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Inspection on 02/06/08 for Bingley Wingfield Nursing Home

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

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

What has improved since the last inspection?

There were 5 requirements following the last key inspection in July 2007 and 3 new requirements were made when we visited in February this year. Four of these have been dealt with, the remainder are carried forward. Work is continuing to improve the environment to make sure the home provides a pleasant and suitably equipped place for people to live. There has been an improvement in the way people are given information about the complaints procedure, this helps people to feel confident that any concerns they might have will be taken seriously and acted on.

What the care home could do better:

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 02 June 2008 09:10 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.V365702.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.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 jenioetgen@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 Emma Louise Rushen 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.V365702.R01.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. 12th July 2007 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 majority of people living in the home are over the age of 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 people living in the home. Car parking is provided at the front of the building. The home has a second entrance via a ramp for wheelchair access. The home has a no smoking policy. In June 2008 the weekly fees ranged from £387.80 to £585.40. Additional services such as hairdressing and chiropody are not included in the fees. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection process included looking at the information we have received about the home since the last key inspection in July 2007. Since the last key inspection we have made two additional visits to the home in February and May 2008. The first was to look into concerns about staffing levels and the cleanliness of the home. The second was to follow up concerns arising from an adult protection referral. The reports from these visits are available on request. We have also received 4 other concerns about the home and these were mainly related to staffing levels. There has been a change of manager since the last inspection; the new manager was registered in February 2008. The purpose of this inspection was to look at how the needs of people living in the home are being met. We did this unannounced visit in one day; one inspector visited the home between the hours of 9.10am and 5.10pm. We were accompanied by an Expert by Experience from the organisation Help the Aged. An “expert by experience” is a person who, because of their shared experience of using services, is able to help us get a better picture of what it is actually like for people using services. During the visit we spoke to people living in the home, visitors, staff and management. We looked at various records including care records and looked at parts of the building. Before the visit we sent surveys to the home to be given to people living in the home, their relatives, and health care professionals involved with the home. In total 41 were returned. Before the visit we sent a self-assessment form to the home, this was returned and gave us the information we had asked for. This report incorporates the information we have received from various sources including our visits to the home, the expert by experience, the surveys and the home’s self assessment. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: These are some of the comments made by relatives of people living in the home: • “Food could be a bit more imaginative” • “I think the home is trying to improve decoration & cleanliness” • “There is a big staff turnover; quite often you don’t see the same person twice.” The home must make sure there are always enough staff to meet people’s needs in a timely way. At the moment daily routines are determined by the Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 7 availability of staff rather than by people’s needs and preferences. This is not acceptable because it means people are not supported in making choices about their daily lives. People living in the home or their representatives must be included in planning and reviewing care to help make sure that care is delivered in a way that takes account of people’s needs and abilities. More attention must be given to making sure that people have an adequate diet and that people are provided with drinks and snacks outside of the set meal times. Staff must be provided with training related to the needs of people living in the home. This must include training on the protection of vulnerable people and promoting people’s rights. New staff must not start work in the home until all the required checks have been completed and all the required documents are available. This is to make sure that they are suitable to work with vulnerable adults. There must be enough equipment to make sure people can be helped to move safely and that people do not have to wait an unreasonably long time for equipment to be available when they need help. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.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.V365702.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3 Standard 6 does not apply. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are given information about the range of services provided and people’s needs are assessed before they move in. EVIDENCE: People living in the home told us they or their families were given information about the home before they moved in. Some people told us they had visited before deciding to move in and others said the home had been recommended to them. One person told us the kindness and understanding of the staff had helped their relative during the settling in period. People’s needs are assessed before they move in to make sure the home will be able to meet their needs. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 10 People told us they had received contracts. The home’s terms and conditions do not specify the room the person will have and this was discussed during the visit. The home told us the Welcome Pack is being updated; there is usually a copy of this in every bedroom. