Inspection on 23/04/08 for Ross Wyld Nursing Home

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ross Wyld Nursing Home 06/04/09

Ross Wyld Nursing Home 15/01/09

Ross Wyld Nursing Home 08/11/07

Ross Wyld Nursing Home 16/04/07

Ross Wyld Nursing Home 04/09/06

Ross Wyld Nursing Home 11/05/06

Ross Wyld Nursing Home 31/10/05

Ross Wyld Nursing Home 17/05/05

Ross Wyld Nursing Home 02/12/04

Ross Wyld Nursing Home 13/07/04

Ross Wyld Nursing Home 20/03/04

Ross Wyld Nursing Home 06/06/02

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ross Wyld Nursing Home Ross Wyld 458 Forest Road Walthamstow London E17 4PZ Lead Inspector Caroline Mitchell Unannounced Inspection 23rd April 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ross Wyld Nursing Home DS0000025960.V362402.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. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ross Wyld Nursing Home Address Ross Wyld 458 Forest Road Walthamstow London E17 4PZ 0208 521 8773 0208 520 0690 ross.wyld@fshc.co.uk 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) Tamaris (South East) Limited (a wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Lutchemee Hele Care Home 54 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (25), of places Physical disability (7) Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To allow the home to provide continuous care for two named service users and to permit admission of one named service user with mental health needs. 8th November 2007 Date of last inspection Brief Description of the Service: Ross Wyld is a care home registered to provide care for a maximum of 54 residents. This includes 25 places for those requiring nursing care, 22 places for older people with dementia and 7 places for younger adults with physical disabilities. The registered provider is Tamaris Ltd, part of the Four Seasons Health Care Group. The home is a large purpose built, three storey detached house with 48 single bedrooms and three double bedrooms located across all three floors. All floors are accessible via a lift. The home is situated on Forest Road, in the London Borough of Waltham Forest. Situated in the Walthamstow area and is close to shops, transport networks and other local amenities. The William Morris Museum and Lloyd Park are local landmarks just opposite the care home. The fees are normally between £450 to £736 for each placement per week, and the people who use the service are expected to pay separately for items such as hairdressing, outings and clothes. Following “Inspecting for Better Lives” the provider must make information available about the service, including inspection reports, to the people who use the services and other stakeholders. Ross Wyld Nursing Home DS0000025960.V362402.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. This inspection was undertaken on an unannounced basis and took 3 days to complete. We stayed for lunch on 2 occasions and took the opportunity to speak to several residents. We observed care practice throughout the course of the inspection. We spoke to staff and managers. We met with some relatives who were visiting the home and we toured the premises. We checked a number of documents including residents’ case files, the record of complaints, the statement of purpose, resident guide, visitors’ book, kitchen records, the record of accidents, health and safety records, the staff personnel records and the residents’ financial records. The manager and regional manager showed us around the home and provided a copy of the schedule of the improvement work that is being undertaken in the home. The managers and staff were unstinting in their cooperation with this inspection, the residents welcoming and the relatives open and frank. What the service does well: What has improved since the last inspection? As stated, the management of the home has improved, as the new managers are professional, proactive, aware of the shortfalls in the service and it was evident that they and the rest of the staff team are working hard to improve the home in a range of areas. At the last inspection a statutory requirement notice was served as the home was failing to comply with the Care Standards Act 2000 and Care Home Regulations 2001 in the fitness of the premises. The registered person was required to make sure that all parts of the care home’s exterior are kept in a good state of repair, to make sure all fire escape routes are kept clear and maintained in good working order, to make sure fire doors are not wedged open and kept in a good state of repair and to consult with the Fire and Rescue Authority and act on any advice given by them. At this inspection it was found that all of these statutory requirements had been acted Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 6 upon, along with a number of requirements that were also made about the maintenance of the building. The care plans and risk assessments are improving and residents all agreed that the food has improved. There was some good work being done in engaging the older residents, those with dementia and those with sensory impairment. 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. The summary of this inspection report can be made available in other formats on request. