000029135.V296872.R02.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. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bingley Wingfield Nursing Home Address Oakridge Court Off Priesthorpe Road Bingley West Yorkshire BD16 4ED 01274 567161 01274 566809 jenioctgen@hotmail.com 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) Dr A T Ghoneim Mrs Jennifer May Oetgen Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home can admit up to a maximum of two people between the ages of 60 and 65. 21st March 2006 Date of last inspection Brief Description of the Service: Bingley Wingfield is registered to provide personal and nursing care for a maximum of 48 people. The home offers care to male and female residents over the age of 65 years, and can admit up to a maximum of two people between the ages of 60 and 65. The original Victorian building has been extended to incorporate a wing of single en-suite accommodation. The home offers both single and shared accommodation, en-suite facilities are provided in twenty-five of the single rooms. There are communal rooms on the lower ground floor, the ground floor, and the first floor. The home is situated near Bingley and is on a local bus route. The area has many shops and local amenities. The home has pleasant gardens that are accessible to residents. Car parking is provided at the front of the building. The home has a second entrance via a ramp for wheelchair access. The weekly fees range from £318.15 to £547.45. Additional services such as hairdressing and chiropody are not included in the fees. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate”, and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk The last inspection was done in March 2006 and there have not been any additional visits to the home since then. The purpose of this inspection was to inspect all the key standards, (the key standards are identified in the main body of the report), to assess how the needs of people living in the home are being met. The methods used in this inspection included looking at care records and other paperwork including staff and maintenance records, talking to residents, relatives, staff, and management, observing care practices in the home and looking at some parts of the home. The home completed a preinspection questionnaire and the information provided was used as part of the inspection. The inspection was unannounced; it was carried out on 19 and 20 July 2006 by one inspector. The inspection was done between 9.30am and 4.30pm on 19/07/06 and 10.15am and 3.30pm on 20/07/06. Feedback was given to the manager and deputy manager at the end of the visit. Comment cards were sent to some relatives before the inspection and comment cards for residents and relatives were left at the home. These provide people with an opportunity to share their views of the service with the CSCI. Information obtained in this way is discussed with the home without identifying who has provided it. Two relatives completed comment cards and showed they were satisfied with the care provided; no comment cards have been received from residents. Comment cards were also sent to a number of GP practices. Three were returned and showed they were happy with the service; none of the GPs who responded have seen copies of the CSCI inspection reports. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There were seven requirements at the last inspection and the majority of these have been dealt with. The care records have continued to improve although there is still more work to be done to make sure that care needs are not overlooked. There has been very little change in the staff team since the last inspection and the home has made a lot of progress on staff training. Residents are benefiting from being cared for by a stable and well-trained staff team. Health care professionals who visit the home said they had seen an improvement in the past six months particularly in terms of how staff respond to residents needs. The owner has started to do regular visits to the home to audit all aspects of the service and speak to residents and staff. This will help the management team to identify areas for improvements and to plan further development of the service. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 7 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. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 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 Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 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): 1, 2, 3 & 5. Standard 6 does not apply to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The needs of prospective residents are assessed before admission in the majority of cases. However the assessment is not always as detailed as it should be. More attention should be given to making sure that all prospective residents have clear and accurate information about the range of services available in the home. Prospective residents and/or their representatives are given the opportunity to visit the home before making a decision about admission. EVIDENCE: The home has a Statement of Purpose and Service User guide however they would benefit from being reviewed and updated, the inspection report in the Statement of Purpose was dated January 2002. Consideration should be given to making the format of both documents more accessible to prospective residents. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 10 The care records of one resident recently admitted to the home showed that a pre-admission assessment had not been done, the manager said it an emergency admission. The records of another resident showed that a preadmission assessment had been done but very little information about his needs had been recorded. The resident had been to look around the home before admission but said that did not really prepare him for what it would be like living there. He said he had chosen the home because he believed there was a smoking area for residents, however he now finds that he can only use the staff room when it is free. The manager said this had been discussed before admission however the written information provided by the home does not make it clear that the home has a no smoking policy for residents. He had not received a contract. Staff said they are given information about new residents at handovers. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 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 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Overall the personal and health care needs of residents are met. However more attention must be given to meeting the nutritional needs of residents, particularly those that are nutritionally at risk. The shortfalls in the care records create the opportunity for care needs to be overlooked. Residents are protected by the homes systems for dealing with medicines EVIDENCE: The care records of three residents were looked at in detail and a further two sets of records were looked at briefly. The care plans addressed how personal and health care needs would be met but did not always provide enough detail. The care plans relating to personal care did not make it clear what level of help people needed and did not show how much people could do on their own. Some care plans said what day people would like to have their weekly bath/shower but others did not. Care staff said they go by the bath lists in the bathrooms; these identify bath days by room numbers. Staff said people Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 12 usually have a bath once a week but can have one more often if they ask. Personal care is recorded in the daily records. The care plans on nutrition did not have enough detailed information, for example saying to make sure people were given plenty of fluids, one care assistant she said she thought about 2 litres a day was the right amount. The cook had a fairly limited knowledge of how to add nutritional value to food; she said snacks were available on request. However, it was clear from discussions with staff and residents that snacks are not routinely offered between meals to residents’ with low weights. Residents said they did not have anything, other than a biscuit, after the evening meal. The nutritional risk assessment being used by the home does not accurately reflect the level of risk, for example one resident with a weight of 36.6kgs was assessed as a low risk. The manager was aware of problems with the nutritional risk assessment but had found it difficult to get information on alternative assessment tools from the local Primary Care Trust (PCT). The manager was given a copy of the CSCI guidance on nutrition, which includes a nationally recognised nutritional risk assessment tool. There was no evidence that people with low weights are weighed more than once a month, care staff were aware that if people were not eating or were losing weight this should be reported to the nursing staff. The home has a risk assessment tool for assessing the risk of developing pressure sores. Two nurses recently attended tissue viability training and obtained a copy of the Bradford pressure care policy; as a result they are changing the risk assessment tool. The manager monitors the incidence of pressure sores. The majority of care plans specified the type of pressure relief equipment in use and said how often residents should be helped to change their position. The care plan of one resident with diabetes did not make it clear how the condition was being monitored; the nurse said it was diet controlled. Residents have access to other health care professionals and specialist advice is sought where appropriate. For example the Parkinson’s nurse specialist had been asked to advise on the care of one resident. District nursing staff that provided feedback to the CSCI said they were satisfied with the standard of care provided in the home. They said they had seen improvements over the past six months particularly in the manner in which staff spoke to and treated residents. They said there were sometimes delays getting the right equipment; the manager said she had ordered more special beds and pressure relieving mattresses. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 13 Continence assessment forms are provided by the local PCT, which is responsible for providing continence products for people living in the home. There was no continence assessment for one resident recently admitted to the home despite the fact that her care plan said she was incontinent, staff said she was continent. The care plans did not contain specific information about the type of continence products. In the majority of care plans seen there was evidence that residents and/or their representatives are involved in care planning and relatives are invited to attend care reviews. However one resident who was admitted to the home 3 months ago had not been involved in care planning and did not know whom his key worker was. One relative said she had found the review very helpful, she now felt more involved in her relative’s care, and more confident about raising any concerns she might have. There was information in some care plans but not in others about how people wanted to be cared for at the end of their lives and what arrangements they had in place for care following death. The manager had identified this as an area for further development. The home has adopted the Liverpool care pathway; this is a nationally recognised model of good practice for end of life care. Staff knocked on doors and waited for an answer before going in, they were kind and respectful in their dealings with residents. Staff receive training on privacy and dignity as part of their induction. There is screening in shared rooms. There are appropriate systems in place to make sure that medicines are dealt with safely and the records were up to date. The home gets a lot of support from the supplying pharmacist who also provides regular training. Nurses administer all the medicines although some senior care staff have been trained in the management of medicines. None of the residents in the home were administering their own medicines. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home offers a range of social activities however more needs to be done to make sure that the programme of activities reflects the preferences and abilities of individual residents. EVIDENCE: The activities organiser was on holiday when the inspection was done and there was very little going on in her absence. Staff said she does lots of different activities with residents when she is there. They said they would do the regular Friday bingo session in her absence. There was no information on social care in the care plans looked at, new forms have been devised to record peoples’ interests, but they have not yet been completed. When completed the information will be kept in each residents care plan. There was little or no information in the daily records seen about how people actually spend their time. The manager said the activities organiser keeps her own records but they were not available because she was on leave. The majority of residents who completed the homes questionnaire said they were happy with the range of activities offered. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 15 Some care plans showed peoples preferred times for getting up and going to bed and others did not. Some residents said they had been asked about this but in reality it didn’t make much difference because staff came when they were ready Residents can spend their time in their bedrooms or in one of the communal rooms. There are no restrictions on visiting and visitors spoken to said they are made welcome and offered drinks, one lady said she is often invited by staff to stay and have a meal with her relative. Residents can see their visitors in private. Staff said that all the residents in the home at present are Christians and that ministers from the local Catholic and Church of England churches visit the home. Some religious services are held in the home. Comments about the food varied, some people said it was very good and others said the choices were fairly limited. On the first day of the inspection one lady in the terrace room who had just finished her lunch commented that the chop had been very nice but very small, and that there had not been many vegetables, she was not offered a second helping. The meals were nicely presented and where necessary residents were helped to eat in a discreet and sensitive way. However there were a number of concerns about those residents that have been identified as being nutritionally at risk, more information about this is provided in the Health and Personal care section of this report. The planned menu was changed because of the exceptionally hot weather and staff were making sure that residents were given lots of extra drinks. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The required policies and procedures are in place with regard to dealing with complaints and the protection of vulnerable adults. Staff are familiar with the procedures thereby ensuring that complaints/concerns are dealt with appropriately and residents are protected. EVIDENCE: The complaint procedure is set out in the service users guide a copy of which is provided in every bedroom. The majority of residents who completed the homes’ questionnaire in June 06 said they were aware of whom to speak to if they had any concerns. The home has had one complaint since the last inspection and this was dealt with appropriately. No complaints have been referred to the CSCI. The manager said day-to-day niggles for example laundry problems are dealt with as they came up and are recorded in the residents’ individual files. Some suggestions were made about how the recording of complaints could be improved. Staff gave a satisfactory account of what they would do if a resident or relative raised a concern with them. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 17 Staff understood the different types of abuse that can take place and knew how to report any concerns, they were aware of external agencies that could be contacted if necessary. Staff understood that they should not accept gifts from residents. All staff receive training on adult protection as part of their induction and are also on a waiting list for external training. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 18 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, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home is clean, comfortable, and generally well maintained despite the fact that is starting to show signs of wear and tear. Equipment used to assist residents moving must be maintained in good working order to reduce the risk of injury. EVIDENCE: The home was clean but there were odours in some bedrooms, particularly those with limited natural ventilation. The home is starting to show signs of wear and tear, doors are scuffed, and the paintwork in some corridors and bedrooms needs attention. There is a refurbishment programme, since the last inspection four bedrooms have been redecorated, the ground and first floor corridors have been repainted, and new carpets have been fitted to these corridors. However the programme of refurbishment does not seem to be keeping pace