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Overall people’s needs are met but because people are not involved in planning how their care needs will be addressed, care may not always be given in a way that takes account of individual needs, preferences and abilities. More attention is needed to the way people’s nutritional needs are dealt with. EVIDENCE: We visited the home in May this year specifically to look at how people’s health and personal care needs were being met. This was in response to a concern about the management of a pressure sore, which had been referred to the adult protection unit in Bradford. The adult protection investigation is still going on. During that visit we looked at the care plans of 30 of the 33 people living in the home. We identified a number of concerns related to management of pressure Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 12 area care; nutrition and the way records are kept in the home. We discussed our findings in detail with the manager at that time. During this visit we looked at a selection of care plans to check if the issues we had discussed with the manager had been followed up. In May 2008 we found that there was one person in the home with a pressure sore. This had not been referred to the tissue viability nurse and there were some shortfalls in the record keeping. During this visit we saw that this had been followed up and the tissue viability nurse has visited to provide advice on the treatment of the pressure sore. The record keeping in relation to the management of the wound has also improved. We also saw that some improvements have been made to the care plans relating to pressure area care, for example the plans now include specific information about the type of pressure relief equipment in use. In May we were also concerned about a number of people who were nutritionally at risk. For example, one person had lost a significant amount of weight in a relatively short period of time. Despite this the nutritional risk assessment tool used by the home showed his risk of malnutrition as “low”. In April a new care plan for eating and drinking was put in place and this included an instruction to make sure he was offered snacks between meals. During this visit we saw that this person has gained less than 1kg in weight and the food/fluid charts put in place to monitor his dietary intake are not being kept up to date. Some days all meals are recorded but mostly the only entry was for lunchtime and there was no evidence that snacks are offered between meals. We looked at food charts for two other people and saw a similar picture. Looking at the charts there was no evidence that these people, who are identified as being nutritionally at risk, had anything to eat between the evening meals and breakfast the next day. This would mean a gap of approximately 16 hours between meals. We looked at the care plans of two other people we had identified as being nutritionally at risk in May 2008. One person’s records showed they weighed 39.9kg in April 2008. The care plan at that time said dietary intake should be monitored but there was no food chart. On this visit we saw that the person had been weighed twice in May and the most recent record showed her weight as 41kg. She has been seen by the GP and dietary supplements have been prescribed, however there is still no food chart in place to monitor dietary intake. Another person’s weight was recorded as 37.5kg in April 08. Again this person was weighed twice in May and the most recent record showed her weight as 37.7kg. A GP visit had taken place although this was not recorded in the form Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 13 specified for this purpose. There was no food chart in place to monitor dietary intake. In May 2008 the manager told us she planned to replace the nutritional risk assessment with a more detailed assessment that provides a measurement of Body Mass Index (BMI). During this visit she told us she had obtained the paperwork but has not yet implemented the new assessment. Our “expert by experience” commented that there seemed to be a lot of underweight people in the home. There are other risk assessments in place for example to identify the risk of falls and these were up to date. The daily notes are fairly detailed. It was evident reading them that a lot of people get up early, “up with the night staff” is a commonly used phrase in a lot of the daily notes. During the visit we noted that a lot of people spent a lot of the day sleeping. There was very little evidence in the records that people or those close to them are involved in drawing up and/or reviewing the care plans. Staff confirmed this however they also said that relatives tended to talk to the nurses if they wanted to know about people’s care. The manager told us one of the nurses has recently attended training on care planning and has identified a number of ways in which the home can improve care planning. This information is to be shared with other staff. The majority of relatives who completed our surveys said they are happy with the care provided. One person said, “The standard of care is excellent”. Another said the home “Contacts professionals i.e. doctor, district nurse when necessary and provides services of chiropodist, hairdresser, optician regularly.” One person said some staff did not know how to deal with their relative’s colostomy. Another said more care should be taken when people needed help and “not leaving them for the next shift”. Another person said, “The odd time the bath time hasn’t been done very well but otherwise the staff are good”. The health care professionals who completed our surveys commented favourably about the home. One said “as a GP who visits patients regularly at Wingfield I am confident residents receive a good level of care”. Medicines are stored and managed safely in the home. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides a variety of social activities and supports people in keeping in touch with their family and friends. However, people’s choices about their daily lives are somewhat limited because they feel they have to work around staff routines. EVIDENCE: People we spoke to generally seemed to feel they had to make things as easy as possible for the staff and therefore their daily routines are not determined by their needs and preferences but by the needs of the staff. For example one person said “I go to bed straight after tea because they have to use the hoist and other people need the hoist and it makes it easier for them.” Another person said “they do try to accommodate us” and another said, “ I try not to bother them”. People start going to bed at 5.30pm and most people are in bed by 7.30pm, only one person said they go to bed after 9.00pm. Some people prefer to stay in their bedrooms rather than use the communal rooms. One person told us they never leave their room because “I have no Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 15 conversation with other people here”. Other people made similar comments, “we don’t talk to each other in general” and “I don’t know who everybody is”. The chairs in the lounges are arranged around the walls and this generally does not encourage people to converse with each other. When we visited the televisions in all the lounges were on but no one was actually watching them. The sound on all 3 TVs was turned low meaning that even if people had wanted to watch it was almost impossible to hear what was going on. In one lounge the picture on the TV was “snowy”. Activities are arranged every afternoon. People living in the home said there are usually activities for them to take part in if they want to. Activities include card games, bingo, visiting entertainers and occasional outings. One person told us they had been out to dinner 3 times and didn’t have to pay. Money raised from jumble sales and raffles is used to pay for these outings. Some people go out with family and/or friends. Not everyone we spoke to had been out, one person said she liked to sit near the front door to get some fresh air but said staff always brought her straight back. One relative told us the home “ Provides activities, trips out to restaurants etc, church services, and entertainment within the home. Encourages residents to sit outside in the garden when warm and sunny providing adequate refreshments.” Another said their relative “attends church services at the home and goes out with their outings but doesn’t participate in other events”. Most of the people we spoke to said the meals were “good” or “ok”. However other comments suggested that this is not always the case. For example people said: • “Some things I don’t like, but I just leave it, I don’t tell them I don’t like it”. • “I don’t have a cooked breakfast because it’s cold when it gets here.” • “I like bacon but I don’t have it because I can’t cut it” • “On Monday we always have lamb chops or mince” • “They come around at tea time and ask us what we want but it’s a bit boring because it is always the same.” • “There’s no choice at tea time, it’s always soup and sandwiches.” Two people also said the quality of the food depended on which cook was on duty. The lunchtime meal on the day we visited was well cooked and warm but not well presented; the food was swimming in gravy. In the lounge very few people went to the table for lunch, they sat in their armchairs with a table in front. Water was served with the meal and tea was offered at the end of the meal. There was no choice of dessert, everyone had an individual trifle in a dish that was difficult to control, and at least 2 people gave up trying to eat Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 16 this after 2 or 3 spoonfuls. There was no attempt to make the meal time a pleasant social event for people. The home is aware that some people are not happy with the meals. There was a meeting with people living in the home in May 2008 specifically about food and menu planning. Questionnaires have been sent to people asking about their food preferences so that a new menu can be planned. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home has procedures in place to make sure complaints are dealt with appropriately. There is a lack of awareness of people’s rights and this potentially puts people at risk. EVIDENCE: Of the 14 people living in the home that completed our surveys 13 said they know how to make a complaint. One person said, “ I have no grumbles”. Eleven of the thirteen relatives who completed our surveys said they know how to make a complaint, one said they had never needed to complain. Another said their relative “Feels safe and has the staff to speak to”. Relatives also said the home usually responded appropriately when they raised any concerns. We have received 5 complaints about the home since the last key inspection in July 2007. In February 2008 we made an additional visit to the home in response to two complaints. The remainder were sent to the home to be investigated and they have dealt with them. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 18 The manager told us no complaints had been made directly to the home since our last visit. Staff told us they know what to do if someone has a concern about the service. There has been one referral to the adult protection unit in Bradford since the last key inspection. This is still being investigated, the home has co-operated with this investigation, and requests for information have been dealt with promptly. The records showed that some of the senior staff have attended adult protection training but the majority of care staff have not yet received this training. Staff we spoke to confirmed this. The manager said there are plans to provide this training for staff. Our observations showed that although staff are kind and well intentioned there is a lack of awareness of people’s rights and therefore it is essential that staff receive this training as soon as possible. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Improvements are being made and this needs to continue to make sure that the home provides a pleasant and suitably equipped place for people to live. EVIDENCE: These are some of the comments people made about the cleanliness of the home: • “Kept fairly well clean” • “Always somebody cleaning” • “The smell is sometimes a bit off putting”. Several people also commented that the home is in need of refurbishment and upgrading. Work has started on this and most of the top floor has now been decorated. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 20 Since the last inspection we have received concerns about the cleanliness of the home. When we visited the home was clean and there were no unpleasant odours. The management team are now having regular meetings with the housekeeping staff to make sure that they are clear about their roles and responsibilities. Staff told us the home has 3 mobile hoists to help people moving and transferring. They said one of these was a manual hoist and of limited use. This means that people sometimes have to wait for a suitable hoist to be available. Staff also said they did not have enough of the right type of lifting belts to help people to move safely. This was discussed with the home when we visited in February of this year. The records showed that the hoists are serviced at the required intervals to make sure they are safe to use. The hot water temperatures in 2 of the bathrooms on the first floor were considerably higher than the recommended safe temperature (430 C plus or minus 2 degrees) when we checked them. This was discussed with the manager. The bathrooms although dated in style were warm and therefore would provide a comfortable environment for people to bath in. Most people have some of their personal belongings in their bedrooms. People told us clothes sometimes go missing or get mixed up. One person said they had lost a coat, which they had only worn 3 times. They said their hearing aid was in the pocket and they now had to pay for a new hearing aid. With her permission this was discussed with the management team who said they would look into it. Another person told us she had bought a marker pen to name her clothes because she was so fed up of them going missing, she said one of the staff had borrowed her marker pen and not returned it. The home has been given a 3 star rating (5 is the maximum) by Environmental Health for its standards of food safety and hygiene. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are not always enough staff to meet people’s needs. The correct recruitment procedures are not always followed and this potentially puts people at risk. EVIDENCE: These are some of the things people living in the home said about staff: • “Staff are helpful” • “Staff have been good to me” • “Carers are very nice apart from one who speaks so quickly I can’t understand what she is saying” • “Staff come as soon as they can but if they’re busy with someone else we have to wait” • “At times staff can be busy”. • “Some staff are better than others”. • “Some staff don’t always listen” When we visited in February 2008 we told the home we were concerned that there were not always enough staff available to meet people’s needs. We were particularly concerned with the way is rota is organised. The finishing times are staggered throughout the afternoon resulting in a steady reduction in the Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 22 number of staff available. By 7:00pm the number of staff on duty has reduced to 4; 1 nurse and 3 care assistants. On the day of this visit there were 33 people living in the home. The staffing arrangements were the same as they were in February. There were 2 nurses, 7 care assistants, and an activities organiser on the morning shift. This reduced throughout the day and by 7.00pm there were 4 staff in total, one nurse and three care assistants. People living in the home told us that they start going to bed after tea, at about 5.30pm, and most people are in bed by 7.30pm, staff confirmed this. Staff who completed our surveys said there are usually enough of them to meet people’s needs. However, some suggested that there are not always enough staff available first thing in the morning and it depends on how many people the night staff have been able to get up. This has implications for how much choice people really have about their daily routines. We looked at the files of three new staff. One file showed that all the required checks had been completed before the person started work. The second showed that the home had not carried out a PoVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) check before the person started work. The person had these checks done by their previous employer in November 2007. However, this is not sufficient and the home is required to carry out its own checks and have the required documents before allowing new people to start work. The third showed that only one written reference had been obtained and the PoVA check was received while we were in the home. The rota showed this person was already working in the home. They had worked five days the previous week and were an extra member of staff on three of these days. The person should not have been working until both two written references and a PoVA First had been received. When we visited in February 2008 we discussed recruitment with the manager and we told the home what they were required to do. It is therefore a matter of some concern that people are still potentially being put at risk by shortfalls in the recruitment procedures. All new care staff have induction training based on the Skills for Care induction standards these are nationally recognised standards. Staff who completed our surveys said they had received a good induction when they started work. Information provided by the home showed over 50 of care staff have achieved a National Vocational Qualification (NVQ) at level 2 or above. When we visited last year the home told us they working on bringing the training records up to date. On this visit we found that these records are still not up to date and therefore it was difficult to get an accurate picture of what training staff have received. For example we could not find a record of recent moving and handling training. The deputy said some staff had done this Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 23 training in May 2008 and more was scheduled for June. The home has a moving and handling co-ordinator who is responsible for staff training however her training was due to be updated and it was not clear when this would take place. Fire training was also overdue; this was scheduled to take place in the two weeks following our visit. The home told us there is a rolling programme of training on palliative care and other training such as infection control is also planned. Staff told us they receive training, which is relevant and helps them to understand the needs of people living in the home. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are a number of areas where the home is not providing good outcomes for people and some examples of the home operating in a way that potentially puts people at risk. Therefore, it is not possible to say that the home is being run in the best interests of the people who live there. EVIDENCE: In December last year a new manager was appointed, and was registered by the Commission in February 2008. She is a nurse and previously worked at the home in the position of deputy manager. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 25 Relatives told us they are kept informed and one person said “There is always someone there to answer any questions and they hold regular meetings to inform relatives of any updates and pressing issues.” The home has meetings for people living there and/or their relatives, the most recent was in May 2008 and concentrated on the issue of meals. Following this meeting people were asked to provide information to help plan new menus. The home sent questionnaires to people asking for their views on all aspects of the service in October last year. They said they are preparing to send more questionnaires in the near future. Generally staff said they felt supported by the management team. Some said they felt communication within the home could be improved particularly with regard to changes in people’s conditions. One person said they felt their supervisions were a bit rushed and focused too much on particular tasks. They said they thought staff would benefit from more time to discuss their strengths and areas for development. When we visited last year we asked the owners to carry out monthly visits to the home to monitor the quality of the service and to provide support for the manager. Initially this did not happen but over the past couple of months these visits have been taking place more regularly. Mrs Ghoneim, the wife of the registered owner, takes an active role in the management of the home and was present during this visit and the inspection in May 2008. The home does not collect pensions for people but does hold some personal money to be spent on people’s behalf, for example to pay for hairdressing. There are records of all transactions and receipts are kept for all purchases. Copies of the transaction records and receipts are given to relatives. The home’s procedure is that receipts must always be given to people when they deposit money and receipt books are provided. In one of the records we looked at a receipt had not been given; this was discussed during the visit. Overall the systems for dealing with health and safety are satisfactory. We looked at a selection of maintenance records and they were up to date. However, one person told us they had often seen just one member of staff helping someone to transfer with a hoist. They were concerned because they know this is not safe practice, they said it usually happened on the afternoon shift, between 2.00pm and 9.00pm. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 26 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X 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 2 2 X X 2 X X 2 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement Timescale for action 29/08/08 2 OP8 16 & 17 Sch 4 3 OP14 12 People or those close to them must be involved in drawing up and reviewing plans of care so that care can be delivered in a way that takes about of people’s preferences and abilities. People living in the home must 31/07/08 be provided with adequate quantities of suitable, wholesome, and nutritious food and where necessary food must be provided outside of set meal times. Records of food provided to people must be sufficiently detailed to show that people are receiving a satisfactory diet. This is to make sure that people’s nutritional needs are met. 31/07/08 People living in the home must be supported in exercising choice and control over their daily lives. There must be appropriate measures in place, including sufficient staff, to make sure that as far as is reasonably practicable daily routines take account of people’s wishes. DS0000029135.V365702.R01.S.doc Version 5.2 Bingley Wingfield Nursing Home Page 28 4 OP19 23 The programme of refurbishment 29/08/08 must be continued to make sure that the home provides a pleasant place for people to live. This is outstanding from previous inspections dating back to October 2006. The Commission must be provided with detailed plans, including timescales, for the refurbishment of the home. Equipment that is needed to help people move and transfer either independently or with help from staff must be provided. This is to reduce the risk of people living and working in the home being injured when moving or helping people to move. This is carried forward from the inspection in May 2008. There must be enough suitably trained and competent staff on duty at all times to make sure that people’s needs are met in a timely way. This is carried forward from the inspection in May 2008. New staff must not start work until all the required checks have been completed and all the information and documents specified in Schedule 2 are available. This is to make sure that people protected. Previous timescale of 31/08/07 not met. When new staff start work, having received a satisfactory PoVA First but pending receipt of a satisfactory CRB disclosure DS0000029135.V365702.R01.S.doc 5 OP22 23(2)(n) 31/07/08 6 OP27 18 31/07/08 7 OP29 19 31/07/08 8 OP29 19 31/07/08 Bingley Wingfield Nursing Home Version 5.2 Page 29 9 OP30 18 & 17 Sch 4 there must be appropriate supervision arrangements in place to make sure that people are protected. Staff must receive training related to the needs of people living in the home. This must include training on • The protection of vulnerable adults • Promoting people’s rights and • The correct use of moving and handling equipment. Records of all training undertaken by staff must be maintained. This is to make sure that staff have the skills and knowledge they need to care for people properly. The CSCI must be provided with a written plan (an improvement plan) setting out in detail how the service will be improved for the benefit of the people living there. This must include details of what action is to be taken, who is to be responsible for the action and the timescale within which it will be done. 29/08/08 10 OP33 24 29/08/08 Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 30 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. Refer to Standard OP2 OP26 OP35 Good Practice Recommendations The terms and conditions should include details of the room to be occupied. The way people’s personal clothing is named should be reviewed to make sure that people’s clothing is not misplaced when it is sent to the laundry. When people deposit money to be spent by or on behalf of their relatives/friends receipts should always be given. Bingley Wingfield Nursing Home DS0000029135.V365702.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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