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has developed a Statement of Purpose, which sets out the aims and objectives of the home, and includes a Service User Guide, which provides basic information about the service and the specialist care the home offers. These need minor amendment. Although there have been no recent admissions, the managers of the home were clear about the criteria for admission and what part of the care home, and in what numbers residents may be admitted. The service has the right policies and procedures and, although there is evidence that practice has not always been consistent or well applied in the past, the new managers were clear that the service would look properly at all assessment information to see if they can meet the prospective resident’s needs before they make the decision to accept the application for admission and offer a place. EVIDENCE: Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 9 We were unable to look at the referral and admission process in depth because no residents have been admitted to the home since the last inspection. However, we spoke to the registered manager and regional manager at length about the process and criteria for admission. Criticism made previously about the home accommodating people whose needs the home could not meet were high on their agenda and it was evident that they were very clear about the needs and mix of people who can be admitted to the home had a clear vision for the improvements that are to be made for the future. They said that the home does not provide intermediate care. At the last inspection a requirement was made for the home’s Statement of Purpose to be dated and subject to regular review. At this inspection we looked at the statement of purpose and found that it had been reviewed and updated. However, it could be clearer about who the home is registered to care for and a recommendation is made about this. At the last inspection it was found that there were a number of people who had been admitted to the home outside of the registration criteria, and the home was accommodating a number of people whose needs would be better met in other settings. At this inspection we found that these residents were still living in the home. However, their needs were being re-assessed by the placing authorities and if their needs are not being best met in the home, alternative placements are being sought. The managers of the home have been reviewing the arrangements for care and considering what action can be taken to improve the suitability of the building in meeting the needs of this group of people who have very diverse needs. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care is becoming more person centred, although there is still room for improvement because of the diverse needs of the people living in the home. People have access to health care services both within the home and in the local community. Health needs are monitored and appropriate action taken. There are care plans, risk assessments and a record of health care information in place for each person. There is room for involving residents more and writing information in a more person centred way. Staff training is necessary in some areas such as with mental health issues, learning disabilities and physical disabilities, the prevention of falls and continence management. The home has a medication policy which is accessible to staff. Medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. The home understands the need to comply with the administration, safekeeping and disposal of controlled drugs. Staff are aware of the need to treat individuals with respect and to consider dignity when delivering personal care. People receiving services are generally happy with the way that staff deliver their care and respect their dignity and rights. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 11 EVIDENCE: We read the written records for 3 residents, we spoke to them, and several other residents and observed care practices, we spoke to staff and managers. We met with some relatives who were visiting the home and we toured the premises. We also took note of a number of complaints received about the quality of care and services in Ross Wyld Lodge. The residents’ records contained a variety of detailed notes including assessments, care plans, risk assessments, monitoring forms and daily records. In line with a requirement made at the last inspection, work has been done to clarify the numerical scores that are part of the assessments, and additional detail has been added about the area being rated the assessments to help make the assessments clearer. We also note that the assessments included assessments of peoples’ mental capacity, especially in the area of their capacity to manage their financial affairs. We noted that professional health care support is provided including community nurses to support residents on the top floor (which is registered as a residential unit and does not provide nursing care on site). There was evidence that Doctors visit regularly as do dentists and opticians. Risk assessments that were in place included nutrition, moving and handling, oral health, pressure ulcers, continence, and falls. Risk assessments about the use of bed rails were in place for those people whose files were seen. The manager has identified room for improvement in this area and a recommendation is made about this. We spoke to manager about falls management and looked at records of accidents. The manager monitors falls and this information is given to Four Seasons in a risk monitoring report on a monthly basis. Although the records showed that there were not a high number of falls, the manager said that most staff have not had training in falls prevention and a recommendation is made about this. Care plans were of a reasonable standard generally, it was evident that work had been done to improve them to meet a requirement that was made at the last inspection for care plans compiled accurately and in sufficient detail. 