with the work needed. More Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 19 attention is also needed to day-to-day maintenance, for example in some bathrooms the fans were not working, there were bare light bulbs, and there were no paper towel dispensers. In the bedrooms seen residents had their own belongings around them. The mobile hoists and bath hoists have not been serviced since May 2005; lifting regulations require that they be checked every six months. The manager said she would arrange a servicing contract. The heating in the old part of the building had been turned down low but some of the radiators were still warm despite the fact that the outside temperature was in the regions of 30 degrees C. The manager said it could not be turned down because it would take too long for the building to heat up again when the temperature dropped and some residents were very sensitive to the cold. Some residents had been moved from bedrooms at the front of the old house because of the exceptionally hot weather. The heating in the extension had been turned off. Housekeeping staff had a good understanding of how to use colour coded cleaning equipment to reduce the risk of cross infection. A number of staff are doing infection control training. The cuddly toys and plastic bags used on some pull cords should be removed and replaced with more suitable fittings that can be cleaned properly, the manager said this was being dealt with. Housekeeping staff confirmed they had received training on using potentially hazardous chemicals. Residents were satisfied with the laundry service however in one room some of the underwear was torn and threadbare. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. There are enough suitably trained staff to meet residents needs. The recruitment procedures are robust and offer protection to residents. Staff are supported in developing their skills and knowledge. EVIDENCE: Duty rosters are available for all grades of staff. Separate staff are employed for domestic and catering duties and the home has an administrator and a handyman. The home has a number of senior care assistants; they provide support to the nursing staff by taking some of the responsibility for organising and supervising care staff. They also help with the induction of new staff and are responsible for care planning for residents not receiving nursing care. Residents, relatives, and staff did not express any concerns about staffing levels. Residents said call bells are usually answered fairly quickly. All new staff have a detailed induction, which meets national standards, (Skills for Care). One care assistant who recently joined the home gave a good account of the induction training she had received; the topics covered included privacy and dignity. The files of three recently recruited staff were looked at and showed that all the required checks had been completed before they started work in the home. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 21 The home has 50 of care staff qualified to NVQ (National Vocational Qualification) level 2 or above and more staff are doing NVQ training. This meets the recommendations of the National Minimum Standards. The home provides a good range of training for all grades of staff, the subjects covered include infection control, palliative care and dealing with challenging behaviour. There have been very few staff changes since the last inspection and staff morale was good. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 22 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, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Overall the home is well managed, staff are supported in their roles and residents and their representatives are given the opportunity to put forward their views on the running of the home and the quality of the services provided. The management team must make sure that the required systems are in place to protect the health and safety of residents and staff. EVIDENCE: There is a clearly defined management structure in the home. The deputy manager has successfully completed the Registered Managers Award. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 23 During the inspection the owner arrived at the home to carry out a monthly audit, it was rescheduled and took place later in the week, a copy of the report from that visit has been sent to the CSCI. Staff meetings for nursing staff and housekeeping staff took place in March 06; it has been some time since the home has had a general staff meeting. Staff said they could ask for a staff meeting if they felt they needed one. The manager said she used to daily handover as a team meeting and found this was more effective than general staff meetings. Staff said they got lots of information at handover and one senior carer who had been on leave said she was given an additional handover to bring her up to date. Staff said they felt supported by the management team, they confirmed that the owners visit the home regularly and talk to staff during these visits. Questionnaires were issued to residents, relatives, and staff in June 06. There was a very low response rate from relatives but about one third of residents and staff responded. Overall the comments were positive, the manager said she would be analysing the responses and putting an action plan to place to address any issues that emerged. The home does not get involved in dealing with residents’ personal finances. A small amount of spending money is kept for some residents to cover expenses such as hairdressing. The home keeps this money in a separate bank account. The account does not earn interest. Records are kept of all transactions made on behalf of residents. A selection of maintenance records were checked including Portable appliance