Inspection on 19/05/05 for Great Wheatley

This inspection was carried out on 19th May 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

Great Wheatley 25/09/07

Great Wheatley 19/02/07

Great Wheatley 10/08/06

Great Wheatley 16/12/05

Great Wheatley 09/12/04

Great Wheatley 15/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Great Wheatley 3a Great Wheatley Road Rayleigh Essex SS6 7AL Lead Inspector Ron Reeves Unannounced 19.05.05 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Great Wheatley Address 3a, Great Wheatley, Rayleigh, Essex SS6 7AL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01268 777281 Mr Raju Ramasamy Vacant CRH 21 Category(ies) of OP x21, DE(E) x21 registration, with number of places Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Care home with nursing Older people 21 places Dementia - over 65 years of age 21 places Maximum places - 21 Date of last inspection Brief Description of the Service: Great Wheatley is a care home, which provides services for older people in need of nursing care. Whilst most service users have long term care requirements, the home also offers short-term respite care provision when needed. The home is situated in a residential area of Rayleigh, close to all amenities and within a quarter of a mile from the A127 London/Southend. Service provision includes nine single rooms and six double bedrooms five of which have ensuite facilities. Assisted bathrooms and WCs are provided on both floors. There are four communal areas for service users and a small terraced garden with seating. Car parking for up to four cars is provided at the front of the property. Both trained nurses and carers make up the staff team; qualifications and training provision are set out in the homes statement of purpose. Other services such as hairdressing, chiropody and aromatherapy are available at an additional charge. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection that place over eight hours on the 19th May 2005. The inspection process included discussions with the acting manager, four staff, seven service users and three relatives, inspection of a random sample of bedrooms, bathrooms, communal areas and the garden. Discussion of the inspection findings with the acting manager and advice and guidance given. What the service does well: 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5 Appropriate verbal and written information is given to prospective service users and their families. This together with pre-admission visits enable informed choices. The acting manager ensures through a pre-admission assessment that the home can meet a prospective service users needs. EVIDENCE: The home provides information on the services offered through its statement of purpose and guide. Each service user is issued with a contract which includes the terms and conditions of residence. The acting manager said she always undertakes a pre-admission assessment of all prospective residents. These were contained in each residents file. The acting manager said that residents and their families are encouraged to visit before deciding on admission. Thus was confirmed by a visiting relative. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-10 Residents’ health and personal care needs are being met although written evidence in the care plans requires development. EVIDENCE: Care plans although covering all residents assessed needs did not provide sufficient clear information to staff regarding how to meet their needs. Residents care plans evidenced that their health care needs were being met. No relative or resident said they had seen their care plan. No resident is able to manage their own medication. Examination of the home’s medication administration system revealed that appropriate procedures and checks were in place. Service users were complimentary regarding the staff. All said “it is much better now we don’t have agency staff” although on some occasions they found it difficult to understand the foreign staff. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 9 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 The dietary needs of the residents are being catered for although the problems regarding the evening meal needs to be addressed. Visiting arrangements were open and relaxed. Activities are limited and require development. EVIDENCE: The home does not have an activities organiser, however staff do organise some activities. The acting manager said he has been investigating ways of improving activities and has written to the proprietor for permission to purchase additional materials. Service users enjoyed the 60th anniversary celebrations with a sing-along and a “walk down memory lane”. Residents said they can have visitors at any time and visitors said they were always made welcome. The home employs two cooks who cover the whole week. The cooks ask the residents every day what they want to eat. Record of residents likes and dislikes are maintained. The cook’s hours have been extended to 5.00pm. However, as so many residents have to be fed the evening meal commences at 4.15pm. The proprietor is now in the process of producing plans to improve the premises including refurbishment of the kitchen. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 10 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: The home has a detailed complaints procedure which is detailed in the service users guide. No complaints have been received since previous period. Relatives spoken with said they feel comfortable discussing their concerns with the acting manager. The manager said she has so far been unable to obtain advocacy services for the home. All the residents are registered to vote. The manager explained that those wishing to vote usually obtain postal votes. Appropriate Adult Protection and whistle-blowing policies and practices were in place. A copy of the Essex procedures was available. Some of the staff have attended Protection of Vulnerable Adults training and others are being booked on courses throughout the year. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 11 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,23,24,25,26 In general the home is well maintained and furnished. Planned improvements to the home will benefit the service users. EVIDENCE: Great Wheatley is located in a quiet residential area closed to bus routes and in walking distance from Rayleigh shopping centre. The home was generally well maintained although a few areas require redecoration. The proprietor is producing plans for improvements to the home which include the upgrading of kitchen and laundry. The residents’ bedrooms looked homely as residents have been able to bring items of furniture and possessions with them. The residents call bell system was noted to be cancelled from outside the bedrooms, which is not good practice. All areas of the home were clean and tidy. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 12 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 The procedures for the recruitment staff are robust. The deployment and number of staff available in the morning shift and afternoon is not sufficient to meet the needs of the service users. Staff training requires better planning and recording. EVIDENCE: Staff rotas evidenced that the morning shift has been reduced from 1 nurse and 5 carers to 1 nurse and 4 careers. The afternoon shift has been reduced from 1 nurse plus 4 carers to 1 nurse plus 3 carers and the evening shift from 1 nurse plus 3 carers to 1 nurse plus 2 carers. Night staff remained the same as 1 nurse and 1 carer. It was noticed that the cooks hours have been extended to finish at 5.00pm. Staff spoken with commented that dependency levels have increased and work on the morning shift is extremely heavy, but remainder to the day is manageable apart from having to start the evening meal at 4.15pm because of the need to feed nine residents. The home now employs an additional three carers and this has resulted in the home no longer using agency staff. Two staff files examined revealed robust recruitment procedures are in operation. There was evidence of staff training planned, however many staff still require refresher courses for food hygiene. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 13 Residents commented that it is much better since agency staff are no longer used, however there were comments that although new staff are very good sometimes it is difficult to understand them. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 14 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35,36,38 Staff morale and service user satisfaction has improved. The home is being adequately managed by the acting manager, however the appointment of a permanent manager must be pursued to ensure continuity. EVIDENCE: The home manager left at the end of March 2005 and the home is being managed by a Senior Nurse. The home has advertised the post but have yet to appoint a new manager. Staff spoken with said they found the acting manager was supportive and easy to approach. Discussions with the acting manager throughout the inspection demonstrated she had a sound knowledge of service users needs, had the respect of staff and was aware of her responsibilities. Staff morale has improved with the recruitment of additional staff which has resulted in the need to no longer employ agency staff. Staff have appraisals and supervision. The acting manager was advised to evidence more clearly staff involved in the supervision process. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 15 The home manages small amounts of service users money. A random check revealed adequate records maintained and money balanced. Records inspected were accessible, in good order and stored appropriately any shortfalls have been referenced earlier in this report. A random sample of safety certificates were inspected and seen to comply with requirements. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 x 3 2 3 3 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 x x 3 2 x 3 Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 17 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 27 Regulation 8 Requirement The registered person must ensure sufficient suitably qualified competent and experienced staff are working at the care home in such numbers as are appropriate for the health and welfare of the residents. ( Care plans must be sufficiently detailed to give clear guidance avoiding generalisations actions for Staff on how to meet the identified care needs. Timescale for action 30/06/05 2. 7 15 30th June 2005 3. 12 16 The registered person must 30th June consult service users about the 2005 programme of activities arranged by the care home. Residents call bell system must only be cancelled at source and not from indicators in the corridor. The home must appoint a manager. The proprietor must ensure that staff receive training appropriate to the work they perform. 30th June 2005 30th July 2005 30th June 2005 4. 24 13 5. 6. 7. required31 30 8 18 Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 18 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 17 28 31 36 15 Good Practice Recommendations Information on advocacy services be made available to service users. A minimum of 50 of care staff achieve qualification at NVQ level 2 or equivalent by 2005. Any manager appointed achieve NVQ level 4 in management and care by 2005. Staff supervision format should be developed to ensure comments made by staff are recorded. The home should review the tea time arrangements for the residents. Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 19 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend On Sea Essex SS2 6BG 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 Great Wheatley I56 I06 S48207 Great Wheatley V222854 190505 Stage 4.doc Version 1.20 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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