1 resident said that the care provided, particularly around continence management, does not always fit in with their needs. We looked at this person’s written records and there was an assessment and a care plan about helping them to manage their continence. However, there was not much detail from the resident’s point of view, being about the resident rather than including them. The manager has identified also identified this as an area for improvement as there is room for the care plans to be more person centred and for residents to be more involved in their creation. A recommendation is made about this. The manager said that she is beginning to focus on continence management now that the priorities of people’s nutritional needs; food, staffing and the building are on track. She said that the home has access to a continence nurse advisor that she intends to ask for their input in Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 12 training for staff and advise about care planning. In terms of records, each resident whose records were seen had information in place about continence management, where this was relevant. As there was feedback from 2 residents and 1 relative that this area could be improved a recommendation is made about this. Some improvement had been made in the area of understanding and meeting the needs of the residents with mental health issues, although this remains an area for improvement. The manager said that there was support from Community Psychiatric Nurses (CPN) for those residents who have a mental illness and that all of the residents had been reassessed by the social workers involved. Alternative placements were being sought for those residents whose needs are not best met by living in the home. A recommendation is made for the management team focus on continuing to improve staff’s understanding of the needs of the residents with mental health issues, learning disabilities and physical disabilities, and that staff be provided with training in these areas. We spoke to several staff during the course of the inspection, particularly when they were supporting residents at meal times. They were very well informed about the residents, their care needs, their personal history and their family circumstances. All staff also demonstrated a caring and thoughtful approach to residents. 1 resident who we sat with at lunchtime had sensory impairments to both their sight and hearing. There was evidence in their file that Sense, an organisation that supports people who have sensory impairments are involved and coming into the home regularly. 1 staff member showed us how the resident lets people know what they want and doesn’t want, like and doesn’t like. The staff member was spelling out simple words on the resident’s hand and showing how different touches indicate different words. The staff member said that working with Sense has been of great benefit for the resident and the staff. We spoke to 2 residents’ relatives. 1 said that despite not being on their feet, their relative had not got any pressure sores. The GP had seen the resident that morning and that Macmillan Nurses, who provide information, advice and support to improve the lives of people with cancer, were involved. We looked at the arrangements for storing, recording and administering medication in the home. 1 senior staff member said that it is the policy of the home not to give disguised medication to residents. The home was storing and administering some controlled drugs at the time of the inspection. We found that they were stored properly and that the records that were kept were in good order. Because this is a large nursing home, there are large amounts of medication stored e home. Although the manager has made good progress with reorganising the way in which medication is stored, there remains room for more work to make sure that the quantity of medication stored does not lead to any confusion for the staff administering it. A recommendation is made for the manager to continue with the work that has been started to address Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 13 this issue. The medication fridge in the office on the first floor needed to be defrosted and reset, and this was addressed during the course of the inspection. At the last inspection the requirement was made for the residents’ bedrooms to be fitted with suitable locks, and residents provided with a key unless a completed risk assessment indicates otherwise. At this inspection we found that this had been addressed. Ross Wyld Nursing Home DS0000025960.V362402.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are given the opportunity to take part in a variety of activities within the home and some in the community, but this could be improved and educational and employment opportunities need to be further explored. The managers recognise this and plan to make some changes. The service has an understanding of human rights and how this impacts on people using the service. There is commitment being shown in the areas of respect, dignity and fairness and some good work is being done around sensory impairment and dementia. Some residents are capable of being involved in more independent living, and there are plans to develop this further. The food in the home is of satisfactory quality, well presented and meets the dietary and cultural needs of people who use the service. Staff are trained to help those individuals who need help when eating and are sensitive in their approach. EVIDENCE: During the 3 days of the inspection we noted that staff were often doing activities with residents in the big lounge on the ground floor. This included dancing, singing, listening to music and doing puzzles. 1 person said they liked doing puzzles and used to do them at home before they moved to Ross Wyld. They said that they had just been enjoying a game of Bingo. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 15 The home employs an activity coordinator, but residents’ needs are very diverse and the work being done does not yet focus enough on providing people with mental health problems or physical disabilities with rehabilitation and skills for daily living such as shopping, cooking, education classes, and employment. Of the 3 files we looked at 1 was for a younger resident who had suffered a head injury. In their records they had said that they wanted to go to college before the injury. There was evidence that they had made good progress in recovering physically and becoming more independent since their injury, but their record of activities didn’t show that they had been helped to look at age-appropriate activities in the community, such as adult education or supported employment. A requirement is made about continuing to develop assessment round peoples’ social, leisure and occupational activities and developing services within the home that are suitable for each person’s background, interests, developmental needs and lifestyle. Another requirement is made about helping people to get access to resources outside the home that provide social, cultural, occupational and educational activities. During the tour of the building the manager pointed out an area in the ground floor dining room that is being used to store materials for activities and said that this is a temporary measure, as the arrangements about where activities areas would be better situated was being reviewed whilst other shared rooms were being decorated. Both the regional manager and the manager said that activities are an area that need further development so that they meet the diverse needs of the older residents and the developmental needs of the younger, physically disabled residents and the rehabilitation needs of the residents with mental health problems. As part of improving the day time activities the regional manager said that he intends to review the staffing hours and the nature of the work done in this area and is working on providing better access to a minibus so that people can get out more often. A recommendation is made about reviewing the staffing hours and arrangements in order that people’s cultural, social, leisure, occupational and educational needs are better met. A recommendation is also made about re-organising the areas in the home that are used for activities. The 2 relatives who we spoke to said that the home does welcome visitors and that they visit freely. The staff who work closely with particular residents knew about their family contacts, such as who visits and who keeps in touch by other means. A requirement was made at the last inspection that staff be trained and supervised in the support of residents at meal times. It was also required that records be sufficient detail to determine whether or not the resident’s diet was satisfactory. At this inspection it was found that both of these areas had been addressed. We looked at the temperature records for regular food core temp checks, temp checks for the food warmers and the record of routine cleaning of the kitchen equipment. These were in good order. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 16 During the 3 days of the inspection we were able to sit and eat lunch with the residents on 2 occasions and had a chance to chat with residents and staff. Residents were having their lunch in various areas around the home, some in the dining rooms in the units, some in the dining room on the ground floor, a staff member was helping 1 person to have lunch in their bedroom and was very encouraging and kept checking if the person was OK. 2 other residents were eating their lunch in the conservatory. There was a choice of main meals on each day, the second choice being a vegetarian option. At each meal we observed staff sitting at tables helping people to eat. This was done in a sensitively and was not rushed. The atmosphere was nice and relaxed. Staff were confident in pointing out the residents who had special diets. We also noted that, where people were given a soft diet, the food was quite nicely presented, with food pureed separately. The regional manager said he tries the food regularly to check the quality and makes suggestions to the manager about how it could be improved. We spoke to the 2 residents who had lunch in the conservatory and they said that they choose which main meal they want from the menu each day. All of the residents we spoke to said that the food had improved. We spoke to a relative of a resident from a minority ethnic background and they said that the food provided was suitable for the needs of the resident. The manager said that improving the food had been a priority when she started to manage the home and to this end, the kitchen staff had been provided with extra training, extra support from a peripatetic chef, and more responsibility. She said that Four Seasons has produced an information pack about providing a good, varied, balanced diet in care homes, in line with the government’s drive towards safer kitchen standards ‘Safer Food: Better Business’, and that this had been given to the kitchen staff. She said that complaints about the food have decreased significantly since making a change to the kind of food and quality of food that is ordered. Ross Wyld Nursing Home DS0000025960.V362402.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new manager has made sure that the home has an open culture that allows residents to express their views and concerns in a safe and understanding environment and that t The home learns from complaints. Residents and others involved say that they are happy with the service provided. The service has a complaints procedure that is clearly written and easy to understand. It is given to residents and is displayed in a number of areas within the service. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. There is a clear system for staff to report concerns about colleagues and managers. The home understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. The outcomes from recent referrals have been are managed well and issues resolved to the satisfaction of all involved. Training of staff in safeguarding is regularly provided. EVIDENCE: Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 18 The home has a complaints procedure in place. This includes timescales for responding to any complaints, and contact details of the Commission. A copy of the procedure was on display within the home and details are contained in both the home’s Statement of Purpose and Service User Guide. We looked at the record of complaints and concerns that is kept in the home and this showed that complaints are dealt with properly and promptly. The manager said that she has an open door policy and it was evident that she has put a lot of effort into making sure that residents and their relatives know that