testing, the thorough examination certificate for the lift, the gas safety certificate, the hot water temperature checks, and the weekly fire alarm tests, they were up to date. The electrical wiring certificate was not available; the necessary work has not been done but has been arranged. There is a system in place for recording and monitoring accidents and falls. In one bedroom the bed rails were fitted to a divan bed and although the correct type of rails was fitted they could still be moved with very little effort. The bed had a pressure relief mattress in place and the bed rails were not high enough. The manager said she had recently checked all the bed rails but had not kept any record of this. The risk assessment needs more information to make it clear why bed rails are being used and what other options have been considered. There is a detailed assessment for checking the bed rails once they are in place, this should be completed every time the bed rails are checked. The form signed by relatives does not specify the risks associated with the use of bed rails. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 24 The deputy manager is a trained moving and handling co-ordinator and the majority of staff up to date with moving and handling training; sessions are scheduled for those that have not attended. Staff said that during the training they have to be moved in the hoist so that they have a better understanding of how it feels for residents, this is good practice. The handyman has attended external training on fire safety and the majority of staff up to date with fire training. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 25 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 2 2 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes Nutritious snacks and supplemented food must be provided to all residents who are considered at risk of poor nutrition. 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. Standard Regulation Requirement Timescale for action 1 OP1 4&5 A copy of the revised Statement 31/10/06 of Purpose and Service User Guide must be sent to the Commission for Social Care Inspection. 2 OP2 5A Each resident must be provided 31/10/06 with a statement by no later than the day of admission, specifying the fees payable by, or in respect of, the resident for the provision of accommodation, including food, nursing, and personal care. 3 OP3 14 New residents must not be 31/10/06 admitted to the home until such time as a comprehensive assessment of their needs has been carried out. Prospective residents must be provided with written confirmation that the home is suitable to meet their needs before admission. 4 OP7 15 Each resident must have a 31/10/06 detailed plan of care setting out how their assessed needs will be met in relation to personal, health and social care. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 27 5 OP8 OP15 17 & 16 Previous timescales of 17/12/04, 31/03/05, 31/08/05, 31/01/06, and 21/07/06 unmet. The care plans for residents that are nutritionally at risk must set out in detail the actions that are to be taken by staff. Nutritious snacks and supplemented food must be provided to all residents who are considered at risk of poor nutrition. The registered persons must after consultation with residents provide a programme of activities that takes account of their preferences and abilities. Particular attention must be given to how the needs of people with cognitive or sensory impairments will be met. The registered persons must make every effort to ensure that care is delivered in accordance with residents’ wishes. This includes taking account of preferences in relation to times of getting up and going to bed. All parts of the home must be kept in a good state of repair and the décor must be maintained to a reasonable standard. Lifting equipment including mobile and bath hoists must be serviced every six months in accordance with the LOLER Regulations 1998. The registered persons must make sure the heating and ventilation in individual rooms is appropriate to the needs of the resident. The risk assessments relating to the use of bed rails must demonstrate clearly that an DS0000029135.V296872.R02.S.doc 15/09/06 6 OP12 16 31/10/06 7 OP14 12 31/10/06 8 OP19 23 31/10/06 9 OP22 23 15/09/06 10 OP25 23 31/10/06 11 OP38 13 15/09/06 Bingley Wingfield Nursing Home Version 5.2 Page 28 analysis of the risks and benefits of has been undertaken. When bed rails are fitted to beds with pressure relieving mattresses they must be high enough to reduce the risk residents falling out over them. Once in use bed rails must be maintained at regular intervals and records of these checks must be kept. A copy of the electrical wiring certificate must be sent to the CSCI. 12 OP38 13 & 23 31/10/06 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 5 Refer to Standard OP3 OP8 OP9 OP16 OP38 Good Practice Recommendations Key workers should be allocated to residents at time of admission so that they can help residents to settle into the home. Residents who are nutritionally at risk or losing weight should be weighed more frequently than once a month. The medicine trolley that is kept on the first floor corridor should be in the treatment room when it is not in use. The complaint procedure should be made available in alternative formats for example large print version for people who are visually impaired. The bed rails consent form that is signed by residents’ representatives should state clearly the risk associated with the use of bed rails. Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Bingley Wingfield Nursing Home DS0000029135.V296872.R02.S.doc Version 5.2 Page 30 - 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. 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