she wants to know what they think about the home. A comment box is placed prominently in the reception area for people who want to make comments anonymously. We spoke to 2 peoples’ relatives, at length and in private and both said they were impressed by the manager’s approach, and the improvements made since she was appointed. They were clear about making complaints, comments and suggestions and confident that if they have anything to say about the care of their relative, that they will speak to the manager and will be listened to, taken seriously and their concerns acted upon. 1 person added that the new deputy manager is also “very good.” The manager said that there have been a gradual decrease in the complaints that she has received over the past year, and records reflect this. We spoke to several residents. They said they had no complaints and that they were happy to talk to the manager about things. The home has a copy of the Local Authorities adult protection, ‘safeguarding’ procedures, and also its own policy on adult protection. The manager said that the staff have received training in adult protection issues. We looked at the records of safeguarding of the residents from abuse and neglect. There were 2 concerns about the care of residents raised by their relatives, in the past year. These were investigated through the local authority safeguarding procedures. There were 2 anonymous allegations about bad practice, made by staff in the past year. There was evidence that these had been investigated as fully as possible and 1 of these issues was dealt with through the local authority safeguarding procedures. The manager and the regional manager said that they thought that the disruption in the management team at the time that the previous manager was suspended might have contributed to some staff feeling unsettled and unhappy. The records kept by the home were clear and reflected that the home co-operated fully in the safeguarding process. The manager said that staff have had or are being provided with training in this area. All of these issues are now resolved, all necessary action has been taken as identified in the safeguarding process, and no further safeguarding issues have arisen since the last inspection in January 2008. Ross Wyld Nursing Home DS0000025960.V362402.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, 20, 21, 22, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is being improved so that it better provides a physical environment that meets the specific needs of the people who live there. The home is reasonably comfortable and has a programme to improve the decoration, fixtures and fittings. Residents can personalise their rooms. They also say they the home is clean and warm. There is usually sufficient hot water. There has been some consultation with residents about the décor, especially for their own rooms. Some en-suite facilities are available, residents can always access a bathroom, toilets are appropriately located within the home, are easily accessible and in sufficient numbers. Toilets and bathrooms are being updated to better meet peoples’ needs. The home has not fully achieved small group living, but is aware of the benefits of small units that have their own communal focus. The home is generally clean and tidy. Hygiene equipment is available and maintenance records are not always kept up to date. EVIDENCE: Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 20 At the last inspection a statutory requirement notice was served as the home was failing to comply with the Care Standards Act 2000 and Care Home Regulations 2001 in the fitness of the premises. The registered person was required to make sure that all parts of the care home’s exterior are kept in a good state of repair, to make sure all fire escape routes are kept clear and maintained in good working order, to make sure fire doors are not wedged open and kept in a good state of repair and to consult with the Fire and Rescue Authority and act on any advice given by them. At this inspection it was found that all of these requirements had been addressed. During the tour of the building there was evidence that improvements were being made and the refurbishment and redecoration progressing well. The manager said that when each shared area is decorated, pictures that reflect the backgrounds of the residents are being chosen, such as reminiscence materials for the older residents. The manager said that the conservatory is currently the room where residents smoke and that this is to be changed as part of the refurbishment. This will allow more residents to make use of the conservatory. The hairdressing room is off the ground floor dining area. The dining room is to be redecorated and the manager said she has ordered new tables and chairs. The management team are considering converting this area into a lounge/dining room and kitchen for the residents with physical disabilities and it is the inspector’s opinion that this would go a long way to enabling the needs of this group of residents to be better met. A recommendation is made about this. At the last inspection a requirement was restated for a schedule of works to be produced to deal with the repairs that are necessary to the building. The registered person has produced the schedule of works and includes changes to the general layout of the rooms and facilities. The registered person was also previously required to demonstrate that an assessment of the premises and facilities has been made by suitably qualified person, such as a qualified occupational therapist with specialist knowledge of the client group catered for; and provide evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of the residents. The registered person has provided a copy of this report and the recommendations that it makes have been included in the schedule of works. The schedule of works also sets out plans to improve the entrance to the home by building of an external Lobby to new double doors into the corridor and providing a secure rear main entrance into the car park enclosed by fencing, and possibly an auto car/lorry barrier. A recommendation is made for all of the improvement work set out in the schedule o works to be completed in a timely manner. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 21 In response to previous requirements a lot of the bedroom furniture has been upgraded and the bathrooms and toilets have suitable locks fitted with an override device for staff to use in an emergency. Any items of discarded furniture are being removed from the home and grounds without delay as the improvement work goes on. Progress was being made with the redecoration of the hallways and corridors. The manager identified that some of the handrails need to be made more secure to the walls. The bathrooms, shower rooms and toilets are in need of redecoration and several need new floor covering. The manager has prioritised these for redecoration, when the corridors are completed. The manager identified those that are earmarked for refurbishment and those that are going to be converted for other uses. She said that she has plans to convert a shower room on the ground floor to be the smoking room for residents and a shower room on the first floor as storage for wheel chairs and hoists. 2 Bathrooms have been fitted with new assisted baths and the manager said that this had been funded through a Capital Grant. The pumps needed to be installed before they can be used, but the manager said that this was not causing too much disruption, as there are plenty of other useable showers and bathrooms. During the tour of the building the water temperatures were tested in the bathrooms at random and it was noted that in 1 ground floor the water was not warm enough at a hand basin in the toilet with disabled access. This was adjusted at the time. The manager said that a new boiler/heating system had been put in that week and the temperature had needed to be adjusted at all of the sinks and baths. The manager said that the kitchen is to be refurbished. This is included in the schedule of works and due to be started very soon. There is a room with large dishwashers and sink, off the kitchen where staff can make drinks for themselves and residents without going into the main kitchen. The manager said this would be used while the kitchen is refurbished. There is a large lounge on the ground floor and the manager said that she wants to divide this to provide a lounge and a dining area. Several of the bedrooms have been fitted with new floor covering and several have been re-decorated and work to make sure that all of the bedrooms are in good condition is progressing well. There was a double bedroom on the ground floor that was unoccupied at the time of the inspection and the manager said that she is considering providing en-suite facilities and converting the space into a studio flat for a resident with physical disabilities, so that they can develop their independence. The maintenance person uses a bedroom on the first floor for storing tools. This arrangement is to change so that the bedroom can be used for a resident and alternative outside storage/workshop is to be organised. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 22 It was noted that 2 external doors, 1 on the ground floor near to the laundry and 1 giving access to the first floor balcony, had been disconnected from the door alarm and a requirement is made about this. There was a small lounge on the first floor, which was being refurbished at the time of the inspection. This work was completed and the room was refurnished during the course of the inspection, making a pleasant lounge for the residents and their visitors. There was also a small kitchen on the first floor, for making drinks and snacks for visitors. The manager said that it is due to be refurbished, and that this might tempt people to use it more often. All rooms fitted with a nurse call system. However, it was noted that the cord was not within reach in 1 of the toilets on the 2nd floor. This was addressed at the time of the inspection. Most areas were observed to be clean and there were proper sluice facilities, a laundry room and an ironing room. These are well equipped with 2 large washing machines, 2 large tumble dryers and there are facilities for staff to wash their hands to prevent cross infection. The staff room includes facilities for staff to have a shower. However, we noted that bedrooms 10 and 11 had a stale odour a requirement is made about this. 1 of the resident’s relatives said “the home has been cleaned up” and the environment is getting better. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 23 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, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are generally satisfied that the care they receive to meet their needs. There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements. The manager is aware that there are some gaps in the training programme, and plans to deal with this. There room to improve the person centred way of delivering care and support, but this is through lack of opportunity rather than a negative approach. All staff are clear regarding their role and what is expected of them. Residents reported that staff work with them in a way that they are satisfied with. The service has a recruitment procedure that meets statutory requirements. The procedure is followed in practice and there is accurate recording at all stages of the process. There is acceptable use of bank staff, which doesn’t adversely affect the quality of the individual care and support that residents receive. EVIDENCE: It was evident that the manger was clear about managing all aspects of staffing in the home. She said that Four Seasons has developed a good induction format, which is intended to both induct and provide basic training for staff for a 12 week period. They are assessed by a “mentor” who is a senior member of staff and, if they require further support, they are signed up Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 24 to the NVQ foundation training. The staff who do not require further support are then signed up for training at NVQ level 2. The manager said that an NVQ assessor assesses the foundation certificate for care workers. We spoke to several staff. They were confident in the way that they communicated with the residents. They showed patience and sensitivity when helping people to eat. 2 staff said that the training that they had in the home was of a good standard and that it is always done with the involvement of the NVQ assessor. They said that there is training time set aside every 2 weeks, for them to work with the assessor. They had both completed NVQ level 2 training recently and were thinking about undertaking NVQ level 3. The manager provided a copy of the monitoring record that she keeps about training for the team. This indicated that staff are receiving the training that they need, on an ongoing basis, to help them to meet the needs of the residents. The manager said that she is moving some care assistants from the nursing unit to the residential unit, and some from the residential unit to the nursing unit. This is to share staffs’ training, skills and good practice throughout the home. 1 person we spoke to said that “staff are good and they try their best”. The home provides 24-hour support including an emergency on-call procedure and waking night staff. The planned rota showed that there were enough staff to meet the needs of the current numbers of residents. There are generally 1 trained Nurse and 3 care assistants for the nursing unit and 1 senior carer and 1 care assistant on duty in the residential unit. The home had policies in place on recruitment and selection and equal opportunities. We looked at the personnel records for 3 staff. There was evidence that the home operated a robust recruitment process and undertook the necessary pre-employment checks for staff before employing them in the home. Each staff members’ file included a written application, Criminal Records Bureau check (CRB) details and 2 written references. The manager said that there has been a 60 turnover in trained nurses in the past year. A number of staff have been interviewed and recruited and 1 trained nurse is waiting for a work permit before starting work. The manager has interviewed recruited a number of new staff, both as bank staff and for permanent positions, and is waiting for CRB checks for 2 of them. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has good people skills, the required qualifications and experience and is competent to run the home. The manager contributes to the organisation’s strategic and financial planning systems and the business plan for the home. She works to continuously improve the service. A strong ethos has been introduced of being open and transparent in all areas of running of the home. The AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes the home has made and where they still need to make improvements. It shows clearly how they are going to do this. The home works to a clear health and safety policy. Staff are fully aware of the policy and are trained to put theory into practice. The home is improved in meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. There is also evidence of organisational monitoring by Four Seasons. Records are of a reasonably good standard and are routinely completed. Four Seasons provide a quality assurance and monitoring process to ensure efficient running of the home. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 26 EVIDENCE: A full time manager has been appointed. She joined the management team in March 2007 to support the previous manager and has been actually managing the home since October 2007. She has applied to be registered with the Commission. Throughout the inspection it was evident that she is experienced, confident and very motivated to improve the service. She proved herself to be aware of the areas that need to be improved, and proactive in addressing these. She is sensitive to the need for professionalism and staff confidentiality. It was evident that both the manager and the regional manager are working very hard to address the criticisms that have been made about the home and are making good progress in improving the building and the outcomes for the residents generally. We saw the notices displayed around the home for the manager’s ‘Surgery’, which she holds weekly to give residents’ relatives a chance to discuss any issues that they might have. Relatives meetings are held once a month, although the manager said that she is trying to improve attendance by making sure more relatives know about these. We looked at the minutes of the staff meetings that are held in the home. There are several different team and management meetings. The manager said that the minutes are copied to the staff members who are not able to attend. She said that she wants the activities co-ordinator to organise and take the minutes of the residents’ meetings. The regional manager visits the home at least once a week and is also available for residents and their relatives to talk to. He said that Four Seasons sends out lots of independent customer survey to residents and relatives so that there is feedback about the home directly to the organisation. The next survey due soon and any deficits identified will be addressed. We spoke to the relatives of 2 residents. Both said that they were happy with the way that the home is being managed. 1 said the home has been cleaned up and is improving. “I think the manager is getting there, and is employing new staff.” We checked a number of records including residents case files, kitchen records, health and safety checks, the record of complaints, of accidents, the staff personnel records and the residents’ financial records. Most were being maintained in good order with minor points noted in other sections of this report. We were shown the arrangements around peoples’ money by the administrator. There were very good records and the system is very much geared to safeguarding people’s financial interests. 1 person is independent in this area and some residents have relatives who support them. The administrator said that some residents come to the office for money and staff sometimes take people out to buy toiletries. A recommendation is made about the home looking for ways that residents can be supported to be more Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 27 independent in this area, particularly the younger people who are living in the home. There is a bank account specifically for residents’ money. She keeps bank statements. Interest is allocated proportionately. The manager completes a monthly report for Four Seasons, setting out all transactions. Expenditure is authorised by the manager and recorded. Receipts are kept. Signed by a resident or their representative, the manager and the administrator. We saw evidence that the Regional Support Administrator for Four Seasons had conducted an audit in July 2007 and the forms for assessment of people’s capacity to manage their money, which is done on admission and included in people’s files. People are advised not to bring valuable, but there is a facility for them to be kept securely in the office. In order for the providers, Four Seasons, to demonstrate how they are monitoring Ross Wyld Lodge they provide the Commission at monthly intervals with a written report as to the outcome of their visits and the regional manager said that he would continue to do this. We looked at the records of health and safety checks undertaken to keep the home and the equipment safe. All checks, such as the electrical and gas safety certificates were in place and a contractor had tested the fire alarm, the hoists and the lift. Staff in the home also keep a record of the regular tests that they do of the fire alarm, door closures, emergency lights, fire alarm and fire fighting equipment. There were good quality environmental risk assessments in place, and the fire risk assessment was being completed during the course of the inspection. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 28 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 X X 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 2 X 2 X 2 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 3 3 3 X 2 X 3 3 Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 OP12 Regulation 12 Requirement The registered person must make sure that the management team continue to develop assessment round peoples’ social, leisure and occupational activities and develop services in the home that are suitable for each person’s background, interests, developmental needs and lifestyle. The registered person must make sure that the management team continue to focus on supporting residents to use resources in the local community that provide social, cultural, occupational and educational activities that are suitable for each person’s background, interests, developmental needs and lifestyle. The registered person must make sure that the 2 external fire doors that were not connected to the door alarm system are connected and operating. The registered person must make sure that bedroom 10 and 11 are free from unpleasant DS0000025960.V362402.R01.S.doc Timescale for action 01/09/08 2. OP12 12 01/09/08 3. OP19 13 30/06/08 4. OP26 16 30/05/08 Ross Wyld Nursing Home Version 5.2 Page 30 odours. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations It is recommended that the statement of purpose and Service User guide be re-written to better reflect the criteria for referral for the home, making it clear what needs the home can cater for. It is recommended that work be continued to improve the care plans to make them more person centred and for residents to be more involved in their creation. It is recommended that staff be provided with training about the prevention of falls. It is recommended that work be continued to improve the risk assessments about the use of bed rails. It is recommended that work be continued to improve continence management in the home and that staff be provided with training in this area. It is recommended that work be continued to improve staff’s understanding of the needs of the residents with mental health issues, learning disabilities and physical disabilities, and that staff be provided with training in these areas. It is recommended that work be continued to make sure that the quantity of medication stored in the home does not lead to any confusion for the staff administering it. It is recommended that the registered person review the staffing hours and arrangements in order that people’s cultural, social, leisure and occupational and educational needs are better met. It is recommended that the registered person continue to review and re-organise the areas in the home that are used for activities. It is recommended that all of the improvement work set out in the schedule of works to be completed in a timely manner. It is recommended that lounge, dining and kitchen facilities be provided for the residents with physical disabilities, which are adapted to help enhance people’s DS0000025960.V362402.R01.S.doc Version 5.2 Page 31 2. 3. 4. 5. 6. OP7 OP8 OP30 OP8 OP8OP30 OP8OP30 7. 8. OP9 OP12 9. 10. 11. OP19 OP19 OP22 Ross Wyld Nursing Home 12. OP27 12. OP35 independence. It is recommended that work be continued to recruit experienced and trained staff and to train the existing staff regarding the specialist needs of the various groups of residents as the home is changed to smaller group living. It is recommend that the registered person look at ways in which some people can be supported to be more independent in managing their finances, particularly the younger people who are living in the home. Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Extracts may not be used or reproduced without the express permission of CSCI Ross Wyld Nursing Home DS0000025960.V362402.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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